Biochemical treatments

• Biochemical treatments include


  • Use of antipsychotic medications
• Administration of biochemical treatments

  1. Orally as tablets/syrups

  2. Transdermally (through the skin) in creams, gels, patches and sprays
• Regular check-ups are needed to monitor symptoms and any side effects
• Dosages may be needed to be altered and it may be necessary to provide other additional medications
• The boy from Aneja was prescribed 5 different drugs at one point
• His case reveals how complex it can be to get the combination right for each individual
• Typical antipsychotics


  The first-generation (early) antipsychotics that were developed in the 1950s
• Chlorpromazine


  The first of these typical antipsychotic drugs
• Haloperidol


  Also blocks dopamine receptors like typical antipsychotics
• Typical antipsychotic drugs


  Block dopamine receptors on the postsynaptic cell, without activating them
• Blocking dopamine receptors


  Leads to less dopamine activity
• Dopamine antagonists


  Effective in reducing positive symptoms of schizophrenia
• Side effects and relapse can be unpleasant, debilitating and even fatal
• Side effects


  • Dizziness
  • Drowsiness
  • Restlessness
  • Nausea
  • Constipation
  • Excessive weight gain
• Side effects often lead to tardive dyskinesia (TD) or extrapyramidal symptoms (EPSS) (both characterized by uncontrollable blinking, jerking and twitching of the face and body)
• Atypical antipsychotics


  Drugs that block both dopamine and serotonin (an inhibitory neurotransmitter) receptors
• Atypical antipsychotics


  • clozapine
  • risperidone
• Atypical antipsychotics


  • Effective in reducing both negative and positive symptoms of schizophrenia
  • They rapidly dissociate (only block dopamine activity for a short period of time)
  • The rapid dissociation allows for normal dopamine transmission to take place less side effects
• Atypical antipsychotics


  Have fewer side effects but come with their own issues
• Clozapine


  Can cause agranulocytosis (a potentially fatal blood condition, although the risk is minimised through regular blood counts)
• Side effects and relapse


  Can lead people to stop taking their medications (non-compliance)
• Non-compliance can be dangerous without the support of a professional
• Texas Medication Algorithm Project (TMAP)


  Designed to assist doctors in the prescription of antipsychotics
• TMAP protocol


  1. Initially use an atypical drug, such as risperidone

  2. If that does not work, move onto a typical drug, such as haloperidol, or a different atypical such as olanzapine

  3. If the person still does not find any relief, trial clozapine
• Patients resistant to biochemical interventions

  • Final stages of TMAP include combining antipsychotics with other types of medication, such as mood stabilisers like lithium
• When doctors have exhausted medication options

  Move onto the use of electroconvulsive therapy
• Randomised control trials (RCTs)


  A study where the participants are randomly assigned to either the treatment or the control condition
• RCTs are used to research the use of antipsychotic drugs
• RCTs


  • They are often double-blind placebo controlled
• 50% of those taking antipsychotic medication show significant improvement in their condition after 4-6 weeks
• 30-40% show partial improvement
• A substantial minority of those remaining show little to no improvement
• The nomothetic approach allows generalisations to be made due to the very large sample size (Zhao, 2016)
• The studies were longitudinal, lasting an average of 48 weeks (1-24 months)
• The studies were assessed to determine their empirical quality using the Cochrane Risk of Bias Tool
• The studies differed in terms of how relapse was measured but many used numerical rating scales
• Positive and Negative Syndrome Scale (PANSS)

  A common tool used to measure relapse, with high validity as it incorporates self-reported data as well as observations made by clinicians and caregivers (Opler, 2017)
• These methodological features increase the overall validity of Zhao's findings, increasing confidence in the ability to apply the findings to others
• When evaluating the efficacy of treatment

  Idiographic approach may be beneficial
• Studies using semistructured interviewing and/or focus groups


  • May be more likely to capture important details (like the role of perceived social support from family members and the nature of the therapeutic alliance between doctor and patient)