Drug treatment for SZ

Question 1

When were anti-psychotic drugs first developed?

Answer 1

-1950’s
-Helped to sedate and reduce intensity and freq of sympt

Question 2

What is the process for how drug therapy is carried out for SZ? (9)

Answer 2

-Prescribe typical anti-psychotic eg chlorpromazine after 1st episode
-Only try one drug at a time
-Monitor carefully
-Can be combined w anti-depressants and anti-convulsants
-Need to be started quickly to be effective
-Those untreated don’t benefit from treatment
-If typical don’t work can use a-typical like clozapine
-Tablet or syrup form or injection
-Some take for short period of time and sympt don’t return, others on it for life long.

Question 3

What did Krishna Patel explain?

Answer 3

-Important to start medication quickly
-In first 7 days, obj to decrease hostility and return to normal functioning
-Carefully monitored
-Once sympt subsided, maintenance dose given
-Encourage socialisation, self-care, mood, prevent relapse

Question 4

How many people relapse when not taking a maintenance dose vs those who do?

Answer 4

-60-80% of those that don’t
-18 -32% of those who do

Question 5

How long should the dosage be maintained for after remission?

Answer 5

12 months

Question 6

What are the 2 main types of anti-psychotics?

Answer 6

-Typical (FGA’s) First gen, dev in 1950’s. Target dopamine
-A-typical (SGA’s) Second gen. Dev 1990’s. Target D, serotonin and GM

Question 7

How did SZ used to be treated?

Answer 7

-Stayed in mental institutions
-ECT
-insulin shock therapy

Question 8

How do first generation anti-psychotics work?

Answer 8

-Block receptors in synapses that absorb dopamine
-Bind to D2 receptors
-Dopamine antagonists, reduce amount of dopamine in brain
-Leads to less positive symptoms (60%) like hallucinations and delusions

Question 9

What is an example of a first generation antipsychotic? (4)

Answer 9

-Chlorpromazine
-Blocks dopamine receptors to lower dopamine in brain
-Improves disturbed thoughts, feelings and behaviour
-Calming effect, controls aggression, delusions and hallucinations

Question 10

How do second generation antipsychotics work?

Answer 10

-Regulate dopamine intermittently but also treat serotonin and glutamate
-Temporarily bind with D2 then disappear allowing normal activity
-Treat more neg sympt than first gen
-less side effects than first gen

Question 11

What is an example of an SGA?

Answer 11

-Clozapine.
-Acts on serotonin and glutamate as well as dopamine
-helps pos and neg sympt
-Works for drug resistant SZ
-More impact on GM than FGA’s
-Need high dosage

Question 12

Another example of an SGA

Answer 12

-Risperidone
-more recent
-binds equally to serotonin and dopamine receptors
-more strongly to dopamine receptors than clozapine
-effective in smaller doses

Question 13

Side effects of FGA’s

Answer 13

-Tardive dyskinesia (TD) spasm of muscles in face etc.
-30% have it
-75% irreversible

Question 14

Side effects of SGA’s

Answer 14

-2% develop agranulocytosis
-fatal blood disorder
-Need regular blood tests and monitoring. More rare than TD

Question 15

Evidence of effectiveness (4)

Answer 15

-Meltzer et al (2004) haloperidol had reduced sympt of SZ. Imp in day to day functioning
-Emsley 2008. Risperidone injections reduced pos and neg sympt. 64% patients no sympt 2 yrs on
-Pickar et al: clozapine most effective and placebo least effective when 21 SZ’s given placebo, clozapine or fluphenazine
-Ying Jiao Zhao. meta analysis. found 17/818 anti-psychotics had sig lower relapse rates than placebos. Successful in allowing ppl to avoid hospital

Question 16

Evidence to contrast (5)

Answer 16

-Patel 2014: 20% SZ negligible imp. 45% only partial imp. bad side effects. may stop taking which leads to relapse
-Rosa et al: only 50% complied with taking anti-psychotics.
-Adityanjee and Kaizad. in 0.05% anti-psychotics lead to neuroleptic malignant syndrome . causes nausea, high bp, confusion, coma
-Bustillo: ACT clear effects on preventing relapse and hospitalisation. Drug therapy not suff on own
-Hartling et al (meta-analysis) reviwed 114 studies. difficult to reach overall conclusion of effectiveness of anti-psychotics due to bias, brief follow up trials and selective populations.

Question 17

Comparisons

Answer 17

-Revolving door phenomenon: maintain sympt but don’t cure. As soon as stop, relapse and back on.
-Chemical straight jacket. social control. keep sympy at bay and ignore other factors or treatment which may be more effective. clinician controls the sympt, neg control
-FGD’s more side effects. TD. stop taking and relapse. but clozapine less side effects and look at serotonin and glutamate too
-Side effects like decrease in motivation so may choose not to take them
-Not cure all. Only treat pos sympt. Likely to relapse if come off
-Don’t take environmental or social problems into account which lead to rehosp. ACT takes these into account

Question 18

Credibility

Answer 18

-chances quite low of relapse. 18-32% if take maintenance dose (Krishna)
-Phenothiazine drugs block dopamine. pts signs of improvement and reduction in SZ sympt
-allow patients to stay in society rather than be institutionalised
-Remove need for older treatment which is more barbaric =. eg ECT, insulin shock therapy and prefrontal lobotomy.
-Lots of other treatment used alongside drug treatment. effective at reducing pos sympt