THE CLINICAL APPROACH KEY QUESTION

Question 1

What is the clinical key question?

Answer 1

Is the use of drugs an effective treatment for mental disorders?

Question 2

How is the clinical key question relevant to today’s society?

Answer 2

A lot of MHDs are treated with drugs whilst the patient may be waiting for psychotherapy or other talking therapies such as CBT
In 2018, over 70.9 million items were prescribed for mental disorders, such as depression, by the NHS in England
Mental health was the top reason for absence from work in 2021, so finding an effective treatment could help prevent this
People on average took 19 days off per single absence for mental health
61 million working days lost in 2021 due to mental health, which has a cost of £8 billion to employers
The use of medication for MHDs can keep people in work so the government receives taxes and doesn’t have to pay some benefits

Question 3

What are the drug treatments for schizophrenia? (KQ)

Answer 3

Typical antipsychotics (FGAs) are dopamine antagonists that work to block the D2 dopamine receptors to reductie dopamine activity
Atypical antipsychotics (SGAs) are dopamine antagonists as well, but also work on serotonin either as an agonist (stimulates more) or as an antagonist on specific serotonin receptors

Question 4

What is evaluation of drug treatments for schizophrenia? (KQ)

Answer 4

Risperidone is 84% effective at reducing at least 50% of positive and negative symptoms according to Emsley
Carlsson et al found that the location of the lower/higher levels of neurotransmitters are different in each individual, and therefore drugs should be specific to each specific unique individual experience
McEvoy et al found that clozapine was effective, partly because patients continued taking this drug for longer due to less side effects so were able to get more benefits from drug therapy
Pickar et al found that clozapine was very effective in treating schizophrenia, even in patients previously unresponsive to drug intervention

Question 5

What are the drug treatments for depression? (KQ)

Answer 5

Antidepressants increase the level of the neurotransmitter by stopping the re-uptake of serotonin
Typical antidepressants - such as SSRIs - are serotonin agonists which work to increase the levels of serotonin and encourage binding to receptors and block the re-uptake

Question 6

What is the evaluation for drug treatments of depression? (KQ)

Answer 6

Antidepressants have been shown to be 50-60% effective at reducing depressive symptoms
The Royal College of Psychiatrists reported that only 50-60% of people treated with antidepressants showed improvement compared to only 25-30% of those treated with a placebo
Pinquart et al concluded psychological therapies were more effective but drugs are cheaper and they avoid the waiting lists

Question 7

What are overall criticisms of drug treatments for mental health disorders? (KQ)

Answer 7

However, drugs can have serious side effects meaning the compliance rate can be low
Doesn’t tackle the underlying issues surrounding mental health, and the reason for it developing in the first place
CBT could be more effective as it tackles the underlying issues - Williams et al found that iCBT avoids the long waiting lists as it is carried out online and is effective as a treatment