Biological therapy for schizophrenia

Question 1

antipsychotics definition

Answer 1

drugs used to reduce the intensity of the symptoms, in particular positive symptoms, of psychotic disorders such as schizophrenia

Question 2

typical antipsychotics definition

Answer 2

first generation of drugs for schizophrenia and other psychotic disorders, having been used since the 1950s. they work as dopamine antagonists and include chlorpromazine

Question 3

atypical drugs definition

Answer 3

drugs for schizophrenia developed after typical antipsychotics. typically target a range of neurotransmitters such as dopamine and serotonin. examples include clozapine and risperidone

Question 4

what does a person with psychosis experience

Answer 4

some loss of contact with reality for example by hallucinations and delusions

Question 5

how long are antipsychotics required for

Answer 5

can be long term or short term as some can take a short course of antipsychotics and stop without symptoms returning and others need antipsychotics for life or otherwise face likelihood of recurrence of schizophrenia

Question 6

types of antipsychotics

Answer 6

-typical (traditional)
-atypical
-second generation drugs

Question 7

when were typical antipsychotics first introduced

Answer 7

1950s

Question 8

common typical antipsychotic

Answer 8

chlorpromazine which can be taken as tablets, syrup or by injection

Question 9

typical antipsychotic maximum doses

Answer 9

-1000mg of orally taken
-initial doses are usually smaller
-typical dose of 400-800mg

Question 10

typical antipsychotic prescription rates

Answer 10

declined over the last 50 years

Question 11

why are typical antipsychotic dopamine antagonists

Answer 11

strong association between use of typical antipsychotics like chlorpromazine and dopamine hypothesis

Question 12

how do typical antipsychotic work

Answer 12

acting as antagonists to dopamine system

Question 13

typical antipsychotic - what are antagonists

Answer 13

chemicals which reduce the action of a neurotransmitter

Question 14

typical antipsychotic - how to dopamine antagonists work

Answer 14

block dopamine receptors in synapses of brain, reducing action of dopamine

Question 15

typical antipsychotic - what happens when individual begins taking chlorpromazine

Answer 15

levels of dopamine build up and then production is reduced. according to dopamine hypothesis this dopamine antagonist effect normalises neurotransmission in key areas of the brain, reducing symptoms like hallucinations

Question 16

typical antipsychotic- which also has a sedative effect

Answer 16

chlorpromazine

Question 17

typical antipsychotic- why does chlorpromazine have a sedative effect

Answer 17

related to effects on histamine receptors but it not fully understood

Question 18

typical antipsychotic- when is chlorpromazine used as a sedative

Answer 18

used to calm individuals with schizophrenia and other conditions. this is often done when patients are first admitted to hospitals and are very anxious.

Question 19

typical antipsychotic- what form chlorpromazine is taken for sedative effect

Answer 19

syrup as id absorbed faster than tablets

Question 20

Atypical antipsychotics - introduced in

Answer 20

1970s

Question 21

Atypical antipsychotics - aim

Answer 21

develop newer antipsychotics was to maintain or improve effectiveness of drugs in supressing psychosis and minimise side effects of drugs used

Question 22

Atypical antipsychotics - clozapine developed in

Answer 22

1960s and first trailed in early 1970s

Question 23

Atypical antipsychotics - clozapine withdrawn

Answer 23

withdrawn in 1970s due to deaths of some patients form a blood condition called agranulocytosis

Question 24

Atypical antipsychotics - clozapine reintroduced

Answer 24

1980s as was discovered to be more effective than typical antipsychotics and was remarketed as the treatment to be used when other treatments had failed

Question 25

Atypical antipsychotics - clozapine how is health monitored when taking them

Answer 25

having regular blood tests to ensure agranulocytosis is not developed

Question 26

Atypical antipsychotics - clozapine taken by...

