Lesson 4: Biological Therapies For Schizophrenia

Question 1

Biological therapies

Answer 1

• Most common treatment for SZ
• Antipsychotic drugs usually taken in the form of tablets, syrups or injections. Injections given to patients who are at risk of not taking their medication
• To control symptoms, nearly all patients are first given antipsychotic drugs either for a short or long period depending on the control of symptoms
• Sometimes once the patient is stable, they may be given psychological therapies as well as such as family therapy or CBT

Question 2

Two types of antipsychotic drugs

Answer 2

• Typical (traditional or first generation)
• Atypical (second generation)

Question 3

Typical antipsychotics

Answer 3

• Dopamine antagonists : reduce the effects of dopamine and thus reduce the symptoms of SZ
• Bind to but do not stimulate dopamine receptors thus blocking their action, this reduces positive symptoms of SZ

Question 4

How long have typical antipsychotics been around for?

Answer 4

Since the 1950s

Question 5

Examples of a typical antipsychotic drug

Answer 5

Chlorpromazine

Question 6

Facts about chlorpromazine

Answer 6

• Chlorpromazine is also an effective sedative and was actually used to calm patients not only with SZ but also other conditions. When schizophrenic patients are first admitted to hospital, they are given chlorpromazine to calm their nerves
• Faster absorbed in syrup form than tablet
• Max dosage is 1000mg, when given first dosage is smaller but gradually increased
• Strong link to the dopamine hypothesis - idea that SZ symptoms are due to high levels of dopamine

Question 7

When did atypical antipsychotics emerge?

Answer 7

Emerged in the 1970s

Question 8

What were atypical antipsychotic drugs used for?

Answer 8

• Used to improve upon the effectiveness of typical antipsychotics and also minimise the side effects when patients were given typical antipsychotics
• Have beneficial effect on negative symptoms and cognitive impairment are suitable for treatment resistant patients

Question 9

How do atypical antipsychotics work?

Answer 9

• Block D2 receptors, 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 side effects

Question 10

When was Clozapine developed?

Answer 10

1960s

Question 11

Why was clozapine withdrawn?

Answer 11

Patients were dying from a blood condition called agranulocytosis.

Question 12

When did clozapine come back?

Answer 12

1980s - seen as a more effective treatment for SZ, used as an alternative

Question 13

Dosage of Clozapine

Answer 13

• patients given regular blood tests when taking it
• not available as injection, only syrup and tablet
• dosage between 300 - 450mg per day

Question 14

How do clozapine work?

Answer 14

• binds to dopamine receptors
• acts on serotonin and glutamate receptors
• helps to reduce depression and anxiety and improve cognitive functioning by working on other neurotransmitters
• as it improves mood, it is often given to patients with a high risk of suicide (important as research has shown that 30-50% of patients with SZ are likely to attempt suicide

Question 15

When did Risperidone emerge?

Answer 15

1990s

Question 16

Why was Risperidone created?

Answer 16

• To reduce the serious side effects of clozapine but still be as effective

Question 17

How is Risperidone taken?

Answer 17

Syrup, tablets or injection
Patients given a dose of about 4-8mb and up to a maximum of 12g

Question 18

How does Risperidone work?

Answer 18

• works by binding to dopamine receptors but works better in binding to dopamine receptors than clozapine leading to less side effects therefore much smaller doses are required