Drug therapy

• Involves the use of antipsychotic drugs which reduce intensity of psychotic symptoms by correcting neurotransmitter imbalances in the brain. Antipsychotic drugs can be split into the older typical antipsychotics and new atypical antipsychotics. This is most common treatment for SZ and may be short or long term depending on severity
• Typical antipsychotics - Older types of drugs used since 1950s. They are dopamine antagonists as they block dopamine receptors in the synapses in the mesolimbic pathway, reducing positive symptoms such as auditory hallucinations. An example is chlorpromazine which not only treats symptoms but acts as a sedative. Usually used to calm patients when admitted into psychiatric institutions
• Atypical antipsychotics - Used since 1970s and developed due to concerns in serious side affects with typical. Several different drugs:

  • Clozapine binds to dopamine receptors in the same way typical do but also act on serotonin and glutamate receptors. Treats psychotic symptoms and improves mood and reduces depression. Prescribed when a patient is a high risk of suicide
  • Risperidone binds to dopamine and serotonin receptors but strongly to dopamine. It is more effective in smaller doses than other antipsychotics
• Evaluation: Typical antipsychotics - Thornley et al reviewed studies comparing effects of chlorpromazine to a placebo. Found chlorpromazine had association with better overall functioning and symptom severity and relapse rate was lower when chlorpromazine was taken
• Evaluation: Typical antipsychotics - Short term use includes side effects like dizziness, agitation, sleepiness, stiff jaw, weight gain etc. Long term use can result in tardive dyskinesia which is caused by a dopamine super sensitivity. Therefore people may not want to take these drugs due to side effects so are not effective in treating SZ
• Evaluation: Atypical antipsychotics - Herbert Meltzer did a review and concluded that clozapine is more effective than typical antipsychotics. In 50% of cases where typical have failed in treatment, atypical have not. Supports atypical are most effective at reducing symptoms
• Evaluation: Atypical antipsychotics - Clozapine is associated with less serious side effects compared to typical drugs however some side effects still exist. Patients on these have to have regular blood tests to alert doctors to early signs of blood clotting. Issue as side effects are still a huge weakness of atypical antipsychotics
• Evaluation: Chemical cosh argument - Drugs are chemical straitjackets which means they are used in hospitals to benefit staff as it calms patients and makes them easier to work with. This violates human rights. However, it may be useful to calm patients to prevent any violence so many actually be beneficial as it can prevent harm to others