Drug therapies

• Drug therapies were established in the 1950s and they aid in functioning and increase a patient's wellbeing due to them reducing dopaminergic transmission.

  There were 2 types of antipsychotic drugs established: typical and atypical
• Typical antipychotics are dopamine antagonists as they bind to D2 receptors but don't stimulate them.

  This leads to a reuction in stimulation in mesolimbic pathway which results in the elimination of hallucinations and delusions.

  An example of a typical antipsychotic is chlorpromazine which initially causes dopamine levels to build up but then its production is reduced.

  It can be taken as a syrup, tablet or an injection and is given in doses of 400mg - 800mg or up to 1000mg if taken orally.
• Atypical antipsychotics are beneficial for both positive and negative symptoms as they block D2 receptors then rapidly dissociate to allow for normal dopamine transmission which is thought to be the cause of lower side effects.

  These help with cognitive impairments and treatment resistance.

  An example of an atypical antipsychotic is Clozapine which acts on serotonin and glutamate receptors, reducing depression and anxiety and improving cognitive functioning.

  It is given in doses of 300 - 450 mg a day and is not available as an injection.
• Another atypical antipsychotic is Risperidone which is given in doses of 4 - 8 mg per day.

  It can be taken as a tablet, syrup and an injection.

  Risperidone binds more strongly to dopamine receptors than Clozapine and therefore can be given in smaller doses.

  It also binds to serotonin receptors as well leading to the least amount of side effects.
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  Research to support drug therapies comes from Leucht et al.

  They conducted a meta analysis of 65 studies with approximately 6000 patients and found that within 12 months 64 % on a placebo relapsed and 27 % on antipsychotics relapsed.

  This therefore shows the effectiveness of antipsychotics in reducing relapse and thus increases their validity.
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  However, there are side effects to antipsyhcotics.

  For example, long term use of typical antipsychotics may result in tardive dyskenesia caused by dopamine supersensitivity which can result in involuntary facial movements.

  Also the worst side effect is neuroleptic malignant syndrome (NMS) believed to be caused by the blocking D2 receptors in the hypothalamus which can be fatal.

  This shows evidence that antipsychotics can do significant harm and should be avoided by those vulnerable, suggesting they're ineffective for some people.
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  A further limitation is that we don't really know why antipsychotics work.

  This is because they're made based on the original dopamine hypothesis which states schizophrenia is the result of hyperdopaminergia but this has been proven to not be a complete explanation and in fact schizophrenia may be the result of dopamine levels being too low.

  Given that, surely antipsychotics shouldn't work which adds to the argument that perhaps they aren't effective.

  This means antipsychotics may not be the best treatment to opt for if other factors are involved in their success.