Lesson 4 - Biological Treatments for Schizophrenia

Question 1

What is the most common treatment for schizophrenia?

Answer 1

Drugs, specifically antipsychotic drugs

Question 2

What are the 3 forms that these drugs can be taken in?

Answer 2

Tablets,
Syrup,
Injection.

Question 3

What are the two types of anti-psychotic drugs?

Answer 3

1. Typical antipsychotics
2. Atypical antipsychotics

Question 4

When did typical antipsychotics initially start being used?

Answer 4

1950s

Question 5

What is the main typical antipsychotic that you must know?

Answer 5

Chlorpromazine

Question 6

What is chlorpromazine?

Answer 6

This is a drug that can be taken as a syrup, injection or tablet. It is also an effective sedative, and is often used to calm the nerves of schizophrenics.

Question 7

What is the maximum dosage for chlorpromazine?

Answer 7

1000mg, but the dosages start at 400mg and gradually increase to 800mg.

Question 8

What do typical antipsychotics do scientifically?

Answer 8

They are dopamine antagonists. This means that they bind to receptors, and then block them from firing, which ultimately reduces the actions of dopamine.

Question 9

What do typical antipsychotics do realistically?

Answer 9

They reduce positive symptoms such as hallucinations, and also calm the nerves of the schizophrenic and make them seem sleepy.

Question 10

When did atypical antipsychotics initially emerge?

Answer 10

1970s

Question 11

What are atypical antipsychotics for?

Answer 11

They were used to improve upon the effectiveness of typical antipsychotics, and minimise the side effects. They also counteract negative symptoms and cognitive impairment.

Question 12

What are the two types of atypical antipsychotics you should know?

Answer 12

Clozapine and Risperidone

Question 13

When was clozapine developed?

Answer 13

It was developed in the 1960s, and trialed in the 1970s. It was withdrawn, and then reintroduced in the 1980s.

Question 14

Why was clozapine initially withdrawn from being used?

Answer 14

It caused a blood condition known as agranulocytosis.

Question 15

How is clozapine practically used today?

Answer 15

It is used as an alternative treatment if typical antipsychotics failed to work. However, the patients must be given regular blood tests if they are taking clozapine, in order to prevent agranulocytosis.

Question 16

What is the maximum dosage for Clozapine?

Answer 16

300-450mg a day.

Question 17

How is Clozapine consumed?

Answer 17

It must be taken as a syrup or tablet, as the injection would be too dangerous.

Question 18

How does Clozapine work neurologically?

Answer 18

It works similarly to typical antipsychotics by binding dopamine receptors, but clozapine also acts on serotonin and glutamate receptors. This reduces anxiety and depression symptoms, and improves overall cognitive functioning.

Question 19

Who is specifically given clozapine due to it’s mood lifting properties?

Answer 19

Patients at a high risk of suicide are given this to try and counteract the suicidal thoughts. This is essential as 30-50% of schizophrenics attempt suicide.

Question 20

When was Risperidone first used?

Answer 20

1990s

Question 21

What was the initial aim of using Risperidone?

Answer 21

It was used to reduce the side effects of clozapine, but still be as effective as clozapine.

Question 22

What is the maximum and recommended dosage of Risperidone?

Answer 22

Patients are given between 4-8mg, and 12mg is the maximum.

Question 23

How can Risperidone be consumed?

Answer 23

It can be used in all 3 forms - syrup, tablets, injection.

Question 24

How does Risperidone work neurologically?

Answer 24

It works the same as clozapine, but it is more efficient so it leads to less side effects. Also, due to it’s efficiency a much smaller dose is needed.

Question 25

Evaluation of drug therapy - Research support for typical antipsychotics

Answer 25

Thornley (2003) compared the use of chlorpromazine with placebos. He did 13 trials with 1121 participants. He found that the chlorpromazine takers had reduced side effects and the placebos were less effective, which proves that the drugs are doing something.

Question 26

Evaluation of drug therapy - Research for atypical antipsychotics

Answer 26

Meltzer (2012) found that Clozapine was more effective than typical and other atypical antipsychotics at treating SZ. Clozapine has been found to be effective in 30-50% of cases where typical antipsychotics failed. This again shows that the popular drugs are the most effective.

Question 27

Evaluation of drug therapy - lack of relapse rates

Answer 27

Leucht (2012) did a meta analysis on over 6000 patients. He found that when patients were taken off antipsychotics and put onto placebos, within 12 months of this happening 64% of them relapsed. However, only 27% relapsed if they continued to take their antipsychotic meds. This shows that the medication is effective and prevents relapse.

Question 28

Evaluation of drug therapy - Side effects of typical antipsychotics

Answer 28

Typical antipsychotics have the side effects of: Dizziness, agitation, sleepiness, stiff jaw, weight gain, and itchy skin.
There is also two more awful side effects.
They could get ‘tardive dyskinesia’ which is a permanent illness which is caused by dopamine supersensitivity.
0.1-0.2% of schizophrenics get NMS. This essentially leads to a high temperature, delirium, a coma and may cause death.
(not good)

Question 29

Evaluation of drug therapy - Side effects of atypical antipsychotics

Answer 29

These were initially developed to overcome these side effects, so there is often not many. However, Clozapine has agranulocytosis as a side effect, which then requires the patient to have constant blood tests. This essentially messes with the production of white blood cells, which leads to problems with immunity).

Question 30

Evaluation of drug therapy - Overexaggerated positive effects.

Answer 30

Healy (2012) claims that many drug trials have been exaggerating the effectiveness of their drugs. Also, antipsychotics have calming effects, but this does not directly tell us if the symptoms are being reduced. The drug trials also only evaluate the short term benefits, and do not look at long term effects.

Question 31

Evaluation of drug therapy - Ethical Issues

Answer 31

There is a large issue with consent in schizophrenia. Technically, due to the mental health of the patients, most patients are not in the right mind to consent to such powerful and potentially damaging drugs.