Biological treatment

• If sz is caused by an excess of deficiency of a certain neurochemical, then medication can be used to correct this imbalance.
• The drugs used in the treatment of schizophrenia are called ‘antipsychotics’ drugs and they work to suppress hallucinations and delusions.
• Typical or first generation antipsychotics (FGA’s) are well- established drugs that were introduced back in the 1950’s.
• Chlorpromazine, thioridazine, haloperidol and trifluoperazine are examples of typical antipsychotic drugs.
• These drugs are dopamine antagonists as they block dopamine activity within 48 hours, and this seems to be why they are therapeutic for people with schizophrenia.
• FGAs are effective in reducing positive symptoms for many people, but as many as 40% gain no relief at all and many people still experience negative symptoms.
• FGAs also have unpleasant side effects, such as stiff or slow movements of your face that you can’t control (tardive dyskinesia), sleepiness/tiredness, weight gain, problems with sex drive and low blood pressure.
• Atypical or second-generation antipsychotics (SGA’s) are newer antipsychotics (1960’s) that cause fewer side-effects.
• Clozapine, risperidone, olanzapine, and quetiapine are examples of atypical antipsychotic drugs.
• Clozapine blocks dopamine in the same way as FGAs but additionally acts on serotonin and glutamate receptors, for example blocking serotonin receptors (having an antagonist effect)
• Risperidone is a more recently developed SGA.
• Risperidone is also believed to bind to serotonin as well as dopamine.
• Risperidone binds more strongly than clozapine so is effective in much smaller doses than most anti-psychotics.
• Antipsychotic drugs are considered more humane as it meant that people with the diagnosis of schizophrenia had the chance to remain in the community instead of being kept in isolation in institutions.
• Drugs do not consider a patient’s environmental and social problems, which might contribute to re-hospitalisation and relapses.
• The main weakness of drug therapy is that it isn’t a cure, it just temporarily reduces the symptoms; as soon as the patient stops taking them, the symptoms return, usually within 3-6 weeks.
• Drugs have been described as a ‘chemical straitjacket’ and some people think that such control by society is unacceptable.
• Guo et al (2011) carried out research into the effectiveness of antipsychotics in China and found few significant differences when they compared 7 antipsychotics.
• Drugs are thought to be better than former (pre-1950’s) treatments for schizophrenia as they are seen as more ethical and effective.
• Carlsson et al (1999/2000) discusses new drugs and their effectiveness.
• It is estimated that this is the case for about 50% of patients (Guo et al 2011).
• Hartling et al (2012) carried out a review and meta-analysis using 114 studies looking at the effectiveness of FGA and SGAs for schizophrenia.
• A strength of drug treatments for schizophrenia is good empirical evidence (gathered by careful observation, experimentation, and measurement)
• Drug treatment for schizophrenia rests on strong biological evidence about the causes of schizophrenia (e.g dopamine hypothesis) so is underpinned by theory.
• Patients with schizophrenia often do not continue to take the drugs that are prescribed for them.
• Patients may find the side-effects to uncomfortable so don’t take them.
• Zhao (2016) conducted a meta-analysis comparing 18 antipsychotics and found that 17 of the antipsychotics tested had significantly lower relapse rates than placebos.
• Although SGA’s cause fewer side-effects, one major side effect is the fatal blood condition agranulocytosis which has led to this drug falling out in favour though it is still used with treatment-resistant clients, providing relief for up to 60% of such people.
• Patel et al (2014), in a review on the efficacy of medication for schizophrenia, explains that it is important to start medication use quickly in order to be most effective.
• In the first 7 days following a psychotic episode, the objective is to decrease hostility and to attempt to return the client to normal functioning (e.g sleeping and eating)
• Once the symptoms have begun to subside, a maintenance dose will be prescribed to encourage socialisation, self-care and improve mood and combat relapse.
• This dosage should be maintained for at least 12 months after remission.
• Meltzer et al (2004) choose 481 patients with schizophrenia and randomly assigned them into groups where one group had a placebo, investigational drugs, and haloperidol (FGA)
• Haloperidol gave significant improvements in all areas of functioning compared with a placebo.