Anti psychotics

Question 1

Treatment before Antipsychotics

Answer 1

No effective treatment for schizophrenia in 50s before discovering link between dopamine and schizophrenia.

Question 2

How many people benefit from antipsychotics?

Answer 2

Royal College of Psychiatry
4/5 people benefit from antipsychotic drugs

Question 3

What are antipsychotics?

Answer 3

a biological therapy focused on producing physical changes in the brain and are given to treat the most disturbing forms of psychotic illnesses.

Question 4

What is the aim of antipsychotics?

Answer 4

Decrease the levels of dopamine in the brain and reduce the symptoms. APs can be split into conventional and atypical psychotics.

Question 5

What are conventional antipsychotics?

Answer 5

A.k.a typical antipsychotics
Used to combat the positive symptoms of schizophrenia
E.g chloropromazine

Question 6

How do conventional antipsychotics work?

Answer 6

As positive symptoms are a product of an overactive dopamine system in the mesolimbic pathway, conventional antipsychotics reduce the dopamine levels and are therefore dopamine antagonistics. Meaning they block the action of the dopamine by binding to the D2 dopamine receptors resulting in reduced synaptic activity in neurons which appear to be implicated in causing the schizophrenia symptoms. A reduction in dopamine activity can result in a reduction in positive symptoms.

Question 7

What does chloroprozamine do?

Answer 7

A conventional antipsychotic which blocks other dopamine receptor sites
1. D1, 3 4 and 5
As well as some serotonin sites
2. 5-HT1 and 5-HT2
Drugs such as chloroprozamine can have a sedative effect meaning they calm patients down and reduce anxiety.

Question 8

Give more info on chloropromazine of a conventional antipsychotic

Answer 8

Largactil (trade name)
-prescribed as a tablet, oral solution or as an intramuscular injection
-1 gram highest dose
-40-75 mg max dose for child

Question 9

What is an atypical antipsychotic?

Answer 9

Became available in the 1990s and still block dopamine but less than conventional ones
E.g clozapine

Question 10

How do atypical antipsychotics work?

Answer 10

Antagonise seretonin 5-HT2A and dopamine receptors D2 equally in the mesocortical pathway. Do not stay on D2 receptors for as long as conventional APS resulting in an increase of dopamine in this pathway which is believed to be why these newer APS help reduce negative symptoms as well as positive symptoms.

Question 11

Give some examples of atypical psychotics

Answer 11

1. Clozapine: most effective AP, nature of how they work unclear,
2. Risperidone: as effective as clozapine binds to dopamine receptors more strongly and produces fewer side effects.

Question 11

What did Thornley find in 2003

Answer 11

Found in a meta-analysis that chloropromazine was associated with better functioning and reduced symptom severity than placebos supporting that the drug does have a positive effect on schizophrenia patients.

Question 12

What did Meltzer investigate in 2014

Answer 12

-used 481 patients with schizophrenia
-patients put in 3 conditions
1. Patients receiving 1 of four new trial drugs
2. Patients receiving a convention antipsychotic called haloperidol
3. Patients receiving a placebo

Question 13

What did Meltzer find after 6 weeks in 2014

Answer 13

After 6 weeks patients taking haloperidol and two of the trial drugs had reduced symptoms
-Patients taking the placebo and two of the trial drugs were still the same
-shows that antipsychotics do better than placebos and really do reduce symptoms

Question 14

What study supports clozapine’s effectiveness in 2012

Answer 14

Meltzer 2012
-concluded that clozapine is effective in 30-50% of cases where other drugs have failed supporting its use in schizophrenia treatment

Question 15

What study shows that atypical drugs are no more effective than conventional ones?

Answer 15

Kahn et al 2008 found that antipsychotics are generally effective for at least 1 year and atypical drugs are no more effective than convential ones.

Question 16

What did Ravanic compare and find?

Answer 16

compared effective’s of chloropromazine and haloperidol (conventional drugs) to clozapine (atypical.) in 325 patients with schizophrenia over a 5 year period. Found that patients on clozapine showed more of a reduction in schizophrenic symptoms as well as fewer side effects.

Question 17

What is a problem with the long-term effectiveness of antipsychotics?

Answer 17

Symptoms reappear after the medication stops
Could be due to the Neurotransmitter balance is the result rather than cause of schizophrenia
Antipsychotics are not effective in managing the negative symptoms of schizophrenia indicating that they could be the result of a different abnormality not dopamine levels
-makes us question AP’s use for modifying schizophrenic symptoms

Question 18

Why are side-effects an issue?

