Drug Therapy

• Antipsychotic drugs


  The most common treatment for schizophrenia
• Antipsychotic drug use

  1. Short-term use

  2. Long-term use
• Typical Antipsychotics


  Antagonistic drugs in use since the 1950s
• Chlorpromazine


  The first antipsychotic drug used to treat psychosis
• Typical Antipsychotics

  • Tightly bind to dopamine receptors (mainly the D2 subtype) without activating them
  • Slowly dissociate from the receptors
  • Greatly decreases the ability of dopamine to bind to the receptors, which greatly decreases overall activity at dopamine synapses
• Typical Antipsychotics

  • Significantly decreases many positive symptoms of schizophrenia, especially hallucinations and delusions
• Typical Antipsychotics

  • Extrapyramidal side effects can occur which often involve movement deficits
  • Tardive dyskinesia develops in 15% of long-term users, involving unwanted movements of tongue, face and jaw
• Atypical Antipsychotics


  Antagonistic drugs in use since the 1970s, mainly used in schizophrenia patients who are unresponsive or intolerant of other antipsychotics
• Clozapine


  The first atypical antipsychotic drug used
• Atypical Antipsychotics


  • Loosely bind and quickly dissociate from dopamine (D2) receptors without activating them
  • Binds to serotonin (5-HT2A) receptors (linked to mood) and glutamate receptors (linked to anxiety)
• Atypical Antipsychotics

  • Decreases many positive symptoms of schizophrenia, especially hallucinations and delusions
  • Decreases negative symptoms such as cognitive impairment, including speech poverty
  • Decreases avolition and suicidal thoughts
• Clozapine

  • Agranulocytosis occurs in 1% of patients in the first few months, a blood condition involving a decrease in white blood cells which can lead to increased risk of infection
  • Daily dosage is low typically 300-400mg a day and regular blood tests are taken to monitor white blood cell concentrations
• Antipsychotics

  Drug therapies used to treat mental health conditions
• Evidence for the effectiveness of antipsychotics

  1. Studies comparing relapse rates for antipsychotics and placebos

  2. Meta-analysis of 65 studies involving nearly 6,000 patients

  3. Patients stabilised on typical or atypical antipsychotics

  4. Some patients taken off antipsychotics and given placebo

  5. Remaining patients continued taking regular antipsychotic
• Within 12 months, 64% of those patients who had been given the placebo had relapsed, compared to 27% of those who stayed on the antipsychotic drug
• This demonstrates strong evidence for the effectiveness of antipsychotics
• Using placebos to test a treatment

  Raises ethical issues
• If an effective treatment exists, placebos should only be used with a control group (who do not have schizophrenia)
• Giving a patient with schizophrenia a placebo instead of an effective treatment is unethical as it exposes individuals to a treatment that is thought to be inferior
• Despite strong support for the effectiveness of antipsychotic drugs

  Many studies refute the validity of this research
• Healy (2012)


  • Suggested that some successful trials have had their data published multiple times often exaggerating the evidence for the improvement of schizophrenic symptoms
• This generates bias and is misleading to healthcare professionals
• The research has only looked at the short-term improvements, rather than the long term
• Research into the effectiveness of antipsychotics has often been misleading
• More research is needed to establish the true implications of using biological drug therapies to treat the symptoms of schizophrenia, especially in the long term
• Serious side effects of antipsychotics

  • Likelihood of side effects ranging from mild to serious, and even fatal
  • Patients on atypical antipsychotics gained more weight
  • Patients on typical antipsychotics experienced more extrapyramidal side effects (such as tardive dyskinesia)
  • Both types of drug therapies can have adverse unwanted effects
• Crossley et al. (2010) carried out a meta-analysis of 15 studies to examine the side effects of typical versus atypical antipsychotics in the early-phase treatment of schizophrenia
• Each patient will experience differing side effects, so what is appropriate for one patient, might not be for another
• Drugs

  Often used by clinicians because of financial constraints as they are cheap and can be provided immediately
• Psychological therapies

  More expensive and usually have long waiting lists
• Drugs

  Offer only a short-term cure
• Symptoms recur when drugs are no longer taken

  Patient relapses
• An ethical implication of using antipsychotic drugs is their misuse in hospitals in order to calm patients and make them 'easier' for staff to work with, rather than for the benefits of the patients themselves
• The National Institute for Health and Clinical Evidence (NICE) recommends the short-term use of antipsychotic drugs during hospital stays
• This practice of using antipsychotic drugs to calm patients is seen by some as human rights abuse, thus questioning the appropriateness of this treatment
• Ideally drugs would only be used in the short-term to stabilise an individual, with the simultaneous use of appropriate psychological therapies
• An eclectic approach using both drugs and psychological therapies is expensive