Schizophrenia - Methods Of Modifying Behaviour: Antipsychotic Drugs

Question 1

What are the 3 components to describe

Answer 1

• conventional antipsychotics
• atypical antipsychotics
• differences between Conventional and Atypical

Question 2

Describe conventional antipsycotics

Answer 2

-Developed in the 1950s by Delay and Deniker and it works by blocking the neurotransmitter dopamine
- Chlorpromazine is an antagonist, which means that it is a blocking agent.
- The drug is mainly received at D2 receptor sites and antagonises them
- After the presynaptic neuron releases dopamine into the synapse, the receptor sites are blocked by the chlorpromazine which therefore reduces the activity of that post-synaptic neuron.
- Initially this causes the presynaptic neuron to temporarily increase the amount of dopamine secreted into the synapse.
- Eventually production ends up dropping because it becomes depleted as a result of being broken down by an enzyme.
- This means that you have lower levels of dopamine overall
- This is maintained if you keep taking the drug, leading to a substantial decrease in neural activity which then eventually leads to lowered levels of dopamine
- This is linked to the mesolimbic pathway (The Ventral Tegmental Area → Nucleus accumbens).
- leads to less schizophrenic symptoms - in particular the positive symptoms, such as hallucinations and delusions.
- It also has an impact on 2 serotonin receptor sites → 5-HT1 and 5 HT-2 as well as also blocking D1, 3, 4 and 4 receptor sites (but mainly blocking D2).

Question 3

Describe Atypical antipsychotics

Answer 3

• developed in the 1990s.
• They work like conventional antipsychotics because they’re a dopamine antagonist.
• However the precise mechanism for how they work is unclear.
• We know it blocks dopamine but don’t know what its effect is on serotonin.

Question 4

Describe the differences between conventional and atypical antipsychotic drugs

Answer 4

• Some report that atypical antipsychotics are different from conventional antipsychotics because they are received at fewer dopamine D2 receptor sites and at more D1 and D4 receptor sites.
• Another difference is that most atypical antipsychotics also antagonise the serotonin receptor 5-HT2A, to the same degree as they antagonise the dopamine D2 receptor.
• Another possible difference between atypical and conventional antipsychotics is the actual amount of time they occupy the D2 receptor sites. Philip Seeman (2002) reports on the ‘fast-off” theory; this proposes that atypical antipsychotics bind more loosely to the D2 receptor sites than conventional antipsychotics. This means that, although the blockade has a therapeutic effect, it does not last long enough to also produce the side effects seen in conventional antipsychotics (such as tardive dyskinesia, which involves involuntary writhing or tic-like movements of the tongue, mouth, face or whole body).
• The ‘half-life’ of atypical antipsychotic medication is also thought to be less than conventional antipsychotic medication - with atypical antipsychotics the occupancy of D2 receptors fall off within 24 hours, however with conventional antipsychotics the fall off is longer than 24 hours.

Question 5

When evaluating this treatment, what do you talk about

Answer 5

• ethical implications
• social implications
• effectiveness

Question 6

When evaluating the ethical implications, what do you talk about

Answer 6

:)
- reduce stress and improve mental health
:(
- side effects
- informed consent
- chemical straitjackets

Question 7

Evaluate the ethical issue of antipsychotics having side effects

Answer 7

P: A key ethical issue with antipsychotic drugs is the severe side effects associated with their use, such as tardive dyskinesia, Parkinsonism, and agranulocytosis.
E: Research by Kane et al. (1988) showed that up to 30% of patients using conventional antipsychotics develop tardive dyskinesia, a potentially irreversible condition characterized by involuntary movements. Additionally, clozapine, an atypical antipsychotic, carries a 1-2% risk of agranulocytosis, a life-threatening drop in white blood cells.
T: This is a weakness because the severity and long-term nature of these side effects pose significant risks to patients’ quality of life and physical health, raising questions about whether the benefits of treatment outweigh these harms.
COUNTER: While side effects are significant, advancements in monitoring (e.g., regular blood tests for clozapine) and newer medications with fewer side effects have mitigated some of these risks, offering patients safer treatment options.

