Drug Therapy

Question 1

What is drug therapy?

Answer 1

Involves treatment of mental disorders through the use of antipsychotics to reduce the symptoms of the disorder.

Question 2

What are antipsychotics?

Answer 2

Drugs that are effective in treating the most disturbing forms of psychotic illness, such as schizophrenia and manic depression (bipolar disorder).

Question 3

How does antipsychotic medication help?

Answer 3

It helps the person with the disorder function as well as possible in their life, while at the same time increasing their feelings of subjective well-being

Question 4

How do antipsychotics work?

Answer 4

By reducing dopaminergic transmission - reducing the action of the neurotransmitter dopamine in areas of the brain associated with the symptoms of schizophrenia.

Question 5

What are the types of antipsychotics?

Answer 5

Typical

Atypical

Question 6

What’s an example of typical antipsychotics?

Answer 6

Chlorpromazine

Question 7

What’s an example of atypical antipsychotics?

Answer 7

Clozapine

Question 8

What are typical antipsychotics?

Answer 8

Dopamine antagonists in that they bind but don’t stimulate dopamine receptors and so reduce the symptoms of schizophrenia.

Question 9

What’s the basic mechanism of typical antipsychotics?

Answer 9

To reduce the effects of dopamine and so reduce the symptoms of schizophrenia.

Question 10

How do typical antipsychotics work?

Answer 10

They’re dopamine antagonists (particularly the D2 receptors in the mesolimbic dopamine pathway), thus blocking their action.

By reducing stimulation of the domaine system in the mesolimbic pathway, antipsychotic drugs eliminate the hallucinations and delusion experienced by people with schizophrenia.

Question 11

When do the typical antipsychotics work?

Answer 11

Hallucinations and delusions usually diminish within a few days of beginning medication, although other symptoms may take several weeks before a significant improvement is noticed.

Question 12

What did Kapur (2000) estimate? (Typical)

Answer 12

That between 60% and 75% of D2 receptors in the mesolimbic dopamine pathway must be blocked for these drugs to be effective.

Question 13

What’s the problem with typical antipsychotics?

Answer 13

For them to be effective, a similar number of D2 receptors in other areas of the brain (outside of the mesolimbic dopamine pathway) must also be blocked, leading to undesirable side effects.

Question 14

What are atypical antipsychotics?

Answer 14

Carry a lower risk of extrapyramidal side effects, have a beneficial effect on negative symptoms and cognitive impairment, and are suitable for treatment-resistant patients.

Question 15

How do atypical antipsychotics work?

Answer 15

They also act on the dopamine system by blocking D2 receptors.

However, they only temporarily occupy the D2 receptors and then rapidly dissociate to allow normal dopamine transmission.

It is this rapid dissociation that is thought to be responsible for the lower levels of extrapyramidal side effects found with these compared to conventional antipsychotics.

Question 16

What are the benefits of atypical antipsychotics?

Answer 16

Because they have little effect of the domaine systems that control movement, they tend not to cause the movement problems found with the typical antipsychotics.

Fewer side effects 
Have an effect on: 
Negative symptoms 
Cognitive impairment 
Treatment resistant patients

Question 17

What are the features that make atypical different from typical?

Answer 17

The effects
Rapid dissociation

Typical antipsychotics block only D2 (dopamine receptors). However, atypical antipsychotics have a stronger affinity for serotonin receptors, and a lower affinity for D2 receptors.
It is this characteristic that explains the different effects of atypical compared to typical.

Question 18

What are the evaluative points?

Answer 18

Antipsychotics versus placebo
Extrapyramidal side effects
Ethical problems with typical antipsychotics
Advantages of atypical over typical antipsychotics
Are atypical antipsychotics better?
Motivational deficits.

Question 19

What is meant by antipsychotics versus placebo?

Answer 19

Support for the effectiveness of antipsychotics comes from studies that have compared relapse rates for antipsychotics and placebos.

Leucht (2012) carried out a meta-analysis of 65 studies, published between 1959 and 2011, and involving nearly 6,000 patients.
Some of these patients were taken off their antipsychotics medication and given a placebo instead. The remaining patients remained on their regular antipsychotics.
Within 12 months, 64% of those patients who had been given the placebo had relapsed, compared to 27% of those who stayed on the antipsychotics drug.

This study clearly demonstrated the superiority of antipsychotics drugs compared to placebo in preventing relapse, although their use must be weighed against their side effects.

Question 20

What is meant by extrapyramidal side effects?

Answer 20

Typical antipsychotics drugs can sometimes produce movement problems for the patient. These are called extrapyramidal side effects because antipsychotics drugs appear to impact on the extrapyramidal area of the brain which helps control motor activity.

The most common are the Parkinsonian and related symptoms, so called because they resemble the features of the neurological disorder Parkinson’s disease (PD).
More than half of the patients taking antipsychotics experience these symptoms.
When people take antipsychotics drugs for an extended period, a second type extrapyramidal effect can occur - tardive dyskinesia.

These side effects can be so distressing for the patient that other drugs have to be given to control them, or the patient may stop taking their antipsychotics medication completely.

Question 21

What is tardive dyskinesia?

Answer 21

Involuntary movements of the tongue, face and jaw

Question 22

What is meant by ethical problems with typical antipsychotics?

Answer 22

The problems associated with antipsychotic medication raise significant ethical issues relating to their use.

Recently in the US, a large out-of-court settlement was awarded to a tardive dyskinesia sufferer on the basis of Article 3 of the human rights act 1988, which states that ‘on one shall be subjected to inhuman or degrading treatment or punishment’ (Chari, 2002, cited in Ross and Read, 2004).

This suggests that if side effects, deaths and psychological consequences were taken into account, a cost-benefit analysis of typical antipsychotics would most probably be negative.

Question 23

What is meant by advantages of atypical over typical antipsychotics?

Answer 23

Atypical antipsychotics are claimed to have a number of advantages when compared to typical antipsychotics. A key advantage of atypical is that patients experiences fewer side effects.

Atypical, particularly newly developed drugs, such as olanzapine, are less likely to produce the extrapyramidal effects commonly found with typical.

As a result, patients are more likely to continue with their medication, which in turn means they are more likely to see a reduction in their symptoms.

Question 24

What is meant by are atypical antipsychotics better?

Answer 24

The introduction of atypical led to claims of superiority of these drugs over the older ‘typical’.

Crossley (2010) carried out a meta-analysis of 15 studies to examine the efficacy (i.e. capacity to reduce symptoms) and side effects of atypical versus typical in the early-phase treatment of schizophrenia.
They found no significant differences between atypical and typical drugs in terms of their effect on symptoms but did note differences in the type of side effects experienced.
Patients on atypical gained more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side effects.

They concluded there was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.

Question 25

What is meant by motivational deficits?

Answer 25

Ross and Read (2004) argue that when people are prescribed antipsychotics medication, it reinforces the view that there is ‘something wrong with them’.

This prevents the individual from thinking about possible stressors (such as like history or current circumstances) that might be contributing to their conditions. In turn this reduces their motivation to look for possible solutions that moth alleviate these stressors and reduce their suffering.

Read (2005) concludes that as human misery is largely inflicted by other people then the best solutions are usually human - rather than chemical or electrical - interventions.