SZ bio treatment: ANTIPSYCHOTICS Flashcards
Antipsychotics SZ
protocol of Antipsychotics
Krishna patel et al 2014
Krishna Patel et al. (2014)
in a review on the efficacy of medication for schizophrenia
they explain that it is important to start medication use quickly
– in order to be most effective in
the first seven days following a psychotic episode, the objectives are to decrease hostility
– and to attempt to return the client to normal functioning (e.g. sleeping ad eating).
The individual is carefully monitored for changes in symptoms and side effects
Once symptoms have began to subside,
– a maintenance dose will be prescribed to encourage socialisation, self-care ad improve mood and combat relapse,
– which occurs in 60-80% of people who do not take a maintenance dosage
– but only 18-32% of those who do
• This dosage should be maintained for at least 12 months after remission.
Antipsychotics SZ
additional conciderations when taking/ perscribing Antipsychotics
• Amphetamines, alcohol, caffeine and nicotine can all disrupt the effectiveness of antipsychotic medications
• Therefore, support for substance abuse may also be a consideration when treating a person with antipsychotics
• Drug treatments often fail to bring relief to people who have experienced symptoms for many years
– as it appears the first five years following an acute episode can lead to the most significant changes in the brain
~ (Patel et al., 2014).
Antipsychotics SZ
First Generation ‘Typical’ Antipsychotics
Chlorpromazine and Haloperidol
The first antipsychotic medications was called chloropromazine which was created 1953
this worked by blocking the uptake from D2 receptors
• and within 48 hours dampening dopamines effect throughout the brain
• it was taken 2-4 times per day in tablet form
• they mainly reduced positive symptoms such as hallucinations and delusions this was only successful in 60% of people
• they had many side effects such as major motor side effects
due to a lack of dopamine in the brain
• such as tardive dyskinesia which is involuntary lip and tongue movements
– which affected 30% of patients
– and was irreversible in 75% of cases even after medication had stopped (Hill 1986)
Other side effects included:
– slow, unusual, lack of and uncontrollable movements
– blurry vision
These side effects were continued in the next medication released Haloperidol in 1967
• this drug was stronger so there was less dosage needed and also slightly less of their side effects
– they were however still very present and very severe
– additional side effects of this drug included:
– dry mouth, dizziness, sleepiness and insomnia and constipation
Antipsychotics SZ
Second generation ‘Atypical’ Antipsychotics
Clozapine and Risperidone
The first of these drugs was closer paying which was developed in 1990.
which worked by blocking dopamine(D2), serotonin and glutamate (NMDA) receptors, and binded Dopamine and Seritonin Receptors also
• an imbalance of dopamine and serotonin levels further increases this difference therefore by blocking serotonin receptors as well as doping receptors it’s reduces the chances of this causing negative side effects such as depression
• glutamate regulates dopamine, and is involved in memory and problem solving this allows it to target negative symptoms
• it was taken in tablets 2-4 daily
• it reduces both positive and negative symptoms of schizophrenia such as hallucinations and poverty of speech
• Because this drug blocked many different kinds of receptors it didn’t 100% block every dope receptor
= less motor side effects
• however the worst still some side effects such as Clozapine in paticular:
– had a 2% risk of agrannlocytosis which is a reduction white blood cell efficiency this had a 10% risk of death
– to combat this regular blood tests needed to be done to patients to make sure they didn’t develop it
• risperidone was developed in 1993 to counteract this risk
– it’s also blocks the same receptors and treats positive and negative symptoms
– another thing this does is it binds serotonin and dopamine receptors more strongly than clozapine and therefore it is more effective in smaller doses
– other side effects that it has include:
– weight changes, appetite changes, sleepy, headaches and movement stiffness
Antipsychotics SZ
Olanzapine SGA
Olanzapine was developed in 1996 and has the same function as risperidone
However it is also highly effective in the earliest stages of schizophrenia
and therefore may be able to be used as a treatment before any major episodes have occurred in a patient
Side effects include blurry vision, dizziness and balance issues
