Drug therapy

• Typical antipsychotic drugs


  Inhibit the effects of the neurotransmitter dopamine which is thought to be heavily associated with schizophrenia, thus minimising the symptoms associated with the disorder. They do this by binding to the D2 receptor and preventing dopamine from being received by those receptors. They tend to be more effective at helping patients with positive symptoms e.g hallucinations.
• Atypical antipsychotic drugs


  Only temporarily inhibit the neurotransmitter dopamine, as after they've binded to the D2 receptor they rapidly disassociate allowing normal dopamine transmission to occur. They also have a higher affinity for serotonin. This has proven to work more effectively on reducing negative symptoms e.g loss of motivation. Because atypical antipsychotic drugs have very little effect on the dopamine systems that control movement, they tend not to cause the movement problems found with the use of typical antipsychotic drugs.
• Support for the effectiveness of antipsychotics

  • Leucht et al carried out a meta-analysis of 65 studies involving 6000 patients in which all patients had been stabilised using antipsychotic drugs. Some patients were taken off their antipsychotic medication and given a placebo instead, and the other participants were kept on their regular medication. The results showed that within 12 months 64% of the patients who had been given the placebo had relapsed, compared to 27% of those who stayed on the antipsychotic drug.
• Leucht concluded that antipsychotic drugs are efficient at minimising the symptoms of schizophrenia
• Weaknesses of antipsychotic drugs

  • They can produce a variety of side effects
  • Typical antipsychotic drugs affect the dopamine systems that control motor functions (the extrapyramidal area of the brain) and can sometimes cause movement problems for the patient
  • More than half the patients taking typical antipsychotic drugs will experience symptoms that resemble parkinson's disease
  • After taking antipsychotic drugs for an extended period of time, a second extrapyramidal side effect called tardive dyskinesia can occur. This is an involuntary movement of the jaw, which can be so distressing for the patient that the patient may stop taking their medication completely.
• Advantages of atypical antipsychotic drugs

  • Patients experience fewer side effects
  • Particularly the more recently developed antipsychotics which are less likely to produce the extrapyramidal effects often found with typical antipsychotics
  • Patients are more likely to continue with their medication, which in turn means they are more likely to see a reduction in their symptoms.
• Comparison of atypical and typical antipsychotic drugs

  • Crossley et al carried out a meta analysis of 15 studies to examine the efficacy of atypical drugs on reducing symptoms and side effects compared to typical drugs. Results showed no significant difference in the reduction of symptoms however did note differences in the types of side effects the patients experienced. They found that those on atypical drugs gained more weight than those on the typicals, whereas those on typical drugs experienced more extrapyramidal side effects. They concluded there was no difference in efficacy in the two drug types however there was a clear difference in the side effect profile.
• The problems associated with the use of antipsychotic medication raise significant ethical issues. This is because some argue that if side effects, deaths and psychosocial consequences were taken into account, a cost-benefit analysis of its advantages and disadvantages would most probably be negative.
• A large out-of-court settlement was awarded to a patient suffering tardive dyskinesia on the basis of article 3 of the human rights act, which states that no one shall be subjected to inhuman or degrading treatment or punishment.