Question 8

Evaluate the ethical implications of antipsychotics being administered without valid consent

Answer 8

P: An ethical concern is whether individuals with schizophrenia can give fully informed and valid consent to treatment, given their disordered thinking and potential cognitive impairments. Also, whether there could be potential risk of overdose due to misunderstanding and inappropriate use
E: A study by Carpenter et al. (2000) found that patients with schizophrenia often struggle with understanding the risks and benefits of treatment due to cognitive distortions, which may compromise their ability to make autonomous decisions.
T: This is a weakness because it raises ethical issues about autonomy and the potential for coercion, especially when the treatment involves serious risks like side effects or overdose (which can cause cardiovascular collapse). Without valid consent, the practice of prescribing such medication could be considered unethical and harmful
COUNTER: Clinicians might argue that treating schizophrenia is often a necessity to prevent greater harm, such as suicide or violent behavior, and that surrogate decision-making by caregivers or psychiatrists serves the patient’s best interests

Question 9

Evaluate the ethical implication of antipsychotics being used as chemical straitjackets

Answer 9

P: Critics argue that antipsychotics act as “chemical straitjackets,” not to alleviate suffering but to enforce conformity with societal norms, an issue raised prominently by Thomas Szasz in the anti-psychiatry movement.
E: Szasz (1960) contended that psychiatric treatments, including antipsychotics, are coercive tools used to manage behavior rather than address underlying distress, likening their use to social control rather than genuine therapy. Supporting this, a meta-analysis found that patients often report feeling sedated and emotionally numbed by antipsychotics, suggesting they suppress symptoms without necessarily improving the patient’s quality of life (Moncrieff et al., 2006).
T: This perspective underscores an ethical weakness, as it implies that antipsychotic drugs may prioritize societal convenience over the well-being and dignity of the individual.
COUNTER: Advocates might counter that symptom stabilization allows patients to function more effectively in society, and without antipsychotics, many individuals might face greater distress and stigma.

Question 10

Evaluate the ethical implication of antipsychotics reducing distress and improving mental health

Answer 10

P: A key ethical strength of antipsychotic drugs is their ability to reduce hallucinations and other positive symptoms of schizophrenia, which can alleviate distress and significantly improve patients’ mental health and quality of life.
E: Research demonstrates that antipsychotic treatment reduces hallucinations in approximately 60-70% of patients with schizophrenia, leading to a notable decrease in feelings of fear, confusion, and distress (Leucht et al., 2012). This improved mental state can also enhance their ability to engage in meaningful relationships and daily activities.
T: This is an ethical strength because by mitigating distress caused by hallucinations, these medications help patients regain a sense of stability and control over their lives.
COUNTER: However, critics might argue that the side effects and potential overreliance on medication could overshadow these benefits, as some patients may feel sedated or emotionally disconnected despite reduced hallucinations.

Question 11

When evaluating the social implications, what do you talk about

Answer 11

:)
- freedom from asylums
- reduction in caregiver burden
:(
- societal stigma still poses challenges that the medication won’t deal with

Question 12

Evaluate the social implication of antipsychotic drugs allowing freedom from asylums

Answer 12

P: A key social strength of antipsychotic medication is that it has enabled individuals with schizophrenia to live outside mental asylums, which were often inhumane and isolating.
E: Prior to the widespread use of antipsychotic medication in the 1950s, people with schizophrenia were commonly institutionalized in overcrowded asylums where they faced deplorable conditions, including forced restraints and unethical treatments like electroconvulsive therapy without consent (Scull, 2015). With the advent of medication, many individuals now manage their symptoms effectively enough to reintegrate into society.
T: This is a significant social benefit as it restores dignity and autonomy to patients, allowing them to live relatively normal lives and contribute to society, including through employment, which also benefits the economy.
C: However, critics argue that community care systems are often underfunded, leaving some individuals without adequate support, which can lead to homelessness or re-hospitalization

Question 13

Evaluate the social implication of reducing caregiver burden

Answer 13

P: Antipsychotic medication reduces the strain on family members and caregivers by managing the symptoms of schizophrenia, thereby improving social relationships.
E: A study by Magliano et al. (2005) found that families reported a significant decrease in stress and an improvement in family dynamics when patients adhered to antipsychotic treatment, as symptoms like aggression and paranoia were mitigated.
T: This is a social strength as it not only improves the well-being of the patient but also fosters healthier social environments and reduces caregiver burnout.
COUNTER: Critics might argue that the emotional toll on families remains significant, particularly when patients experience severe side effects or non-adherence to medication.

