biological treatment for Sz (antipsychotics)

• If Sz is caused by an excess/deficiency of a neurotransmitter

  The treatment for Sz is also biological
• Antipsychotic medication

  Can alleviate symptoms associated with a psychotic episode such as delusions or hallucinations
• Antipsychotic medication treatment

  1. One antipsychotic prescribed at a time

  2. Usually given after the first psychotic episode

  3. Can be paired with antidepressants and anticonvulsants

  4. Injections may be given if high risk of not taking medication

  5. Support offered for disrupting substances like alcohol and caffeine
• Medication started quickly

  Aim to decrease hostility and return patients to normal functioning in the first 7 days
• Symptoms begin to subside

  Patient given a maintenance dose for 12 months after remission
• Deinstitutionalisation

  • Removes the need for a 'straight jacket' and is better than previous treatment such as electroconvulsive therapy
• Patients don't take maintenance dose

  60-80% relapse
• FGA (First Generation Antipsychotics)

  Developed in the 50s, work by targeting excess dopamine by blocking D2 receptors, reduces positive symptoms of Sz by approximately 60%
• FGA

  • chlorpromazine, helps with hallucinations and delusions
• FGA

  • Successful at reducing positive symptoms, but many still experience negative symptoms
• Ying Jiao Zhao meta-analysis found 17 out of 18 antipsychotics significantly lowered relapse rates compared to placebo
• FGA side effects

  50% experience feelings of sedation, 16% experience blurred vision, 18% had poor concentration, may lead to drop out rates
• SGA (Second Generation Antipsychotics)

  Developed in the 90s, work by targeting dopamine, serotonin and glutamate receptors, some temporarily bind with D2 receptors and then disappear to allow for normal functioning, work for both positive and negative symptoms, useful for drug resistant patients
• SGA

  • clozapine which blocks D1 and D4 receptors, linking to serotonin and works to reduce both positive and negative symptoms
• SGA side effects

  Around 2% develop agranulocytosis, can lead to weight gain and metabolic changes
• SGA

  • More effective than FGA, patients continued taking clozapine for longer and it was most effective in symptom assessment 3 months later
• Patients feel forced to take medication

  Links to issues with social control
• ACT (Assertive Community Treatment)

  Provides a more holistic treatment, looks at both biological and environmental factors, provides housing and medication to help with symptoms