Biological treatments

• what is schizophrenia most commonly treated with?

  antipsychotic drugs
• how are they administered?

  orally (tablet or syrup) or intravenously (injection where the drug is put directly into the bloodstream)
• what is an example of a typical antipsychotic drug?

  chlorpromazine
• how long has typical drugs been around?

  since the 1950s
• how does chlorpromazine?

  this drug works as a dopamine antagonist. It reduces the action of the neurotransmitter dopamine. It blocks the dopamine receptors in the synapse so that dopamine cannot be absorbed by the adjoining neuron.
• why does this work?

  its based upon the dopamine hypothesis, increased levels of dopamine in the sub cortex is responsible for some of the symptoms of schizophrenia, such as hallucinations. Therefore, by blocking the action of dopamine, we should be able to reduce the symptoms of schizophrenia.
• what are examples of atypical antipsychotics?

  clozapine and risperidone
• what are atypical antipsychotics?

  they are newer drugs which have been used since the 1970s to treat psychosis but reduce side effects.
• how does clozapine work?

  it binds to dopamine receptors. it also blocks the action of serotonin and glutamate. this helps improve schizophrenic symptoms but also enhances mood and cognitive functioning. This is beneficial since many schizophrenic people experience suicidal thoughts. 30-50% of them make an attempt to take their own live. The daily dose is 300-450mg
• how does risperidone work?

  been around since 1990s and works by binding to dopamine and serotonin receptors. it binds more strongly to dopamine receptors than the drug clozapine allowing smaller doses to be given that are just as effective, the typical dose 4-8mg maximum of 12mg.
• What is the name of a drug used for treating schizophrenia that blocks dopamine receptor sites?

  Chlorpromazine
• How does chlorpromazine work in treating schizophrenia?

  It blocks dopamine receptor sites and decreases dopamine activity
• What type of antipsychotic is haloperidol?

  Typical
• What is the mechanism of action for haloperidol?

  It blocks dopamine receptor sites and decreases dopamine activity
• What type of antipsychotic is clozapine?

  Atypical
• What receptors does clozapine block?

  It blocks both dopamine and serotonin receptor sites
• What type of antipsychotic is risperidone?

  Atypical
• What is a common side effect of chlorpromazine typical antipsychotics?

  Muscle tightening in neck and jaw
• What is tardive dyskinesia?

  A side effect characterized by involuntary movements, often in the face and jaw
• What is the relapse rate found in Schooler et al (2005) study?

  55%
• What are the side effects and risks associated with antipsychotic treatments more specifically chlorpromazine?

  • Muscle tightening in neck and jaw
  • Tardive dyskinesia
  • Decrease in emotional spontaneity and motivation
  • Motor restlessness and fidgeting
  • Sedation, dry mouth, constipation
  • Weight gain, neuroleptic malignant syndrome (can be fatal)
• What did Barlow & Durand (1995) find regarding chlorpromazine's effectiveness?


  It is effective in reducing schizophrenic symptoms in about 60% of cases
• What was the outcome of the study by Schooler et al (2005) regarding haloperidol and risperidone?


  In both groups, 25% showed a reduction in symptoms
• What did Pickar et al (1992) conclude about clozapine?


  Clozapine was found to be the most effective in reducing symptoms
• What are the side effects of clozapine compared to typical antipsychotics?

  • Similar side effects to typical antipsychotics
  • Tardive dyskinesia much reduced
  • Fewer side effects than typical antipsychotics
  • Rare side effect: agranulocytosis (can be fatal)
• What is the relapse rate for clozapine compared to haloperidol according to Schooler et al (2005)?


  45% for clozapine compared to 55% for haloperidol
• What are the side effects associated with risperidone?

  • Weight gain
  • Severe anxiety
  • Sedation
  • Insomnia
  • Sexual dysfunction
  • Low blood pressure
  • Muscle stiffness, muscle pain, tremors
  • Increased salivation, stuffy nose
  • Associated with diabetes, increased risk of suicide and tumors
• What did Emsley (2008) find regarding early treatment with risperidone?


  Patients had low relapse rates and high remission rates
• What percentage of patients showed at least a 50% reduction in symptoms when treated early with risperidone?


  84%
• What percentage of patients went into remission when treated early with risperidone?


  64%
• what is a strength of drug therapies?


  they work instantly. This can allow the patient to become more functional in shorter space of time than with other therapies. CBT takes many sessions
• What is one strength of using antipsychotics to treat schizophrenia?


  They work instantly, allowing patients to become functional more quickly.
• Why is continuous use of antipsychotics necessary for patients?


  Stopping the medication leads to a return of psychotic symptoms.
• What is a major limitation of antipsychotic drugs in treating schizophrenia?


  They do not provide a long-term, permanent solution to eliminate symptoms.
• What is a significant side effect of Clozapine?


  Patients must have regular blood tests to monitor for agranulocytosis.
• What condition can result from agranulocytosis?


  It leaves individuals vulnerable to infection.
• Why might the potential for fatal side effects from antipsychotics be concerning?


  It raises questions about whether quality of life improves with drug use.
• What is tardive dyskinesia?


  It is characterized by involuntary facial movements such as grimacing and lip smacking.
• What fatal condition can typical antipsychotics cause?

  Neuroleptic malignant syndrome (NMS).
• How does NMS occur in relation to dopamine action?


  It occurs by reducing dopamine action in the hypothalamus.