Biological Treatments for Schizophrenia

Question 1

Name a typical antipsychotic.

Answer 1

Chlorpromazine

Question 2

How much chlorpromazine is administered orally per day in mg?

Answer 2

1000

Question 3

What does chlorpromazine do in the brain?
How does it reduce hallucinations?

Answer 3

Reduces action of dopamine by blocking receptors, also reducing how much dopamine is produced.
This normalises neurotransmitters in the brain, reducing hallucinations.

Question 4

What are the issues with chlorpromazine?

Answer 4

High side effects

Question 5

Name 2 atypical antipsychotics.

Answer 5

Clozapine and risperidone

Question 5

Chlorpromazine can also be used as a…

Answer 5

Sedative

Question 6

How many mg of clozapine can be administered per day?

Answer 6

300-450mg

Question 7

Which 3 neurotransmitter receptors can clozapine bind to?

Answer 7

Binds to dopamine, serotonin and glutamate receptors.

Question 8

Why is clozapine useful in patients experiencing depression and schizophrenia?

Answer 8

Also helps to regulate serotonin levels

Question 9

Why is clozapine better than chlorpromazine? (2)

Answer 9

Treats comorbid disorders
Prevents suicidal thoughts

Question 10

What are the risks of administering clozapine by injection?

Answer 10

Fatal side effects

Question 11

How many mg of risperiodone should be administered daily?

Answer 11

4-8mg

Question 12

Why is risperiodone more effective than clozapine?

Answer 12

Binds more strongly to dopamine and serotonin receptors

Question 13

Why is risperidone bettwe than chlorpromazine?

Answer 13

Fewer side effects

Question 14

Explain the strength of there being supportive evidence for the effectiveness of drugs.
In a meta analysis, Crossley found a reduction in which type of schizophrenia symptoms?
How do atypical/typical drugs differ in effectiveness and side effects?
What % of patients showed no improvement after taking drugs? What % did not show full remission?
What is the relapse rate % as discovered by Anderson?
What is the relapse rate for family therapy?
What is the relapse rate when therapy is paired with drugs?
What does this show about optimal treatments?

Answer 14

Crossley found in a meta-analysis that medication leads to a significant reduction in positive symptoms. Atypical drugs were no more effective than typical drugs but did have fewer side effects. However, they are not a full cure, as 25% of patients show no improvement, and a further 30-40% do not show full remission. Anderson found a relapse rate if almost 40% when patients had drugs, compared to only 20% when family therapy was used. A relapse rate of less than 5% was found when drugs and family therapy were used together. This shows how effective drugs are, and how effectiveness can be increased when pairing them with other treatments.

Question 15

Explain the limitation of side effects surrounding drugs?
What is tardive dyskinesia and which drug causes it?
What might patients do if side effects are too much and how does this increase hospital admission?
However, why are drugs practical compared to therapy?

Answer 15

For example, chlorpromazine may lead to stiffness, tardive dyskinesia and muscle spasms. Also, patients often experience weight gain when treated with both typical and atypical drugs. Side effects are important as they can lead to patients choosing to discontinue use of the medicine should side effects be too much, leading to relapse and hospital admission. However, drugs are practical in terms of time and cost. They take a few seconds to take compared to therapy sessions which can take hours over several months to be successful. Additionally, drugs are quick to mass produce compared to therapies that required highly trained professionals. Therefore, drugs are often the preferred treatment despite issues with side effects.

Question 16

Explain the limitations of tolerance, dependency and failure to treat the cause of schizophrenia.
As dependency on the drug increases, what else increases?
What happens if they stop taking the drug and how does this lead to increased addiction?
Why might risperidone be the best treatment and how does it reduce risk of addiction?

Answer 16

Some people become addicted to antipsychotics leading to them becoming more dependent on them. As they become more dependent, they experience more side effects of the drug. Once they stop taking them, the symptoms return so they take more drugs and become more addicted. This means that drugs such as risperidone are the best choice for treatment because only 4-8mg are needed to successfully reduce symptoms. This means that the patient needs to take less of the drug, reducing the risk of addiction. This shows the importance of having a variety of different drugs available.

Question 17

Explain ethical issues surrounding use of antipsychotics?
Give the alternative use for antipsychotics that nurses sometimes use them for.
What ethical issues does this lead to?
On the other hand, how does this benefit the patient when using other treatments as well?

Answer 17

Antipsychotics have been used in hospitals to calm schizophrenia patients down and make them easier for staff to work with, rather than for the benefit of the patient themselves. This is because antipsychotics are good sedatives. But this leads to issues with informed consent as patients believe that they are taking the drug to treat schizophrenia, not to calm them down. However, calming people distressed by hallucinations and delusions makes them feel better and helps them to engage with other treatments such as CBT.