Drug Therapy

• what are antipsychotics?

  • chemical treatment usually prescribed through tablets, intravenous means, or both. This treatment is based on the dopamine hypothesis, which assumes that dopamine activity is linked to schizophrenia.
• what are typical antipsychotics?

  • used primarily to combat the positive symptoms of schizophrenia
  • An example of a typical antipsychotic is the drug chlorpromazine.
  • The basic function of this drug is to reduce or block the effects/actions of dopamine and therefore reduce the symptoms of schizophrenia.
  • Drugs like chlorpromazine are dopamine antagonists, as they bind to dopamine receptors, reducing their action and not stimulating them.
• what are atypical antipsychotics?

  • combat the positive symptoms of schizophrenia, but there are claims that they also have beneficial effects on negative symptoms as well.
  • An example of an atypical antipsychotic is clozapine.
  • These drugs also work on the dopamine system but also block serotonin and glutamate receptors.
  • Drugs like clozapine work by temporarily occupying the D2 receptors and then rapidly dissociating it to allow normal dopamine distribution, as this means the receptors still receive dopamine but just in smaller levels.
• why are atypical preferred to typical antipsychotics?

  • These drugs are thought to be responsible for lower levels of side effects (such as tardive dyskinesia) compared with typical antipsychotics.
• evaluation of typical antipsychotics

  • Kapur et al. (2000) estimate that between 60-70% of D2 receptors in the mesolimbic dopamine pathway must be blocked for typical antipsychotics to be effective which leads to side effects. One side effect is tardive dyskinesia, which often becomes a reason why patients stop taking their medication. There are several dopamine pathways in the brain and while blocking dopamine receptors in one of them is useful, blocking dopamine receptors in the remaining pathways may be harmful to the person.
• evaluation of atypical antipsychotics (1)

  • Atypical antipsychotics tends to not cause the movement problems found with typical antipsychotics. For example, atypical antipsychotics lower the chances of tardive dyskinesia. Jeste et al. (1999) found that 30% of patients on typical antipsychotics (for nine months) suffered from tardive dyskinesia rates, compared to just 5% on atypical antipsychotics.
• evaluation of atypical antipsychotics (2)

  • Atypical antipsychotics may ultimately be more appropriate in the treatment of schizophrenia because there are fewer side effects, which means patients are more likely to continue their medications and therefore see more benefits. However, atypicals are not side effect free; they are associated with diabetes for example, which can be fatal, alongside cardiac arrest.
• evaluation of atypical antipsychotics (3)

  • There are claims that atypicals are more effective at treating schizophrenia and treat a wider range of symptoms. However, Leucht et al. (1999) conducted a meta-analysis of atypicals and found that two of the atypical drugs were only ‘slightly’ more effective than typical drugs, one was ‘effective’ and the other ‘slightly worse’. Also, the claim that atypical drugs are very good at treating negative symptoms has also received little support. Indicating that atypicals may not be a superior treatment.
• evaluation of drug therapy (1)

  • Drug therapy is effective in reducing the symptoms of schizophrenia, especially positive symptoms. They are relatively cheap to produce making them cost effective, easy to administer and have positive effects on many sufferers. It is estimated that less than 3% of people with schizophrenia in the UK live permanently in hospital- largely due to medication. Drug treatment is successful for a large number of people with schizophrenia, meaning more people can live in the community rather than being institutionalised.
• evaluation of drug therapy (2)

  • Drugs are more effective than placebos. Lecht et al. (2012) found that patients that remained on their antipsychotic medication were only 27% likely to relapse compared to 64% for those given a placebo. This shows that drugs are successful in preventing relapse
• evaluation of drug therapy (3)

  • chemical cosh argument: widely believed that antipsychotics have been used in hospital situations to calm people with schizophrenia nad make them easier for staff to work with rather than the benefits to the people themselves. on the other hand, calming people distressed by hallucinations etc almost certainly makes them feel better and allows them to engage in treatments such as CBT
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  evaluation of drug therapy (4)

  • treatment etiology fallacy: meaning that they only treat the symptoms of schizophrenia and do not offer a cure. If a patient stops taking their medication, their schizophrenia symptoms will return. Those from a Psychodynamic perspective argue that drugs treat the symptoms of the illness but not the cause. This leads to the ‘revolving door phenomenon’, where patients are constantly being discharged and re-admitted to the hospital. They take their medication and therefore feel better; then they wrongly assume that they are cured and stop taking their drugs