Biological treatments.

Question 1

Benefits of using drugs.

Answer 1

• The effects are not necessarily permanent (unlike a lobotomy).
• There is no surgery = less danger of surgery going wrong.
• More ethical and less dehumanising.
• Drugs are easier to take or administer.
• The patient has more motivation to take drugs than having invasive surgery/dehumanising treatment.

Question 2

Drug therapies.

Answer 2

• The most common treatment for SZ involves use of antipsychotic drugs, they can be taken as tablets or in form of syrup.
• For those at higher risk of failing to take their medication regularly, some antipsychotics are available as injections given every 2-4 weeks.
• Antipsychotic use can be either short or long term (for life) depending on severity of illness in an individual.
• They do not cure SZ but they dampen the symptoms so that a degree of normal functioning can occur e.g. live relatively normal life.
• Antipsychotics divided into typical (traditional, first generation) and atypical (newer, second generation) drugs.

Question 3

Limitation of antipsychotics - unethical.

Answer 3

P: It is widely believed that antipsychotics have been used in hospital situations to calm people and make them easier for staff to work with.
E: The National Institute for Health and Clinical Excellence (NICE) recommends that short-term use of antipsychotics to calm agitated people is acceptable practice.
L: However, this is seen as human rights abuse by some (Moncrieff, 2013).

Question 4

Typical antipsychotics: Chlorpromazine.

Answer 4

Chlorpromazine is also an effective sedative and often used to calm people, this is usually the case when patients are first admitted to hospital and are very anxious.

Question 5

Side effects of Chlorpromazine.

Answer 5

• A problem with antipsychotic drugs is the likelihood of side effects, ranging from mild, to serious, to fatal.
• Long term use can result in tardive dyskinesia, which is caused by dopamine super-sensitivity and manifests as involuntary facial movements e.g. grimacing, blinking and lip smacking.
• Most serious side effect = neuroleptic malignant syndrome (NMS), this is believed to be used because the drug blocks dopamine action in the hypothalamus and results in high temp, disorientation and coma.

Question 6

Strength of biological treatments - effectiveness of typical antipsychotics.

Answer 6

P: A strength is that there is a lot of evidence to support the idea that typical antipsychotics are at least moderately effective in tackling the symptoms of SZ.
E: Thorny et al (2003) reviewed data from 13 trials (1121 participants) and found that chlorpromazine was associated with better
functioning and reduced symptom severity compared with a placebo.
L: Therefore, this suggests that typical antipsychotics are beneficial as they have been found to be effective in the treatment of SZ.

Question 7

Atypical antipsychotics: Clozapine.

Answer 7

• Clozapine was developed in 1960s and first trialled in early 1970s, but was withdrawn temporarily in 1970s following the deaths of some users from a blood condition called agranulocytosis.
• However, in 1980s, when it was discovered to be more effective than typical antipsychotics and was remarketed as a treatment for SZ to be used when other treatments failed. Daily dosage is typically 300-450mg a day.
• Clozapine binds to dopamine receptors in same way that Chlorpromazine does, but in addition it acts on serotonin and glutamate receptors, it is believed that this action helps improve mood and reduce depression.
• These mood-enhancing effects means that Clozapine is sometimes prescribed when a person is considered at high risk of suicide.

Question 8

Side effects of clozapine.

Answer 8

• Weight gain
• High fever
• Sweating
• Unstable blood pressure
• Muscle rigidity
• Blood clots
• Diabetes
• Muscle tremors (similar to Parkinson’s disease).

Question 9

Strength of biological treatments - effectiveness of atypical antipsychotics.

Answer 9

P: Similarly, another strength is that there is support for the
effectiveness of atypical antipsychotics to treat SZ.
E: Meltzer et al concluded that clozapine is more effective than typical antipsychotics, and that is 30-50% more effective in treatment-resistant cases.
L: Therefore, this suggests that atypical antipsychotics are beneficial for patients with SZ and therefore this is a strength.

Question 10

Atypical antipsychotics: Risperidone.

Answer 10

• Risperidone is a more recently developed atypical antipsychotic, having been around since the 1990s, it was developed in an attempt to produce a drug as effective as Clozapine but without its serious side effects.
• Risperidone is believed to bind to dopamine and serotonin receptors, but it binds more strongly to dopamine receptors than Clozapine and is therefore effective in much smaller doses than most antipsychotics.

Question 11

Limitation of biological treatments - exaggeration.

Answer 11

P: However, a limitation is that some people have suggested that the evidence provided to support the effectiveness of antipsychotics in treating SZ is exaggerated.
E: Healy et al (2002) suggests that data from some successful trials have been published multiple times, exaggerating the positive
effects. Also, most studies only review short-term effects.
L: Therefore, this can be seen as a significant weakness of the use of antipsychotics to treat SZ as it overestimates the effectiveness of antipsychotics.

Question 12

Limitation of biological treatments - dopamine hypothesis.

Answer 12

P: A limitation is that the dopamine theory, on which the premise of using antipsychotics to treat SZ is based upon, has flaws.
E: There is evidence that dopamine levels in other parts of the brain are too low rather than too high meaning anti-psychotics shouldn’t work.
L: Even though atypical antipsychotics have been successful in eradicating most side effects, they do still exist and therefore they remain a significant weakness of their use in treating SZ so may not
be appropriate.