Schizophrenia: drug treatment

Question 1

What are the 2 main types of antipsychotics

Answer 1

• typical antipsychotics
• atypical antipsychotics

Question 2

What are typical antipsychotics

Answer 2

• the first generation of antipsychotics (developed during the 1950s). They work as dopamine antagonists (e.g. Chlorpromazine).

Question 3

what are antagonists?

Answer 3

• An antagonist blocks or reduces the effect of a neurotransmitter.

Question 4

What are atypical antipsychotics

Answer 4

• 2nd generation of antipsychotics (developed during the 1990s).
• They typically target a range of neurotransmitters such as dopamine and serotonin (e.g. Clozapine & Risperidone).

Question 5

Explain how typical antipsychotics (chlorpromazine) are used to treat schizophrenia

Answer 5

• used to calm patients especially when admitted to hospital.
• Initially the dopamine builds up in the brain, then production is reduced.
• According to the hypothesis, this dopamine-antagonist effect normalises neurotransmission -> reduced symptoms such as hallucinations.

Question 6

Explain how atypical antipsychotics (clozapine) are used to treat schizophrenia

Answer 6

• used when other treatments have failed.
• daily dosage is between 300-450mg per day.
• Helps mood and reduces depression and anxiety.

Question 7

Explain how atypical antipsychotics (risperidone) are used to treat schizophrenia

Answer 7

• Developed in 1990s as an attempt to reduce side effects of clozapine.
• Smaller doses are given from 4-8mg up to 12mg per day.
• Binds to dopamine and serotonin receptors -> However, it has a stronger binding effect on dopamine than clozapine and is effective in lower doses.

Question 8

list the evaluations for drug treatment for schizophrenia

Answer 8

Positive
- Evidence for effectiveness

Negative
- serious side effects
- use of antipsychotics depends on the dopamine hypothesis
- problems with evidence
- chemical chosh argument

Question 9

(+) explain how there is evidence of effectiveness of drug treatment for schizophrenia (Thornley)

Answer 9

• Thornley et al. (2003) reviewed studies comparing the effects of chlorpromazine to control conditions - patients in this control condition received a placebo.
• Data from 13 trials with a total of 1121 participants, showed that chlorpromazine was associated with better overall functioning and reduced symptom severity.

Question 10

(+) explain how there is evidence of effectiveness of atypical antipsychotics for schizophrenia (Meltzer)

Answer 10

• Meltzer (2012) concluded that clozapine is more effective than typical antipsychotics and other atypical antipsychotics.
• Effective in 30-50% of cases.
• Meltzer also stated that other atypical antipsychotics have been developed to reduce side effects and have succeeded.

Question 11

(-) Explain how there are serious side effects

Answer 11

• some side effects are mild but can be fatal: dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin.
• Typical antipsychotics can produce ‘Tardive dyskinesia’ (uncontrollable movements of face, lips, mouth, tongue as well as other areas of the body.)

Question 12

(-) explain how use of antipsychotics depends on the dopamine hypothesis

Answer 12

• has been found that schizophrenia results from much higher levels of dopamine activity in the subcortex.
  -> However not a complete explanation for schizophrenia.
• Levels were too low (in other parts of the brain) rather than too high.
• therefore, not clear whether an antagonist can help with schizophrenia symptoms as dopamine levels in the sub cortex can be too low rather than too high.

Question 13

(-) explain how there are problems with evidence for the effectiveness of drug treatments

Answer 13

• Healy (2012) has suggested that over publication has lead to misleading positive evidence.
• Due to the drugs calming effects, it can be concluded that they help patients with schizophrenia, but do they actually reduce the severity of psychosis?
• Most publications discuss short term rather than long term benefits.

Question 14

(-) explain the chemical cosh argument

Answer 14

• chemical cosh: sedation of an individual with chemicals or a medication, especially where sedation is unnecessary.
• NICE recommend using antipsychotics to calm patients, but could this be of benefit to staff rather than patient.
  -> human rights abuse
  -> Ethics

Question 15

(-) Explain how there is evidence refuting use of antipsychotics (antipsychotics vs placebos, Ross and Read)

Answer 15

• Davis analysed results of 29 studies, found relapse occurred in 55% of patients whose drugs were replaced by a placebo, 19% of those who remained on the drug relapsed.
• Ross and Read say these figures are misleading -> also indicate that 45% of those on a placebo did benefit (100%-55%).
• Likewise, the 81% (100%-19%) who benefitted from the drug, the data suggest that a large proportion (i.e. 45%) would also have benefitted from a placebo.