Drug Therapy Flashcards
What are the 2 main antipsychotics
Typical antispychotics
Atypical antipsychotics
What can drugs do
make a bad time a good fuckin time
Reduce the intensity of symptoms, in particular the +ve symptoms, of psychotic conditions like SZ
What are typical antipsychotics
The first generation of antipsychotics (developed during the 1950s)
Work as dopamine antagonists
Name an example of typical antipsychotic
Chlorpromazine
What are atypical antipsychotics
Second generation of antipychotics (developed during the 1990s)
They typically target a range of neurotransmitters such as dopamine and serotonin
Name some examples of atypical antipsychotics
Clozpine
Risperidone
Describe chlorpromazine as a typical antipsychotic
Taken daily w dose up to 1000mg
Typical doses are 400-800mg and has decreased over last 50 yrs (Liu and de Haan 2009)
Strong association between chlorpromazine and the dopamine hypothesis - antagonists
Has same effect has antihistamine (makes you drowsy, sedates patients)
Initially the dopamine builds up in the brain, then production is reduced
According to the hypothesis this dopamine-antagonist effect normalises neurotransmission - reducing symptoms such as hallucinations
Tell me some more abt atypical antipsychotic
Used when other treatments have failed
Daily dosage between 300-450 mg daily
Binds to dopamine receptors, similarly to chlorpromazine, but also acts on serotonin and glutamate receptors
Helps mood and reduces depression and anxiety
What is risperidone
Developed in 1990s as an attempt to reduce side effects of clozapine
Smaller doses are given from 4-8mg up to 12mg per day
Binds to dopamine and serotonin receptors
However it has a stronger binding effect on dopamine than clozapine and is effective in lower doses
How is evidence for effectiveness a +ve evaluation
Thornlet et al 2003
Reviewed studies comparing the effects of chlorpromazine to control conditions - patients in this condition received a placebo
Data from 13 trials with a total of 1121 participants, showed that chlorpromazine was associated with better overall functioning and reduced symptom severity
Data from three trials with 512 participants show that relapse rates were also lower when the drug was taken
What is a +ve evaluation for atypical antipsychotics
Meltzer 2012 concluded that clozapine is more effective than typical antipsychotics and other atypical antipyschotics
Effective in 30-50% of treatment-resistant cases
Meltzer alsp stated that other atypical antipsychotics have been developed to reduce side effects and have succeeded
What is a -ve evaluation regarding side effects
Serious side effects
Some are mild but can be fatal - dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin
Neuroleptic malignant syndrome (where the drugs block the dopamine in the hypothalamus) - high temperature, delirium, coma and death
What are some serious side effects of typical antipsychotics
Tardive dyskinesia
-Uncontrollable movements of the face, lips, mouth tongue as well as other body areas
Agranulocytosis
-Deficiency of granulocytes in the blood, causing increased vulnerability to infection
How is the use of antipsychotics depending on the dopamine hypothesis a -ve evaluation
Much higher levels of dopamine activity in the subcortex
However not a complete explanation for SZ
Levels were too low (in other parts of the brain) rather than too high
What are problems w evidence as a -ve evaluation
Healy 2012
Suggested over publication has lead to misleading +ve evidence
Due to the drugs calming effects, it can be concluded that they help patients w SZ, but do they acc reduce the severity of psychosis
Most publications discuss short term rather than long term benefits and compare those that have started taking them after withdrawal
