Schizophrenia; antipsychotic drugs evaluation

Question 1

Effectiveness Of Conventional antipsychotics

Answer 1

• Jonathan Cole et al (1964) conducted one of the earliest major studies of the effectiveness of conventional antipsychotic drugs.
• The findings suggested that psychiatry could treat mental disorder in the same way that physical disorders were are treated - by using drugs.
• Cole et al. found that 75% of those given conventional antipsychotic were considered to be ‘ much improved’ compared with only 25% of those given a placebo
• in addition, Cole et al. note that none of the patients given the antipsychotic were considered to have gotten worse, in comparison to 48% of those given the placebo.
• This sort of finding was revolutionary as, before the prescription of conventional antipsychotics, schizophrenia was largely considered by many psychiatrists to be untreatable.

Question 2

Comparing conventional and atypical antipsychotics.

Answer 2

• atypical antipsychotics are generally considered to be more effective than conventional antipsychotics.
• Dragan Ravanic (2009) compared the effectiveness of Clozapine, chlorpromazine and haloperidol (all antipsychotics) in 325 individuals with schizophrenia. The researchers found that over a period of five years there were significant differences in psychometric scores measuring schizophrenic symptoms, favouring clozapine.
• They also found clozapine had fewer adverse effects ( average of 0.9 adverse events per patient) then haloperidol (2.7) and chlorpromazine (3.2).
• This suggests that atypical antipsychotics are a more effective and preferable option when treating schizophrenia.
• although this research suggests conventional antipsychotics are redunandant , we must note that different individuals may respond better to conventionals than atypicals, and so these drugs still have a role still have a role in treating schizophrenia..

Question 3

Difficulty assessing the effectiveness of antipsychotics.

Answer 3

• One major problem with assessing the effectiveness of antipsychotic medication is that of non compliance.
• Non compliance is a particular issue in individuals with chronic schizophrenia because many of these individuals tend to lack the necessary ‘insight into their condition - they dont believe they have a problem and therefore dont take the medication
• Maria Rettenbacher and colleagues (2004) found full compliance in only 54.2% of individuals with schizophrenia, partial compliance 8.3% of individuals with schizo, and non compliance in 37.5%.
• This suggests in the real world antipsychotics may not be as effective as they seem to be in closely controlled clinical studies.

Question 4

Ethical implications: Side effects

Answer 4

• One Major Problem with both conventional and atypical antipsychotics is that they have side effects, such as Tardive dyskinesia and parkinsonianism, including tremors, instability and seizures.
• As a result, psychiatrists have to consider if the benefits offered to each individual are worth the potential costs of the side effects.
• when individuals are first diagnosed with schizophrenia or are experiencing an acute episode of the disorder, antipsychotics may be administered without their valid consent, meaning the resultant side effects are definitely of their choosing.

Question 5

Evaluation; ethical implications; Chemical straitjackets

Answer 5

• The antipsychiatry movement claims that antipsychotics are little more than chemical straitjackets, in other words, they are only useful in keeping people quiet and under control.
• psychiatrist Thomas Szasz (1960) argued that using physical treatments for mental disorder is no more sophisticated than believing in demonology. He suggested that the concept of mental illness was simply a way of excluding non conformists from society.
• brings about the important ethical dilemma, are antipsychotics administered to alleviate suffering or to increase compliance with institutional regimes and society in general.
• on the other hand if we offer the right to refuse the medication, we need to be aware of the harm that could cause, e.g. patient could potentially be a threat to themselves or others.

Question 6

Evaluation; Social implications; asylums or care in the community

Answer 6

• Psychiatrists Stephen Lawrie claims that ‘antipsychotic drugs revolutionised the care of schizophrenia, changing it from an acurable condition which required institutionalisation to one that could be treated in the community, with the potential for independent living and recovery’ (2011).
• This emphasizes the social revolution which took place with the introduction of antipsychotics- which was beneficial both for patients because they could lead more normal lives and beneficial for society because of the costs of lifetime hospitalisation.

Question 7

Social implications; risk of violence

Answer 7

• One very serious consequence of individuals with schizophrenia who do not follow their drug therapy is that they may pose a threat to themselves or others.
• Jari Tilhonen et al (2006) noted a 37 fold increase in suicide in patients who stopped taking their medication.
• The NCISH (2015) report that 346 homicides had been committed in England by people with a history of schizophrenia between 2003 and 2013 (6% of the total homocide rate); they also reported 29% of these individuals had been non adherent with drug treatment in the month before the homocide.
• Although we cannot be sure that lack of compliance to antipsychotic medication caused this 29% to commit homicide, it may most definitely be a risk factor.