Drug Therapies

Question 1

What are antipsychotics?

Answer 1

Drugs used to reduce the intensity of symptoms, in particular the
positive symptoms of psychotic conditions in schizophrenia.

Question 2

What are typical antipsychotics?

Answer 2

• The first type of antipsychotic drugs, were developed in the 1950s.
• They work as dopamine antagonists and include Chlorpromazine.
  -They are mainly effective on positive symptoms such as delusions and hallucinations.
  -The side effects can be severe, which is why atypical drugs have been developed.

Question 3

What are Atypical antipsychotics?

Answer 3

• They typically target a range of neurotransmitters such as dopamine and serotonin.
  They are antagonists on the dopamine D2 and serotonin 5-HT2A sub-receptors.
• They are thought to also reduce negative symptoms

-Compared to typical antipsychotics, they more rapidly release themselves from the dopamine D2 sub-receptors.

-It is believed that this action results in less
extrapyramidal side effects (physical movement) and may improve cognitive
functioning.

Question 4

A03 - Side Effects + Discontinuation

Answer 4

• The side effects experienced by a patient can have a considerable impact in antipsychotic therapy.
• Theyinclude: stiffness and shakiness known as extrapyramidal effects, uncomfortable restlessness), movements of the jaw, lips and tongue (tardive dyskinesia), sleepiness and slowness and weight gain.

-. Hill (1986) found that 30% of people taking typical antipsychotic drugs develop
tardive dyskinesia, of those who develop tardive dyskinesia, it is irreversible in for many patients.

• Lieberman et al (2005) found that 74% of patients discontinued their atypical
  antipsychotic drugs medication within 18 months, so leading to the reappearance of symptoms.

Question 5

A03 - Anti-psychotic cost

Answer 5

• The treatment of schizophrenia accounts for 2.5 % of national healthcare expenditures.

-Atypical antipsychotics are expensive, with clozapine, one of the least expensive, costing
over £200 per person each month.

-However, Seshamani (2002) examined cost-effectiveness studies that addressed the use of clozapine.

They found that:

● clozapine significantly improves patient symptoms and quality of life
● patients who receive clozapine experience a reduction in the number of hospitalizations
● This can lead to a decrease in hospital costs that can experience a reduction in overall treatment costs.

= Hence, the use of clozapine seems effective and economically
viable.

Question 6

A03 - Effectiveness

Answer 6

-Thornley et al. (2003) reviewed studies comparing the effects of Chlorpromazine to control
conditions in which patients received a placebo so their experiences were identical except for the presence of Chlorpromazine in their medication.
-Data from 13 trials with a total of 1121 participants showed that Chlorpromazine was associated with better overall functioning and reduced symptom severity.
-Further, their findings also showed that relapse
rate was also lower when Chlorpromazine was taken.
-However, we must apply caution to these findings, as they do not apply to all patients in the study and therefore antipsychotics may not be effective medication for all sufferers of SZ.

Question 7

What are the typical side effects of anti-psychotics

Answer 7

Uncomfortable restlessness (akathisia).
● Movements of the jaw, lips and tongue (tardive dyskinesia).
● Sleepiness and slowness.
● Weight gain.
● A higher risk of getting diabetes.
● Sexual problems due to hormonal changes.
● Constipation.