THE BIOLOGICAL THERAPY: DRUG THERAPY

Question 1

Define antipsychotics

Answer 1

Drugs use to reduce intensity of symptoms→ Particularly +ve symptoms

Question 2

Define typical antipsychotics (3)

Answer 2

• First gen of antipsychotics
  
  • Have been used since 1950s
  • Work as dopamine antagonists

Question 3

example of typical antipsychotics

Answer 3

Chlorpromazine

Question 4

Define atypical antipsychotics (2)

Answer 4

Drugs for schizophrenia develope after typical antipsychotics

Typically target range of neurotransmitters such as dopamine & serotonin

Question 5

How is chlorpromazine (typical) drug effective as a sedative (3)

Answer 5

• Believed to be related to its affect on histamine receptors
  
  • often used to calm patients not only with schizophrenia but with other conditions
  • being done when patients are first admitted to hospital and are very anxious

Question 6

example of atypical antipsychotics (2)

Answer 6

Clozapine

Risperidone

Question 7

Why was the first atypical antipsychotic drug potentially harmful (4)

Answer 7

Developed in 1960s first child in 1970s but withdrawn following deaths of some patients from blood condition called agranulocytosis

however 1980s it was discovered to be more effective than typical antipsychotics 

still used today people taking it have regular blood test to ensure they are not developing agranulocytosis

because of its potential fatal side-effects not available as an injection and dosages a little

Question 8

Explain what the typical antipsychotics do (3)

Answer 8

• taken as syrup, tablets or by injection
  
  • Typical antipsychotic drugs are used to reduce the intensity of positive symptoms, blocking dopamine receptors in the synapses of the brain and thus reducing the action of dopamine.
  • Work as dopamine antagonist in dop system⇒ They arrest dopamine stimulation by blocking the D2 receptors in synapses that absorb dopamine, in the mesolimbic pathway thus reducing positive symptoms, such as auditory hallucinations.

Question 9

What was the problem found with typical antipsychotics & an example

Answer 9

they tended to block ALL types of dopamine activity, (in other parts of the brain as well) and this caused side effects and may have been harmful.

Number of side effects associated with neurotransmitter system they affect 

For instance their anti-cholinergic side effects include dry mouthed

15 % sufferers develop tardive dyskinesia⇒ uncontrollable muscle movement especially around the mouth→ in some this becomes perminent

Question 10

Explain what the atypical psychotics do (4)

Answer 10

• Newer drugs, attempt to target D2 dopamine activity in the[limbic system]but not D3 receptors in other parts of the brain.
  
  • Atypical antipsychotics such as Clozapine bind to dopamine, serotonin and glutamate receptors.
  • Atypical antipsychotic drugs work on negative symptoms, improving mood, cognitive functions and reducing depression and anxiety.→ important as 30-50% ppl suffer from schizo commit suicide/ attempted
  • They also have some effect on other[neurotransmitters such as serotonin]. They generally have fewer side effects eg. less effect on movement Eg. Clozapine, Olazapine and Risperidone.

Question 11

Who did a systematic review of atypical antipsychotic drugs in schizophrenia

Answer 11

Bagnall et al

Question 12

What was the aim of bagnall’s study on the systematic review of atypical antipsychotic drugs in schizophrenia (2)

Answer 12

• Compare clinical effectiveness, safety and cost effectiveness of typical & atypical antipsychotic drug in treatment for schizo
  
  • Assess the effectiveness of typical and atypical treatments
    against ‘treatment-resistant’ schizophrenia, as well as “first-
    onset’ schizophrenia.

Question 13

What was the procedure used of bagnall’s study on the systematic review of atypical antipsychotic drugs in schizophrenia (3)

Answer 13

• Data was compiled from 171 randomly controlled trials and 52 non-randomised trials of the effectiveness of drug treatments on schizophrenia.
  
  • Data was additionally compiled for 31 economic evaluations of antipsychotic drug treatment for schizo
  • Data was analysed by two independent researchers to establish inter-rater reliability

Question 14

What was the findings of bagnall’s study on the systematic review of atypical antipsychotic drugs in schizophrenia on effectiveness (4)

Answer 14

• Effectiveness: atypical drug were more effective than typical drugs in reducing symptoms of schizo
  
  • Clozapine was more effective than typical antipsychotic drugs in improving negative symptoms in treatment-resistant forms
  • No real difference noted between typical and atypical antipsychotics in treating first-onset schizophrenia.
  • no difference in the effectiveness of atypical v. typical drugs for patients with concurrent substance abuse problems or co-morbid mental illnesses such as depression.

