Drug therapy

• Most common form of treatment for schizophrenia.

  Older types are known as 'typical' and have been used since the 1950s.

  A common example of this is chlorpromazine. This is a dopamine antagonist which blocks dopamine receptors in the synapse. This normalises dopamine levels in key areas of the brain and can lead to a reduction in hallucinations.

  It can be taken in tablet, syrup, or injection form.
• Newer types are known as 'atypical' and have been used since the 1970s.

  They are used when other treatments for schizophrenia have failed. They target a range of neurotransmitters, e.g. dopamine, serotonin and glutamate.

  Common examples are clozapine, risperidone.

  Clozapine is thought to improve mood, reduce anxiety, and depression and can be used if thought a person is a high risk for suicide. Risperidone was developed in the 1990s, and is thought to be safer than clozapine and requires lower dosage due to binding strongly to dopamine receptors
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  Supporting evidence

  • Davis et al.
  • Conducted a meta analysis of 100 studies comparing anti psychotics with placebos
  • Over 70% of sufferers treated with anti-psychotics improved after 6 weeks, while fewer than 25% improved with the placebo group.
  • Suggests that the drugs are clinically beneficial
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  Problem

  • An issue with using these is that they are difficult to tolerate due to negative side effects.
  • Lieberman et al. Showed that 74% discontinued within 18 months.
  • Similar for both typical and atypical anti-psychotics.
  • May not be appropriate for widescale use.
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  Other side effects

  • Antipsychotic drugs have side effects such as dizziness, agitation and weight gain.
  • Some of the more severe side effects include
  • dystonia - results in continued spasms and muscle contractions
  • Parkinsonism - leads to periods of rigidity
  • tardive dyskinesia - irregular jerky movements and occurs in 15% of cases

  Most serious side effect is neuroleptic malignant syndrome which occurs due to blocking dopamine in the hypothalamus. Leads to high temperature, fever, high blood pressure and in some cases, a coma. This can be fatal
• Often patients must discontinue their meds due to side effects and then these leads to readmisstion into a psychiatric unit.
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  Incomplete understanding

  • Understanding how drugs work is based on the dopamine hypothesis, and high levels of the neurotransmitter in subcortical regions of the brain.
  • However it is now known that low levels of doapmine in other areas of the brain for schizophrenic patients.
  • Means our understanding of how drugs work is incomplete.
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  • Used in mental health institutions to calm patients down and make them easier to work with.
  • Patients may be more able to engage in other forms of therapy such as CBT and social workers can arrange accomodation with them.
  • Many people within the psychiatric community see the widespread use of drugs fuelled by the powerful influence of pharmaceutical companies.
  • Continously replacing typical with atypical drugs brings even greater profit
  • Evidence for the effectiveness of newer drugs is often based on short term trials where side effects are not yet available