DRUG THERAPY

• DRUG THERAPY 


  Antipsychotic drugs is the most common treatment for schizophrenia.
• Antipsychotic drugs are divided into typical (traditional/first generation) or atypical (second-generation) drugs.
• All antipsychotic drugs work by reducing dopamine transmission.

  They do not cure schizophrenia, but they dampen symptoms so that a degree of normal functioning can occur and allow people with schizophrenia to live relatively normal lives outside of mental institutions.
• TYPICAL (FIRST GEN)


  Used since the 1950s and include Chlorpromazine.  It can be taken as tablets, syrup or injection, with most dosages ranging from 400 to 800 mg with a maximum of 1000mg. They work by acting as antagonists in the dopamine system, blocking dopamine receptors in the brain, reducing the action of dopamine.  Initially dopamine levels build up, but then its production is reduced. 
• TYPICAL 


  It helps reduce positive symptoms like hallucinations.

  It is also an effective sedative and is often used to calm patients down and reduce anxiety.
• ATYPICAL (SECOND GEN)


  Used since the 1970s and include Clozapine.  The aim of newer drugs was to maintain or improve the effectiveness in suppressing symptoms (positive and negative), as well as reducing side effects.
• ATYPICAL 


  Clozapine is not available as an injection (due to lethal side effects), with daily dosages of 300 to 450 mg a day.  It not only acts on dopamine receptors, but also serotonin and glutamate receptors.  It helps improve mood and is prescribed to patients with high risk of suicide (30-50% of schizophrenics attempt suicide). Risperidone was developed in 1990s and does not have the serious side effects of Clozapine.  It can be taken as tablets, syrup or injection, with a dosage of 4 to 8 mg, with a maximum of 12mg.
• (+) ANTIPSYCHOTICS 


  Comparing real drug to placebo = LEUCHT ET AL =

  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. = 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. = antipsychotic drugs are efficient at minimising the symptoms of schizophrenia.
• (-) TYPICAL

  MORE SIDE EFFECTS = typical antipsychotic drugs affect the dopamine systems that control motor functions; can sometimes cause movement problems for the patient. More than half 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.
• (+) ATYPICAL 


  FEWER SIDE EFFECTS = the more recently developed antipsychotics which are less likely to produce the extrapyramidal effects often found with typical antipsychotics. Therefore patients are more likely to continue with their medication, which in turn means they are more likely to see a reduction in their symptoms.
• (-) ANTIPSYCHOTIC 


  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. E.g 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.