A03: Biological Therapy for SZ

• Evaluation of Biological Therapy Sz?

  +Effectivness of TYPICAL

  +Effectiveness of ATYPICAL

  -Side Effects of TYPICAL

  -Side Effects of ATYPICAL

  -Counterpoint to effectiveness of atypical AND typical antipsychotics

  -Ethics

  -Study Issues
• Ethics of Drugs - A03 Bio Therapy

  P: Some have criticised drugs, particularly atypical drugs for the calming effect they have on difficult patients

  E: It is thought that this calming effect, while beneficial to hospital staff, is only acting as a chemical straitjacket for the patient

  E: However, such effects might be considered necessary to keep the patient from harming themselves or other people or to allow other therapies to have an opportunity to work

  L: Therefore it is important the practitioner weighs up the costs and benefits involved
• Studies Issues A03 - PART 1: Bio Therapy

  P: Multiple issues with many of studies used to support effectiveness of drug treatment

  E: When under placebo condition, Ross & Read (2004) point out patient is usually in withdrawal state as their antipsychotic replaced with an inert substance

  E: Means dopamine receptors suddenly flooded with dopamine—at much greater levels than they usually experience

  E: According to Healy (2012) some of successful trials showing effectiveness of drug therapy been published multiple times, exaggerating their success.
• Studies Issues A03 - PART 2: Bio Therapy

  E: Studies ignore success of placebos—while antipsychotic may have greater effectiveness, placebos often show some degree of effectiveness too, highlighting importance of patient’s psychology on their recovery.

  L: All of this shows we should be wary when making direct comparisons in drug treatments & consider who funds trials (drug companise) & how they might benefit from +ve outcomes
• A03 Side Effects of Atypical Antipsychotics: Bio Therapy:

  • P: There are limited side effects associated with atypical antipsychotics as they were developed specifically to address this issue
  • E: However, there is still one major side effect which is agranulocytosis. This is a dangerous blood disorder which affects immune system functioning
  • E:For this reason, this drug cannot be given in injection form and users must have regular blood checks
  • L: This may affect the suitability as patients may be more reluctant to use it 
• Effectiveness - Typical Antipsychotic: A03 Bio Therapy

  Empirical evidence show effectiveness of Chlorpromazine

  Thornley et al (2003) reviewed data from 13 drugs trials comparing effectiveness of chlorpromazine with placebo.

  1121 ppt tested & results showed Chlorpromazine was associated with greater overall functioning & reduced symptom severity vs placebo

  3 of those trials were isolated to look at relapse rates. 521 ppt showed relapse rates were lower when chlorpromazine was taken.

  L: Suggests chlorpromazine works at reducing symptom of Sz in short & long term. Typical Antipsychotics work!
• Effectiveness - Atypical Antipsychotic: A03 Bio Therapy

  • There is empirical evidence for Meltzer (2012) which supports the effectiveness of clozapine.

  Meltzer (2012) found clozapine to be more effective than typical & other atypical antipsychotics taken.

  He found 30-50% patients responded well to clozapine in treatment-resistant cases where the patient had not had success with typical drugs.

  • This shows that clozapine is a powerful drug and can be useful in cases where there seems little hope left. Atypical antipsychotics work!
• Side Effects - Typical Antipsychotic

  • Sleepiness
  • Stiff Haw
  • Weight Gain
  • Itchy Skin
  • Agitation
  • Dizziness
  • Headaches
  • Tardive Dyskinesia
  • Neuroleptic Malignant Syndrome (NMS)
• A03: Side Effects of Typical Antipsychotics: PART 1

  P: Side effects associated with typical antipsychotics, range from mild-fatal

  E: Users experience mild effects: sleepiness, weight gain, agitation, dizziness

  E: More seriously/long term: tardive dyskinesia - disorder which causes involuntary facial movements e.g grimacing, lip-smacking, blinking due to dopamine super-sensitivity
• A03: Side Effects of Typical Antipsychotics: PART 2

  E: Most serious NMS (neuroleptic malignant syndrome): blocking dopamine action in hypothalamus, lead to coma/death (due to disrupting regulation of several body systems)

  L: Suggests side effects involved in typical antipsychotics may, at worst, outweigh advantages gained & affect compliance rates. Can do harm as well as good & individuals may avoid them reducing their effectiveness
• A03: Counterpoint to effectiveness of atypical AND typical antipsychotics: Bio Therapy

  Most studies are of short-term effects only and some data sets have been published several times, exaggerating the size of the evidence base (Healy 2012).

  Also benefits may be due to calming effects of drugs rather than real effects on symptoms

  • This means the evidence of effectiveness is less impressive then it seems