Drug treatment

Question 1

What is the dopamine hypothesis?

Answer 1

• messages from neurons that transmit dopamine fire too easily or often
• schizophrenics thought to have abnormally high D2 receptors, resulting in more dopamine binding
• dopamine neurons guide attention, so disturbances can lead to attention and perception problems, found in schizophrenia
• decreasing the levels of dopamine helps to alleviate symptoms, which can be done through anti-psychotics

Question 2

What are typical antipsychotic drugs?

Answer 2

• to reduce effects of dopamine and so reduce symptoms of schizophrenia
• conventional antipsychotics are dopamine antagonists so bind to dopamine receptors but do not stimulate them, thus blocking their action.

Question 3

What is Chlorpromazine?

Answer 3

• typical antipsychotic drug
• can be taken as tablets, syrup or injected
• initially dosages are small, gradually increased to maximum 400 to 800mg
• act as antagonists which reduce the action of dopamine, by blocking the dopamine receptors in the synapses of the brain
• this dopamine-antagonist effect normalises neurotransmission, reducing positive symptoms e.g. hallucinations
• also an effective sedative to calm patients with other conditions.

Question 4

What are atypical antipsychotic drugs?

Answer 4

• used since 1970s with the aim of improving the effectiveness of suppressing symptoms and also minimising the side effects
• thought to block serotonin receptors as well as dopamine receptors, Kapur & Remington suggest they only involve the dopamine system
• temporarily occupy the D2 receptors and then rapidly dissociate to allow normal dopamine transmission
• this is thought to be responsible for the lower levels of side effects e.g. tardive dyskinesia

Question 5

What is Clozapine?

Answer 5

• atypical antipsychotic drug
• developed in the 1960s, withdrawn at first due to following deaths from agranulocytosis (blood condition, decrease in white blood cells)
• 1980s remarketed as a treatment for schizophrenia when other treatments fail
• people taking it have regular blood tests
• potentially fatal side effects mean it cannot be taken as injection, daily dosage low - 300 to 450mg
• binds to dopamine receptors, acts on serotonin and glutamate receptors - believed to improve negative symptoms affecting mood and depression
• mood enhancing effects means often prescribed when at high risk of suicide - 30-50% schizophrenics attempt suicide

Question 6

What is Risperidone?

Answer 6

• more recently developed atypical antipsychotic drug (1990s)
• attempts to produce a drug as effective as clozapine without serious side effects
• form of tablets, syrup or injection which lasts for around 2 weeks
• small dosage initially, builds up to 4-8mg, maximum 12mg
• believed to bind to dopamine and serotonin receptors
• binds more strongly to dopamine than clozapine so is effective in smaller doses

Question 7

What are 2 strengths of drug treatment?

Answer 7

Reduces relapse rates:
- studies have evaluated effectiveness of medication on those with medication and those on placebo
- Leucht et al reviewed meta analysis of 65 studies with 6000 patients, all patients stabilised on either typical antipsychotics or atypical
- some were taken off their medication and given a placebo instead
- within 12 months 64% of those given placebo relapsed, only 27% on medication did
Demonstrates therapeutic effectiveness of these drugs.

Drugs are cheap for patient and act quickly:
- prescribed easily through NHS, and effective almost immediately, rapidly reduce effects of symptoms.
- much better than psychological treatments e.g. CBT which involves working with a therapist over long time. Typically have a 1hour session costing upwards of £100 each. Must commit to treatment for a while to see improvement.
Drug treatments are preferable due to their cheap and rapid nature.

Question 8

What are 2 limitations of drug treatments?

Answer 8

Responsibility is removed with drug treatments:
- Ross & Read argue being prescribed drugs reinforces the view that there is something wrong with you
- prevents individual thinking of possible stressors that could trigger it e.g. family environment
- reduces motivation to look for possible solutions that could alleviate these stressors
Psychological treatments e.g. CBT may be preferable as gives them skills to recover, increases motivation to improve their condition.

Cost of drug treatments to the NHS:
- atypical antipsychotics cost much more than conventionals e.g. Prolixin costs £4-8 per patient per month, Clorazil £1200-1500 per patient per month
- NHS more likely to prescribe cheaper typical -> greater side effects e.g. tardive dyskinesia
- must be prescribed over lifetime as only tackles symptom, not cause -> greater strain on expenses
- CBT may be preferred option - NHS save £989 every time they were treated with CBT rather then hospital
Although initial outlay for CBT is expensive for patient, it is a cost effective long term treatment for NHS

Question 9

What is a conclusion to drug treatments?

Answer 9

A combined course of treatment may be most effective:
- antipsychotics are fast acting, cheap and effective in tackling positive symptoms
- psychologicals e.g. CBT proven more effective with negative symptoms, tackling the cause, and teaching individual skills for a long term solution
With this in mind, best approach would be a combination of drugs and psychological treatments