Drug treatments

• Antipsychotics are medications used to control psychosis, such as delusions and hallucinations. These are taken either by injections or in the form of a pill.
• Psychosis is the loss of contact with reality.
• Typical antipsychotics (the first generation of antipsychotics) is a drug therapy used since the 1950s. They tend to only treat positive symptoms but have very severe side effects.
• Typical antipsychotic - Chlorpromazine:

  • Work as a dopamine antagonist by reducing dopamine activity by blocking the receptors at the synapse.
  • This calms the dopamine system in the brain, reducing the positive symptoms and generally has a sedative effect.
  • Side effects include dry mouth, constipation, lethargy and confusion, tardive dyskinesia and uncontrollable muscle movement usually affecting the face.
  • Maximum dosage of 1000mg, but generally taken in smaller doses from 400mg up to 800mg.
• Atypical antipsychotics (the second generation of antipsychotics) were used in the 1970s to avoid more severe side effects of the typical antipsychotics.
• Atypical antipsychotics - Clozapine:

  • Blocks the dopamine receptors but also act on other neurotransmitters (eg - acetylcholine, glutamate and serotonin).
  • It addresses the negative symptoms such as avolition.
  • Side effects include weight gain and cardiovascular problems.
  • They are less likely to cause involuntary side movements.
  • Have a daily dosage of 300mg to 450mg.
  • Typically assigned to patients who are at the risk of suicide (around 30-50%).
• Clozapine was first introduced in the early 1960s as a test trial but was later discontinued due to many deaths. This was because of a condition known as agranulocytosis (having low neutrophil levels in the blood). When prescribing the pills again, clinicians were advised to check patients blood before giving the tablets to avoid death.
• Strengths of the biological treatments:

  • Effectiveness levels - Thornley (2003) reviewed data from 13 trials with 1121 participants using chlorpromazine and found it was associated with better functioning and reduced symptom severity compared with placebo. This suggests the drugs were effective.
• Strengths of the biological treatments:

  • Effectiveness levels - Meltzer found there is also support for the benefits of atypical antipsychotics. Clozapine is more effective than typical antipsychotics, and that it is effective in 30-50% of treatment-resistant cases. This means that, as far as we can tell, antipsychotics work.
• Strengths of biological treatments:

  • Research support - Bagnall reviewed 232 studies to compare the effectiveness of a range of Atypical and Typical antipsychotics. It was found that Atypical were more effective in treating overall symptoms, resulting in fewer side effects. Clozapine was also more effective in reducing negative symptoms and treating people who were more resistant to other drugs. This suggests antipsychotics are an effective treatment plan.
• Strengths of the biological treatments:

  • Economic benefits - Drug therapies are often cheaper than providing hospital treatment or psychological therapies such as CBT and family therapy. It has also resulted in the end of long term institutionalisation in mental health hospitals and perhaps enhanced quality of life with people living with their families and additional independence.
• Limitations of biological treatments:

  • Flaws in effectiveness - Healy (2012) suggested most studies are of short-term effects only and some data sets have been published several times, exaggerating the size of the evidence base. Also, benefits may be due to calming effects of drugs rather than real effects on symptoms. This means the evidence of effectiveness is less impressive than it seems.
• Limitations of biological treatments:

  • Counter research - Tarrier placed patients randomly into two conditions; antipsychotics alone or antipsychotics with CBT. Patients in the combined condition has a significant improvement in the severity of their symptoms as well as fewer days in hospital receiving care. This suggests drug therapy alone is not the most effective treatment and an interactionalist approach alongside CBT is better.
• Limitations of the biological treatments:

  • Ethical concerns - Drugs are often prescribed forcibly when the disorder is severe. There are ethical issues regarding consent, especially considering the severe side effects.