Drug Therapy

• Antipsychotics


  Drugs used to reduce the intensity of symptoms in particular the positive symptoms of schizo
• Typical antipsychotics


  Only treat positive symptoms of schizo. Work as dopamine antagonists and an example is Chlorpromazine
• Atypical antipsychotics


  Treat positive and negative symptoms of schizo and target dopamine, serotonin and glutamate. Examples include Clozapine and Risperidone
• Antipsychotics explained

  • Can be taken as a tablet or syrup form
  • Can be given as injections every 2-4 weeks
  • May be used short term or long term
• Typical Antipsychotics explained

  • Work by acting as antagonists in the dopamine system
  • Antagonists are chemicals that reduce the action of dopamine
  • Work by blocking dopamine receptors in the synapses of the brain reducing levels of dopamine
  • Reduces symptoms like hallucinations
• What are some side effects of typical antipsychotics?

  • May affect other neurotransmitters
  • Long term use can lead to tardive dyskinesia
  • Uncontrollable muscle movements
  • Effective sedative
  • Effects the histamine receptors
• Chlorpromazine

  • Typical antipsychotic
  • Dopamine antagonist
  • Used to calm people with schizo and other conditions
• Atypical Antipsychotics

  • Drugs act on D2 and occupy the receptors temporarily and then rapidly dissociate to allow normal dopamine transmission
  • Combats positive and negative symptoms
  • Also works in serotonin production systems
  • Act in D2 receptors and serotonin levels
  • Less side effects than conventional drugs
• Side effects of atypical antipsychotics

  • Reduced levels of tardive dyskinesia
  • Weight gain
  • Increased risk of stroke
  • Sudden cardiac arrest
  • Blood clots
  • Diabetes
• Clozapine

  • Atypical antipsychotic
  • Binds to dopamine but also serotonin and glutamate receptors
  • Improves mood
  • Reduces depression and anxiety
  • Improves cognitive functioning
  • Prescribed to high suicide risk patients
• Risperidone

  • Atypical antipsychotic
  • Developed to reduce side effects
  • Effective in small doses
  • Binds more strongly to dopamine than clozapine
• How do atypical antipsychotics reduce effects?

  • Hallucinations and agitation reduce in a few days
  • Delusions reduce in a few weeks
  • Most improve significantly in 6 weeks
  • Individual differences in improvement
  • Some take one course while others need many
  • Some people do not respond to drugs at all
• AO3 Drug Therapy: Evidence for effectiveness

  • Chlorpromazine was compared to a control group
  • Data with 13 trials with 1121 PPs found that chlorpromazine was associated with better overall functioning and reduced symptom severity compared to placebo
  • Other evidence found that clozapine is better compared to typical antipsychotics suggesting antipsychotics work
• AO3 Drug Therapy: Serious side effects

  • Carry a risk of developing tardive dyskinesia makes them inappropriate as the effects of this may be seen as worse than that of schizophrenia
  • Atypical antipsychotics also carry the risk of serious health problems ranging from weight loss to stroke, cardiac arrest and diabetes
  • Both groups of antipsychotics carry serious side effects making them unethical
  • Some argue that cost benefit would happen as there are more benefits for the drug
• AO3 Drug Therapy: Mechanism unclear

  • We do not know why antipsychotics work
  • Our understanding of the mechanism is strongly tied up to the original dopamine hypothesis
  • But the dopamine hypothesis is not a complete explanation for schizo
  • Dopamine levels in parts of the brain are too low or high
  • If this is the case then antipsychotics should not work
  • Questions of the effectiveness makes drug therapy seem ineffective
• AO3 Drug Therapy: Don't treat the underlying cause

  • Antipsychotics are not effective in treating the underlying cause of schizophrenia and only provide relief for the symptoms
  • Drug therapies do not cure the patient and only mask symptoms so need to be continuously used for many patients
  • Have high relapse rates with up to 40% in the first year of treatment and then 15% in later years generally due to patients stopping their course because of the side effects and the impact this has on quality of life
  • This means for many sufferers they are not a effective long term solution