DRUG THERAPY

• How can schizophrenia be treated?

  • Antipsychotic medication
  • Either typical or atypical
• What are typical antipsychotics?

  First generation of antipsychotic drugs used since 1950s, work as dopamine antagonists
• What is an example of a typical antipsychotic?

  Chlorapromazine
• What are atypical antipsychotics?

  Drugs that target a range of neurotransmitters (e.g. dopamine and serotonin)
• What are 2 examples of atypical antipsychotics?

  Clozapine and Risperidome
• How do typical antipsychotics work?

  • Bind and block dopamine receptors but do not stimulate them
  • This reduces the action of dopamine
  • Dopamine levels build up but then production is reduced
  • This normalises neurotransmitters in key areas and therefore reduces positive symptoms (e.g. hallucinations)
• How do atypical antipsychotics work?

  • Block dopamine receptors on a temporary level
  • They rapidly dissociate to allow normal dopamine transmission
  • This causes fewer side effects
  • Also act on other neurotransmitters (dopamine AND serotonin)
  • Addresses both positive and negative symptoms
  • Risk of causing a blood disorder (risperidone)
• What are some dangerous side-effects of drug therapy?

  • Tardive dyskinesia
  • Neuroleptic malignant syndrome (NMS)
  • Agranulocytosis
• Research support for efficacy TYPICAL

  • Thornley's meta analysis
  • Reviewed studies comparing chlorpromazine to a placebo.
  • Data from 13 trials with 1121 ppts
  • Trials were randomised controlled trials, over 50.
  • FOUND: Chlorpromazine (TYPICAL) was associated better with overall functioning and reduced symptom severity and lower relapse rate
• Research support for efficacy ATYPICAL (AO3)

  • Metlzer  
  • Clozapine is more effective than typical antipsychotics
  • effective in 30%-50% of cases where typical antipsychotics have failed.
  • Other studies have compared the effectiveness of clozapine and other atypical antipsychotics, but results have been inconclusive
  • They also tend to be months long and ignore the study of long-term effects.
• Limitation- lack of appropriateness TYPICAL (AO3)

  • Serious side effects related to drug therapy.
  • E.g. 20-25% of schizophrenia sufferers will suffer from some form of disordered motor movements like tremors and involuntary tics. (e.g. tardive dyskinesia, involuntary movements of face, tongue and jaw)  
  • This is a reason why around 50% of schizophrenia sufferers stop taking drugs within the 1st year.
  • However, the newer forms of antipsychotic drugs have been found more effective.
• What is NMS?

  • neuroleptic malignant syndrome (NMS)
  • Believed to be caused because the drug blocks dopamine action in the hypothalamus which regulates several body systems
  • NMS results in high temperature, delirium and coma (can be fatal). This requires immediate medical attention.
• Limitation due to drug dependency (AO3)

  • Some sufferers who undertake drug therapy are liable to relapse after the drugs have been discontinued
  • Sufferers can also get used to drug therapy, body begins to compensate and change, therefore dependency becomes an issue.