Schizophrenia- Drug Therapy

Question 1

Impact of neurotransmitters on schizophrenia?

Answer 1

Research suggests that people with SZ have shown more dopamine activity in their brains. Too much dopamine in one area of the brain will produce ‘perception’

E.g. seeing and hearing things that aren’t there

Question 2

Mode of action

Answer 2

Anti-psychotic drugs block the dopamine receptors and reduce dopamine activity; certain types also reduce serotonin activity

Question 3

2 types of anti-psychotic drugs

Answer 3

1) Typical anti-psychotics
2) Atypical anti-psychotics

Question 4

What happens with a typical anti-psychotic?

Answer 4

They bind to specific D2 dopamine receptors on the post-synaptic neuron but doesn’t stimulate them, just blocking their action

Question 5

What happens with an atypical anti-psychotic?

Answer 5

They bind to specific D2 dopamine receptors. They occupy D2 receptors then dissociate to allow normal uptake.

AA’s also block serotonin receptors in certain parts of the brain, which increases dopamine levels in these areas.

Question 6

What are the side effects of anti-psychotics?

Answer 6

Drug therapy has many side effects

E.g. Tardive Dyskinesia (TD)- irregular jerky movements, more common with Typical anti-psychotics

Question 7

Effectiveness of anti-psychotics
Leucht et al

Answer 7

Leucht et al: Found that 2 out of 4 atypical drugs tested were more effective compared to typical

The other 2 showed no difference. They also were more efcteive at treating negative symptoms in comparison to typical anti-psychotics

Question 8

Effectiveness of anti-psychotics
Using placebos

Answer 8

Davis et al: Reviewed the relapse rate of 29 studies and found that there was a higher relapse rate using the placebo (55%) compared to the anti-psychotic drug (19%)

Ross et al: Stated that the previous study is misleading as it doesn’t take into account that 45% of people did benefit from the placebo. When comparing to environment which the drug was given:placebo.

In a hostile and critical environment relapse rate using drugs = 53% : 92% placebo
In a supportive environment the relapse rate using drugs
= 12% : 15% placebo

Question 9

Appropriateness of typical anti-psychotics

Answer 9

Many worrying side effects such as Extrapyramidal effects (involuntary movements, tremors, rigidity)

Hull: claimed that 30% of people on these drugs developed tardive dyskinesia (uncontrollable limb and facial movements)

Question 10

Appropriateness of atypical anti-psychotics

Answer 10

Less occurrence of tardive dyskinesia

Jeste et al: noted that after 9 months 30% of patients using conventional drugs developed the disease (5% using atypical). As there are fewer side effects, patients are more likely to continue taking the drug and see the benefits

But some AA’s can lead to agranulocytosis

Question 11

Ethical issues of drug therapy?

Answer 11

It only treats symptoms but not the causes

Question 11

What is agranulocytosis?

Answer 11

This is where there is a reduction in white blood cells; this can be fatal

Question 12

Ross et al

Answer 12

Drugs reduce the effects but not the cause, and therefore they decrease the motivation of the patient to find their cause of SZ

Question 13

Moncrieff (2013)

Answer 13

Anti-psychotics have been used in hospitals to calm patients, for the benefits of the staff, rather than the patients themselves. This is an issue as it isn’t helping to treat SZ patients but to manage their symptoms