treatments for schizophrenia -drug therapy Flashcards
Types of drug therapy
. typical anti-psychotics
. atypical anti-psychotics
Drug therapy
. antipsychotics most common treatment
. depending on severity of psychosis some short course others life-time or face re-occurrence of symptoms
. two types of anti-psychotics
. typical - first gen - traditional
. atypical - second gen - newer
. typical used more often if symptoms not improve atypical used
Typical antipsychotics
. Chlorpromazine
. dopamine antagonists
. reduce levels of dopamine activity in brain
. chlorpromazine binds to D2 receptors on post synaptic neurons in brain
. reduce action of dopamine
. reduce dopamine activity levels
. results in reduction of positive symptoms (hallucinations)
. also used as sedative - calm patients
Atypical antipsychotics
. Clozapine
. act on dopamine and serotonin neurotransmitters
. clozapine binds to D2 dopamine receptor sites on post synaptic neuron
. reducing positive symptoms (auditory hallucinations)
. also act as agonists on serotonin receptor sites
. increase levels of serotonin
. reduces negative symptoms - lack of emotions - improves mood - reduces depression and anxiety (avolition)
Atypical psychotics - agonists and antagonists
. serotonin agonists - INCREASE
. dopamine antagonists - DECREASE
Which antipsychotics have fewer side effects?
. atypical antipsychotics (clozapine) fewer side effects
. than typical antipsychotics (chlorpromazine)
. have less action on dopamine system
Outline the difference between typical and atypical antipsychotics - symptoms
. atypical antipsychotics (clozapine)
. used to treat both positive + negative symptoms of Sz
. as act on both dopamine and serotonin
. WHEREAS
. typical antipsychotics (chlorpromazine)
. only treat positive symptoms (hallucinations/delusions)
. as only act on dopamine
Outline the difference between typical and atypical antipsychotics - agonists
. atypical antipsychotics are
. serotonin agonists (inc)
. dopamine antagonists (dec)
. WHEREAS
. typical antipsychotics are
. dopamine antagonists (dec)
.reduce dopamine activity levels
Agranulocytosis
. life-threatening illness
. associated with atypical antipsychotics (clozapine)
. blood condition - low levels of white blood cells
. preventing ability to fight off disease
. only given if typical antipsychotics not effective
. or if patient has severe negative side effects (suicide)
. if prescribed atypical regularly monitored for signs of agranulocytosis by blood tests
Parkinsonism
. caused by typical antipsychotics (chlorpromazine)
. parkinson like symptoms
. affects motor movements
. be distressing if previously fit and able
AO3 for drug therapy as a treatment of Sz: evidence to support
P - strength antipsychotics as treatment Sz evidence to support their effectiveness
E - is large body of RTS effectiveness of typical and atypical antipsychotics
E - Thornley et al found meta-analysis 13 studies 1121 ppts investigating Chlorpromazine (typical) against placebo - that typical antipsychotic was associated better overall functioning reduced symptom severity - also Meltzer concluded Clozapine (atypical) more effective than typical antipsychotics - is effective in 30-50% of treatment resistant cases.
L - so supporting antipsychotics are effective treatment for positive and negative symptoms Sz
AO3 for drug therapy as a treatment of Sz: evidence - RTS COUNTER ARGUMENT - Healy
. research by Healy suggests serious flaws with evidence for effectiveness of antipsychotics
. e.g. most studies of short-term effects only
. some successful trials were published several times with exaggerated results
. also as antipsychotics have calming effect on behaviour can be confused for positive effect on symptoms Sz
. so placing doubt on RTS effectiveness of antipsychotics as treatment SZ
. unsure from results whether they reduce symptoms of psychosis or show calming effect.
AO3 for drug therapy as a treatment of Sz: requires little motivation
P - strength drug therapy as treatment Sz typical and atypical antipsychotics require little motivation from patient
E - cause patient only has to take tablet in order to reduce symptoms Sz - unlike CBT requires motivation from patients to attend and engage in sessions to identify/challenge irrational thoughts e.g. delusions
E - may be difficult for Sz person as may not have accurate perception of reality - also is beneficial for ppl with negative symptoms (avolition) struggle keeping up with everyday tasks - they receive immediate positive effects on symptoms
L - so drug therapy may be more appropriate than CBT in treating Sz cause more accessible treatment across symptoms
AO3 for drug therapy as a treatment of Sz: cause negative side effects
P - weakness using drug therapy to treat Sz can cause negative side effects
E - typical antipsychotics (chlorpromazine) produce movement side effects parkinsonism - Parkinson-like symptoms - also atypical antipsychotics carry risk of life-threatening illness agranulocytosis - reduced white blood cell count
E - Unlike CBT this involves aperson identifying/challenging their irrational thoughts (delusions) - no use of drugs so no negative potentially life-threatening side effects
L - so drug therapy may not be appropriate for all patients as side effects reduce effectiveness of drug therapy as treatment of Sz - some people may stop taking them resulting in relapse of symptoms.
AO3 for drug therapy as a treatment of Sz: THINK FURTHER - ethical issues
. ethical issues surround use of antipsychotics in treating Sz
. widely believed antipsychotics been used in hospital situations to calm patients make them easier for staff to work with
. rather than for benefits of patients
. some see this as human rights abuse
. also questionable if severely affected Sz patients can give fully informed consent to medication
. suggest that drug therapy not be ethical in treating Sz
. cause antipsychotics being used ward management rather than treatment