Answer 18

-for some individuals side effects can be more debilitating than schizophrenia itself making us question effectiveness of APs if they help us target schizophrenia but cause unwanted behavioural and health problems
-can cause ethical issues

Question 19

Side effects of conventional APs

Answer 19

-Blurred vision
-Sedation
-Dry Mouth

Question 20

Side effects of atypical APS

Answer 20

-Sexual Dysfunction
-High cholesterol
-Weight Gain

Question 21

Why is non-compliance an issue?

Answer 21

-lack insight into their disorder and consequently don’t take medication due to side effects leading to revolving door syndrome. Discharge into community and réadmission back into hospital which leads to problems researching patients with schizophrenia and can cause harm to the patient and negative financial implications to hospitals.

Question 22

What do statistics show about non compliance?

Answer 22

-54.2% of patients fully comply with their medication
-8.3% partially comply
-37.5% don’t comply
-suggests that findings of research into effectiveness and well controlled trials don’t reflect real life experience of taking antipsychotics.

Question 23

How are AP’s deterministic?

Answer 23

-prescribing medication reinforces a view that something is wrong with the individual
-do not have free will to help themselves and can prevent them from identifying possible stressors or triggers in their lives which could be causing their condition
-therefore APs can be a deterministic view of treatment as it implies there isn’t anything an individual can do to change or improve their condition. This can have a negative impact on effectiveness and long term benefits and removes but a positive it can remove any feeling of blame, responsibility individual and family may feel about the cause of their disorder.

Question 24

How can AP’s be reductionist?

Answer 24

-focuses purely on dopamine levels and doesn’t take into account social and environmental factors which could be causing the disorder -can have a negative impact on the effectiveness of APs as they are not addressing other factors that may be causing symptoms -more holistic approach to treatment may be more effective and beneficial for patients where a number of influences are taken into account and considered when modifying symptoms.

Question 25

How can AP’s be nomothetic?

Answer 25

-nomothetic approach to treatment it assumes cause of schizophrenia is the same for everyone, therefore treatment should be the same. -major flaw with the treatment and impacts the effectiveness as not all patients benefit from APs -suggests that the nomothetic approach of AP’s is not appropriate as important individual differences in the cause of the disorder are being ignored.

Question 26

Chloroprozamine and tardive dyskinesia

Answer 26

Uncontrollable movements of the tongue, face, hands and feet . Affects 1/3 of patients taking the drug and irreversible in 75% of cases.

Question 27

Life threatening side effects in atypical antipsychotics

Answer 27

Clozapine can cause a 3% chance of developing agranulocytosis which is a drop in white blood cells.

Question 28

Why are AP’s emergency consent an ethical issue?

Answer 28

Emergency antipsychotics can be administered without the consent of the patient which means they do not have the control to refuse the drug because of the potential side effects. The patients are not deemed to be thinking clearly enough to make decisions regarding their treatment which raises ethical issues surrounding valid consent.

Question 29

Why is consent an ethical issue for patients with schizophrenia and antipsychotics?

Answer 29

If patients do give consent to drugs can we be fully confident that they fully understand the potential side effects. However, if the patient did refuse drug treatment there are possible risks and consequences such as harm to self and others.

Question 30

Why is price of antipsychotics an ethical issue?

Answer 30

Conventional antipsychotics are cheaper than atypical which could be a factor for some physicians making a prescriptions. This raises ethical issues if patient is not being given the most appropriate drug for finance reasons.

Question 31

Why is harm of vulnerable individuals an ethical issue concerning research

Answer 31

there is potential harm in studies associated with placebo conditions or medication discontinuation. Not all sufferers are being offered medication which could have the potential to improve the quality of their life which raises ethical issues.

Question 32

Chemical straitjackets

Answer 32

Thomas Szasz in 1960 believed that society has constructed the concept of mental illness as a way of dealing with non-conformists from society. He argued that antipsychotics are a way of keeping people quiet and under control. If this is true then it raises an ethical concern of who benefits from antipsychotics more the individual or society.

Question 33

What is one benefit to society antipsychotics has brought?

Answer 33

Before APs schizophrenia was seen as an incurable condition and patients faced long periods of institutionalisation. Drugs offered them care in the community and in their own homes with more opportunities to live independently, maintain employment and relationships, have a better quality of life due to the reduction in symptoms.

Question 34

What did NCISH find in 2015

Answer 34

found that 346 murderers in England between 2003 and 2013 (6% of all murderers) were committed by people with a history of schizophrenia. 29% of these individuals were found to be non-compliant with drug treatment one month before the murders making non-compliance an important risk factor in acts of violence.

Question 35

What is a negative implication of care in the community rather than the security of a hospital?

Answer 35

Patients may be putting themselves or others at risk if they don’t take their medication which is far more difficult to monitor outside of a hospital setting.