Question 14

Evaluate the social implication of antipsychotics having a harmful stigma

Answer 14

P: While antipsychotic medication allows for better symptom management, it has not fully eliminated the stigma associated with schizophrenia, which can hinder social inclusion.
E: Research shows that over 60% of people with schizophrenia report experiencing discrimination in employment, housing, and social relationships even when their symptoms are well-managed (Thornicroft et al., 2009).
T: This highlights a social weakness, as the reliance on medication alone does not address societal misconceptions or biases, limiting patients’ opportunities for genuine social integration.
COUNTER: Advocates might argue that increased public awareness and education campaigns alongside medication have started to reduce stigma over time. Perhaps it is only a matter of time before this stigma is gone

Question 15

When evaluating the treatment’s effectiveness, what do you talk about

Answer 15

:)
- supporting evidence
- advancements in reducing side effects
:(
- not appropriate for all
- treating symptom, and not addressing cause

Question 16

Evaluate the effectiveness of antipsychotic medication for having supporting research

Answer 16

P: A strength of antipsychotic drugs is their proven effectiveness in reducing schizophrenia symptoms, as demonstrated by research.
E: Cole et al. (1964) conducted a study comparing two groups of schizophrenics. Group 1 received conventional antipsychotics, while Group 2 received a placebo. The results showed that 75% of patients in Group 1 were much improved, compared to only 25% in the placebo group.
T: This highlights the effectiveness of antipsychotics in managing symptoms like hallucinations and delusions, which can significantly improve patients’ quality of life and functionality.
COUNTER: Critics might argue that such studies may not account for long-term effectiveness or the impact of side effects, which could reduce the treatment’s overall benefit.

Question 17

Evaluate the effectiveness of antipsychotic medication in relation to modern advancements in reducing symptoms

Answer 17

P: significant strength of antipsychotic medications is the continuous advancement in drug development, leading to more effective treatments with fewer side effects.
E: Recent advancements have led to the development of atypical antipsychotics, which are less likely to cause the severe side effects associated with conventional antipsychotics, such as tardive dyskinesia and Parkinsonism. Drugs like aripiprazole and lurasidone are now available, offering better tolerability and a more favorable side effect profile, which has improved patient adherence to treatment (Muench & Hamer, 2010).
T: This represents a strength because these advancements provide patients with better treatment options, improving their chances of managing their symptoms effectively with a reduced risk of long-term, debilitating side effects.
COUNTER: However, the high cost of newer atypical antipsychotics may limit their accessibility, especially in low-resource settings, making them less viable for some patients despite their advantages.

Question 18

Evaluate the effectiveness of antipsychotic medication due to issues with compliance

Answer 18

P: A significant weakness of antipsychotic medication is the challenge of ensuring consistent compliance among individuals with schizophrenia.
E: Maria Rettenbacher et al. found that full compliance with medication was observed in only 54.2% of individuals with schizophrenia, with 8.3% being partially compliant and 37.5% being non-compliant. Symptoms such as delusions of persecution can make self-medicating difficult, as patients may distrust their healthcare providers or the medication itself.
T: This demonstrates that antipsychotic drugs are not a universally appropriate treatment, as their effectiveness is heavily dependent on regular usage, which many patients struggle to maintain.
COUNTER: Advocates might argue that advances in treatment, such as long-acting injectable antipsychotics, can help address non-compliance issues by reducing the need for daily medication.

Question 19

Evaluate the effectiveness of antipsychotics for only treating the symptoms and not the cause

Answer 19

P: Another limitation is that antipsychotic drugs primarily address the symptoms of schizophrenia without treating its underlying causes.
E: While antipsychotics are effective in reducing positive symptoms like hallucinations and delusions, they have limited impact on negative symptoms such as apathy and social withdrawal, which often persist and severely affect quality of life (Kirkpatrick et al., 2006). Moreover, the etiology of schizophrenia involves complex factors like genetics and environmental triggers, which medication alone cannot resolve.
T: This suggests that while antipsychotics can provide symptom relief, they do not promote long-term recovery or address the root causes of the disorder, necessitating complementary treatments like therapy or psychosocial interventions.
COUNTER: Supporters might contend that symptom relief is a critical first step in enabling patients to engage in other therapeutic activities that can address the disorder more holistically.