Antipsychotics SZ
3rd generation antipsychotics
3rd generation antipsychotics have been recently developed to utilize being a partial agonist and therefore reduce the side effects of the drug
Some third generation antipsycotics may use partial glutamate agonists whereas others may use partial dopamine Agonists
One such example of a partial dopamine agonist is Aripriprizole
Developed in 2002 it is a partial dopamine agonist therefore it blocks some dope mean and replicate a dopamine effect in other places therefore reducing motor side effects
Side effects it does have however are:
– light-headedness, anxiousness, feeding sick, sleepiness, constipation and blurry vision
Antipsychotics SZ
support research
Leutcht et al 2012
A meta analysis of 65 studies between 1959-2011
6,000 patients all of which had been stabilized by antipsychotics
some will then put on a Placebo and within 12 months the Relapse late rates were as followed:
the placebo had a 64% Relapse rate
while antipsycotics had a 27% Relapse rate
meaning that the drugs are much more effective treatments compared to a placebo
Providing evidence to support the effectiveness of antipsychotics
Antipsychotics SZ
Research -
Krishna patel 2014
Notes that 20% of people show almost no improvement after multiple FGA use
48% experience inadequate improvement and unacceptable side effects
and reduced Relapse rates are important
but lots of people who are on drug therapy fail to function well in everyday life and are unemployed
showing that drug treatments are inadequate 65% of the time
and fail to incorpricate patients back into Society
only reducing their symptoms
therefore it criticizes drugs as an effective treatment as it shows drugs only reduce symptoms and don’t help patients every day
Antipsychotics SZ
research + Ying jiao zhao et al 2016
+ ma is ethical
Conducted a meta-analysis which is ethical as its full of secondary data
(which means that no negative ethical impacts can be done on a participant because there are no participants)
Comparing 18 anticyclotics and utilizing data from 56 randomized control trials
with over 10,000 people they
found that 17/18 of the antipsychotics tested significantly lowered the Relapse rates compared to placebo’s
showing their effectiveness reducing symptoms reoccurring
Antipsychotics SZ
research -
Kapur et al 2000
States that using an animals in clinical trials to give schizophrenic medication to
does not show the effects of such medication on humans and how they would also interfere with their everyday lives
providing a weakness of drug trials used for sz
Antipsychotics SZ
Availability
Drugs are widely available and are also used in almost all over treatments including act
Antipsychotics SZ
ethics (+/-) + side effects (-)
Antipsychotics can be considered ethical as they rapidly decrease symptoms and reduce the need for physical straight jackets
However they do not aid the reimplication of patients into Society as act does via its complex one to one program
Also due to the amounts of side effects of antipsychotics that could also be considered an ethical as more problems are created than resolved by them:
FGA:
Motor side effects, seizures, dry mouth, dizziness, blurry vision, sleepiness, Insomnia, constipation, tardive dyskinesia
SGA:
Agrannlocytosis, blurry vision, balance troubles, dizziness, lightheadness, constipation, sleepiness, clumsiness, walking changes, stomach pains, anxiousness and feeling sick
Where is alternatives such as act have no side effects other than possibly being distressing
this is because there is no physical changes within the patient there compared to in drug treatment
Antipsychotics SZ
time +
Daily doses of drugs forever May in the long term be a long time but for their effective use it is much shorter term
especialy shorter than act which also lasts until the patient dies or until they can live independently which rarely occurs
however for the effects to be achieved antipsychotics do this much faster
Antipsychotics SZ
cause -
Antipsychotics and act both do not tackle the root cause of schizophrenia
as one Focuses on the implementation of the patient back into Society
and the other one Focuses on reduction of symptoms of schizophrenia
neither permanently resolve to the issue
Antipsychotics SZ
symptoms +
Unlike act
anti psychotics actively decreased the prevalence of schizophrenic symptoms including positive symptoms
such as + hallucinations and later in second generation anticyclotics negative symptoms such as poverty of speech
in 1997 the American psychiatric Association claims that anticipotic drugs are effective for 60% of schizophrenic patients