Question 15

What was the findings of bagnall’s study on the systematic review of atypical antipsychotic drugs in schizophrenia on dropout rates

Answer 15

Fewer patients taking atypical drugs left trials early than those from typical drugs groups, the exceptions of the type of drug taken

Question 16

What was the findings of bagnall’s study on the systematic review of atypical antipsychotic drugs in schizophrenia on Side effects (2)

Answer 16

• all atypical antipsychotics drugs caused fewer movement disorders than typical
  
  • A typical drugs clozapine were associated with sudden cardiac death

Question 17

What was the conclusion of bagnall’s study on the systematic review of atypical antipsychotic drugs in schizophrenia (3)

Answer 17

• Atypical drugs generally seem more effective than typical drugs, though there are differences in effectiveness between individual drugs.
  
  • No one drug can be considered superior in terms of symptom reduction, side effects and cost-effectiveness.
  • All antipsychotics, typical and atypical varieties, have their criticisms. Different drugs suit different patients better, though this can be determined only by trial and error.

Question 18

Evaluate the bagnall’s study on the systematic systematic review of atypical antipsychotic drugs in schizophrenia (2 -ve)

Answer 18

• most trials of new atypical antipsychotic drugs on negative symptoms was not assessed→ surprising as manufacturers claim about their effectiveness in treating these symptoms
  
  • Evidence for effectiveness of newer atypical antipsychotic drugs compared with older typical drugs was in general poor quality based on short term trials and difficult to generalise to all schizophrenics

Question 19

What did Davis et al do and find in his study of meta analysis of antipsychotics vs placebo

Answer 19

Recovery may be due to psychological factors – The placebo effect is when patients’ symptoms are reduced because they believe that it should – However Davis et al study:

100 studies compared antipsychotics with placebo

Found: drugs more effective with over 70% of sufferers treated after 6 weeks while fewer than 25% improved with placebo

Antipsychotics have beneficial medical effect

Question 20

Evaluate Healy point on these drug trials evidence (4) (-ve)

Answer 20

• Suggested they have had their data published multiple times exaggerating evidence for positive effect
  
  • Bc they have powerful calming effects⇒ easy to demonstrate that they have some positive effect on patient→ not same as saying they rlly reduce severity of psychosis
  • most published studies assess short term benefits rather than long term
  • compare patients who keep taking antipsychotics with those suffering withdrawal having just stopped taking them

Question 21

Evaluate how drug companies are found to lie about the Benefits of atypical drugs other typical and why they do it (6) (-ve)

Answer 21

• There are many within the psychiatric community who see the widespread use of antipsychotics as being fulled by the powerful influence of the drug-producing companies, which stand to make enormous profits from their use, especially the replacement of typical with atypical drugs, which bring even bigger profits
  
  • Atypical antipsychotics cost about €75 per prescription compared with only €17 for typical
  • research has not really backed up claims that they are more effective. Although they reduce side effects associated with typical drugs, they incur serious side-effect risks of their own, which drug companies were not keen to admit to.
  • The Johnson & Johnson pharmaceutical company was fined $2.2 billion (€1.4 billion) in the USA after allegations of “purposely withholding findings’ about antipsychotics it sold increasing risk of strokes, diabetes and being associated with breast growth in males.
  • Accusations have also been made about research into such drugs being largely controlled by drug companies that influence which findings are published.
  • found cannabidol, an active ingredient in marijuana (which does not contain THC, an ingredient of cannabis associated with triggering schizophrenia), worked just as effectively as antipsychotics, but with far fewer side effects. However, the suspicion is that as it is much cheaper to produce it would not generate great profits, so the drug companies will not be overly keen to produce it.

Question 22

evaluate problem of causation with drugs (2)(-ve)

Answer 22

known as aetiology fallacy

Antipsychotic drugs are highly effective as they are relatively cheap to produce, easy to administer and have a positive effect on many sufferers. However they do not "cure" schizophrenia, rather they dampen symptoms down so that patients can live fairly normal lives in the community.

Question 23

Evaluate ethical issues associated with antipsychotics

Answer 23

Antipsychotics have been used in hospitals to calm patients and make them easier for staff to work with rather than for the patients’ benefit – Can lead to the abuse of the Human Rights Act (no one should be subject to degrading treatment).

Question 24

Evaluate 2 +ve of drug treatment

Answer 24

• highly effective as they are relatively cheap to produce, easy to administer and have a positive effect on many sufferers-> However they do not “cure” schizophrenia, rather they dampen symptoms down so that patients can live fairly normal lives in the community.
• RWA: Offering drugs can lead to an enhanced quality of life as patients are given independence – Positive impact on the economy as patients can return to work and no longer need to be provided with institutional care