Biological therapy for SZ

Question 1

What is the most common treatment for schizophrenia?

Answer 1

antipsychotic drugs

Question 2

What are the two types of antipsychotic drugs used for the treatment of schizophrenia?

Answer 2

• typical antipsychotics (first gen) > used since 1950s
• atypical antipsychotics (second gen) > used since 1970s

Question 3

How are antipsychotics use differently for different people with SZ?

Answer 3

• may be required in the short or long term
• some people can take a short cause of antipsychotics then stop use without return of symptoms
• other people may require use for life or face likelihood of relapse

Question 4

What is one type of typical antipsychotic and how can it be taken?

Answer 4

• (since 1950s) Chlorpromazine
  can be taken as tablets, syrup or by injection
• taken orally it is administered daily up to max of 1000mg
• initial does are smaller & for most people dosage is gradually increased to a max of 400-800mg

Question 5

How do typical antipsychotics like chlorpromazine work?

Answer 5

• strong association with the DA hypothesis
• they work by acting as antagonists (reduce action of neurotransmitters) in the dopamine system
• DA antagonists block dopamine receptors in the synapses of the brain which reduces the action of dopamine

Question 6

What are the effects of chlorpromazine on the dopamine system?

Answer 6

• when an individual begins taking chlorpromazine dopamine levels builds up, but then production is reduced
• this dopamine-antagonists effect normalises neurotransmission in key areas of the brain reducing symptoms like hallucinations

Question 7

What effect does chlorpromazine also have?

Answer 7

• sedation effect
• used to calm individuals not only with SZ but with other conditions
• used with patients first admitted to hospitals & are very anxious
• used in syrup form for sedative affect as it is absorbed faster

Question 8

What are the two atypical antipsychotic?

Answer 8

• Clozapine (300 to 450mg a day)
• Risperidone

Question 9

What were the main aims of the atypical antipsychotics?

Answer 9

to improve effectiveness in suppressing symptoms and minimise side effects

Question 10

When was clozapine first used and why was it withdrawn?

Answer 10

• first trialled in the 1970s
• it was withdrawn following deaths of some patients from a blood condition called agranulocytosis
• 1980s it was discovered to be more effective than typical antipsychotics and used when other treatments failed (treatment resistant cases)

Question 11

If clozapine is used how do individuals ensure they are not developing agranulocytosis?

Answer 11

regular blood tests

Question 12

How does Clozapine work and what are its benefits?

Answer 12

• binds to dopamine receptors in the same way as chlorpromazine does but also > acts on serotonin and glutamate receptors as well
• this helps improve mood & reduce depression & anxiety
• & may improve cognitive functioning
• this mood enhancing effects means it is sometimes prescribed when an individual is considered high risk of suicide > important as up to 50% of people with SZ attempt suicide as some point

Question 13

Why was Risperidone developed and how can it be taken?

Answer 13

• since 1990s
• developed to be as effective as clozapine but without serious side effects
• can be taken in from of tablets, syrup, or an injection that lasts around 2 weeks
• small does initially given & is built up to to a typical daily dose of 4-8mg & a maximum of 12 mg (more effective so less)

Question 14

How does Risperidone work?

Answer 14

• like clozapine, risperidone is believed to bind to dopamine & serotonin receptors
• it binds more strongly to dopamine receptors than clozapine & is therefore effective in much smaller doses than most antipsychotics
• reduces side effects

Question 15

What is a strength of antipsychotics?

Answer 15

• evidence to support their effectiveness
• Thornley et al> reviewed studies comparing the effects of chlorpromazine to control conditions
• data from 13 trials showed that chlorpromazine was associated with better overall functioning & reduced symptom severity as compared to placebo
• also evidence for the benefits of atypical antipsychotics > In Meltzer’s review he concluded that clozapine is more effective than typical antipsychotics & other atypical antipsychotic & that it is effective in up to 50% of treatment resistant cases were typical antipsychotics have failed
• implies that clinical evidence suggests that both typical & atypical antipsychotics are effective in treating symptoms of SZ

Question 16

What is a counterpoint to effectiveness of antipsychotics?

Question 17

What is a limitation of antipsychotics?

Question 18

What is another limitation of antipsychotics?