Biologicalll

• When were atypical and typical antipsychotics introduced?

  Atypical - 1970

  Typical - 1950
• What is chlorpromazine?

  Type: Typical

  • blocks dopamine receptors at synapses - reduce hallucinations
  • administered as a tablet, syrup, or through an injection.
  • maximum 100mg per day
• What is clozapine?

  Type: Atypical

  • briefly withdrawn - caused blood condition called agranulocytosis
  • Last resort drug - good with resistant patients
  • binds to dopamine, serotonin and glutamate receptors -improve mood and reduces anxiety
  • 300mg to 450mg per day.
• what is risperidone?

  Type: Atypical

  • Risperidone is as effective as Clozapine but without the serious side effects.
  • administered in tablet, syrup and injection
  •  dopamine and serotonin receptors, but binds more strongly to dopamine receptors than Clozapine.
• Negative and cognitive symptoms of schizophrenia are thought to arise from a deficit of dopamine in the areas of...

  The prefrontal cortex
• Dopamine hypothesis and negative symptoms


  Wang and Deutch (2008) induced dopamine depletion in the prefrontal cortex in rats. This resulted in cognitive impairment (e.g. memory deficits) that the researchers were able to reverse using olanzapine, an atypical antipsychotic drug thought to have beneficial effects on negative symptoms in humans.
• Why do atypical antipsychotics have less side effects?


  Blocks D2 receptors AND serotonin but more strongly block serotonin
• Why are drug therapies preferred to other therapies?

  • Cheap
  • Effectiveness
  • Less effort for patients - increased likelihood of continued use
• The main advantage of such drug treatments, compared to cognitive therapies such as CBT, is that they require minimal effort on the part of the patient. They are non-invasive and not time-consuming, unlike cognitive therapies which require willpower and regular sessions
• Dopamine hypothesis:


  • Excess neurotransmitters = positive symptoms
  • Schizo patients proposed to have higher number of D2 receptors
• Davis + kahn


  Hugh dopamine levels in subcortical areas = positive symptoms
• Typical side effects:

  • Dizziness
  • Weight gain
  • Sleepiness
  • Itchy skinny

  Long term:

  • Tardiness dyskinesia
  • NMS
• What is NMS?


  Neuraleptic Malignant syndrome

  Characterised by fever symptoms, altered mood, muscle rigidity
• Atypical side effects


  Clozapine cause agranulocytosis
• What is agranulocytosis?


  Agranulocytosis is a condition characterized by a severe decrease in the number of granulocytes, a type of white blood cell, in the blood.
• Elesser- longitudinal study


  Antipsychotics do not cure Schizo they just help alleviate symptoms. But this isn't always effective.

  Typical: 65 %

  Atypical: 85 %
• Interactionist approach


  AP success can be increased with psychological therapies

  • Drugs help suspend delusions allowing cognitive and family issues to be dealt with
• Thornley et al - chlorpromazine


  13 trials of 1121 pps associated with overall better functioning

  3 trial of of over 500 pps showed a decreased relapse rate
• Meltzer - clozapine


  Effective in 30-50% that are non-resistant patients
• Dopamine hypothesis revision


  • Drug therapy based on dopamine hypothesis that suggest increase Dopamine cause increased symptoms
  • Revised hypothesis states low levels also can cause symptoms and possibly worsen them
• Healy - masking symptoms

  Chlorpromazine a sedative

  Calmness and functionality of presence do to sedative than reduction if symptoms