Biological Therapy for Schizophrenia

• What is the most common treatment for schizophrenia (SZ)?

  Antipsychotic drugs
• In what forms can antipsychotic drugs be taken?

  Tablets, syrup, injections
• How can antipsychotics be administered in terms of duration?

  Short or long-term
• How are antipsychotics categorized?

  Typical and atypical
• Since when have typical antipsychotics been available?

  Since the 1950s
• What is the maximum daily dosage for typical antipsychotics when taken orally?

  1000mg
• What is the typical dosage range for most people taking typical antipsychotics?

  400 to 800mg
• What trend has been observed in prescribed doses of typical antipsychotics over the last 50 years?

  Doses have declined
• What is the strong association of Chlorpromazine in relation to schizophrenia?

  It relates to the dopamine hypothesis

  
• How do typical antipsychotics affect dopamine in the brain?

  They act as antagonists, reducing dopamine action
• What is the mechanism by which typical antipsychotics work?

  They block dopamine receptors in synapses

  
• What condition can develop as a side effect of typical antipsychotics?

  Tardive dyskinesia

  
• What are the symptoms of tardive dyskinesia?

  Uncontrollable movements of tongue, face, jaw
• What system is affected by typical antipsychotics leading to tardive dyskinesia?

  The extrapyramidal system
• Besides being an antipsychotic, what other effect does chlorpromazine have?

  It acts as a sedative
• Why is syrup form of chlorpromazine preferred for sedative properties?

  It is absorbed faster than tablets
• Since when have atypical antipsychotics been used?

  Since the 1970s
• What was the purpose of developing atypical antipsychotics?

  To be more effective and reduce side effects
• What symptoms do atypical antipsychotics improve?

  Positive, negative, and cognitive impairment
• How do atypical antipsychotics interact with D₂ receptors?

  They temporarily block and rapidly dissociate
• When was Clozapine developed?

  In the 1960s
• Why was Clozapine withdrawn for a while?

  Due to deaths from agranulocytosis
• Why is Clozapine used when other treatments fail?

  It is more effective than typical antipsychotics

  
• What precaution is taken for patients on Clozapine?

  Regular blood tests for agranulocytosis
• Why is Clozapine not available as an injection?

  Due to potentially fatal side effects
• What is the typical daily dosage range for Clozapine?

  300-450mg
• What receptors does Clozapine bind to besides dopamine?

  Serotonin and glutamate receptors

  
• What forms can atypical antipsychotics be taken in?

  Tablets, syrup, or injection
• How does Clozapine affect mood and cognitive functioning?

  It improves mood and reduces anxiety
• Why is Clozapine prescribed to patients at risk of suicide?

  30-50% of patients attempt suicide
• What is the typical daily dose range for atypical antipsychotics?

  4-8mg, maximum 12mg
• How does risperidone compare to Clozapine in terms of receptor binding?

  It binds more strongly to dopamine receptors
• When was risperidone developed?

  In the 1990s
• How might Brendan's psychiatrist explain the effects of antipsychotics?

  • Antipsychotics reduce symptoms of schizophrenia
  • They block dopamine receptors in the brain
  • Help normalize dopamine levels

  
• Why might Brendan's psychiatrist have prescribed Clozapine?

  • More effective than typical antipsychotics
  • Used when other treatments fail
  • Monitored for agranulocytosis risk
• What are the strengths and weaknesses of antipsychotic drugs?

  Strengths:

  • Evidence of effectiveness (Thornley et al., 2003)

  
  

  Weaknesses:

  • Side effects (e.g., tardive dyskinesia, NMS)
  • Uncertainty about why they work
  • Possible incorrect assumptions about dopamine levels
• What are the side effects associated with typical antipsychotics?

  • Dizziness
  • Agitation
  • Sleepiness
  • Weight gain
  • Tardive dyskinesia
  • Neuroleptic malignant syndrome (NMS)