Answer 26

-due to potentially fatal side effects it cannot be taken by a injection -daily dosage is lower than for the typical antipsychotic chlorpromazine and is typically 300-450mg per day

Question 27

Atypical antipsychotics - clozapine works by

Answer 27

-binding to dopamine receptors and acts on serotonin and glutamate receptors -belioeved that this action may help improve mood and reduce depression and anxiety in patients and may improve cognitive functioning

Question 28

Atypical antipsychotics - clozapine used for mood enhancing effects

Answer 28

mood enhancing effects mean it is often used when an individual is considered at a high risk for suicide -this is important as 30-50% of schizophrenia patients will attempt at some point

Question 29

Atypical antipsychotics - Risperidone developed

Answer 29

more recent used since the 1990s

Question 30

Atypical antipsychotics - why was Risperidone developed

Answer 30

produce a drug as effective as clozapine without the serious side effects

Question 31

Atypical antipsychotics - Risperidone taken by ...

Answer 31

-tablets -syrup -injection that lasts for 2 weeks

Question 32

Atypical antipsychotics - Risperidone dose

Answer 32

small dose is initially given which gradually increases. the dose is 4-8mg typically with maximum of 12mg

Question 33

Atypical antipsychotics - how does Risperidone work

Answer 33

binds to dopamine receptors and serotonin receptors. binds more strongly to dopamine receptors than clozapine so is much more effective in lower doses. some evidence suggests this causes less side effects

Question 34

Strength of biological therapy for schizophrenia - evidence for effectiveness

Answer 34

-large body of evidence supports idea that both typical and atypical antipsychotics are at least moderately effective in tackling symptoms of schizophrenia. Thornley et al reviewed studies comparing the effects of chlorpromazine to control conditions. data from 13 trials with over 1121 participants showed that better overall functioning and reduced symptom severity compared to the placebo. there is also evidence for the benefits of atypical antipsychotics. Meltzer concluded that clozapine is more effective than typical antipsychotics and other typical antipsychotics, that is effective in 30-50% of treatment-resistant cases where antipsychotics have failed --> means that as far as we can tell antipsychotics work

Question 35

limitation of biological therapy for schizophrenia - counterpoint to evidence for effectiveness

Answer 35

-Helay has suggested some serious flaws with evidence for effectiveness. for example, most are only short term and some successful trials have has there data published multiple times, exaggerating evidence for positive effects. also because antipsychotics have powerful calming effects it is easy to demonstrate they have positive effects on people experiencing symptoms of schizophrenia. not the same as really reducing severity of psychosis --> means antipsychotic effectiveness is less impressive than it first appears

Question 36

limitation of biological therapy for schizophrenia - serious side effects

Answer 36

-typical antipsychotics are associated with range of side effects including dizziness, agitation, sleepiness, stiff jaw and itchy skin. long term use can result in traditive dyskinesia, which is caused by dopamine supersensitivity and causes involuntary facial movements such as grimacing, blinking and lip-smacking.. the most serious side effect of antipsychotics (partially typical) is neuroleptic malignant syndrome. this is beloved to be the caused when drugs block the dopamine action in the hypothalamus an area of the brain associated with regulation of number of body systems. results in high temperature, delirium and coma and can be fatal. the estimates of frequency range are 0.1%-2% --> do harm as well as good and individuals who experience these may avoid such treatments

Question 37

limitation of biological therapy for schizophrenia - mechanism unclear

Answer 37

-do not know how they work (typical and some atypical) -understanding of mechanism by which antipsychotic drugs work is strongly tied up in original dopamine hypothesis- idea that the symptoms of schizophrenia are linked to high levels of dopamine activity in the subcortex of the brain. however, the original dopamine hypothesis is not a complete explanations in fact dopamine levels in other parts of the brain are too low rather than too high. if this is true most antipsychotics should not work. given that there are questions over the effectiveness of antipsychotics anyway this adds to argument that in fact they are ineffective --> some of the antipsychotic treatments may not be the best treatment to opt for- perhaps some other factors is involved in their apparent success

Question 38

evaluation of biological therapy for schizophrenia - chemical cosh

Answer 38

-widely beloved that antipsychotics have been used in hospitals to calm people with schizophrenia and make them easier for staff to work with, rather than for the benefits to people themselves (Moncrieff) -on other hand, calming people distressed by hallucinations and delusions almost certainly makes them feel better, and allows them to engage with other treatments (such as CBT) and services (such as meetings with a social worker to organise accommodation)