Biological Treatments of Schizophrenia

Question 1

Outline the brief history of biological schizophrenia treatment.

Answer 1

Historical research, before 1950’s no known cure for schizophrenia.

1900’s – Patient Warehousing: Problems with how patients were treated and also a lack of trained staff created a climate that allowed experimentation with radical biological interventions. Rosenhan - even in 1973 they were still warehousing.

1930s Insulin shocks.

1935 Psychosurgery.

1938 ECT.

Question 2

Is drug therapy a cure?

Answer 2

Drug therapy is the prime treatment for schizophrenia.

However, it is not a cure, but they do enable people with schizophrenia to live relatively normal lives outside of mental institutions.

Question 3

How long does it take for drug therapy to work?

Answer 3

Hallucinations and agitation tends to reduce within a few days of taking antipsychotic medication, and delusions after several weeks.

Question 4

Do all drugs work the same for everyone?

Answer 4

No, drugs affect people in different ways.

Some patients take different types of antipsychotics before they find one that works for them.

Some have to take one course, while other individuals may need to take antipsychotics at regular intervals in order to prevent schizophrenic symptoms reappearing.

A sizeable minority do not respond to drug therapy.

Question 5

Antipsychotic drugs are sometimes used alongside what?

Answer 5

Antipsychotics are also used sometimes alongside psychological therapies (e.g. CBT).

Question 6

There are two types of antipsychotic drug therapy. What are they?

Answer 6

Typical antipsychotics = the first generation of antipsychotics (developed during the 1950’s).

Atypical antipsychotics = the newer generation of antipsychotics (developed during the 1990’s).

Question 7

What are psychoactive drugs?

Answer 7

Drugs that alter brain function, resulting in changes to perception and behaviour.

A group of psychoactive drugs commonly used to treat schizophrenia and other psychotic disorders.

Question 8

What is the main typical antipsychotic drug? What does this usually treat?

(Typical antipsychotics)

Answer 8

Chlorpromazine:

This tends to treat positive symptoms.
For example, hallucinations and delusions.

Question 9

What do typical antipsychotics do?

(Typical antipsychotics)

Answer 9

Work as antagonists in the dopamine system, reducing the action of a NT.

Question 10

What is a dopamine agonist?

(Typical antipsychotics)

Answer 10

Work by blocking dopamine receptors in the synapse, reducing the action of dopamine.

Question 11

As well as having antipsychotic properties, what else can chlorpromazine do?

(Typical antipsychotics)

Answer 11

Work as an affective sedative.

Question 12

What happens at the synapse when chlorpromazine is first taken?

(Typical antipsychotics)

Answer 12

Levels build up, but then its production is reduced.

This is because a feedback signals notices that dopamine isn’t being up-taken - so more is released - (levels reduce after).

Question 13

What side-effects are seen with typical antipsychotic anticholinergic?

(Typical antipsychotics)

Answer 13

Side effects include dry mouth, urinary problems and constipation.

Question 14

If someone is given psychoactive drugs that increase dopamine activity, it produces what?

(Typical antipsychotics)

Answer 14

Can produce the symptoms of psychosis.

E.g. amphetamines and L-Dopa can both produce schizoform symptoms.

Question 15

If a someone is given psychoactive drugs that decrease dopamine activity, it produces what?

(Typical antipsychotics)

Answer 15

Reduces the symptoms of psychosis.

E.g. using Chlorpromazine.

Question 16

Are there long-term side effects of taking typical antipsychotics?

(Typical antipsychotics)

Answer 16

Long term use leads to 30% of suffers developing tardive dyskinesia (TD).

This causes uncontrollable muscle movements, especially around the mouth.

Question 17

Outline Hill’s study from 1986.

(Supports the severity of tardive dyskinesia)
(Typical antipsychotics)

Answer 17

Supports the severity of tardive dyskinesia.

This is because they found that in 75% of patients, the side-effects are permanent.

This highlights the potential dangers of taken typical antipsychotics.

Question 18

Outline Frude’s study from 1998.

(Supports the use of antipsychotic drugs in providing positive change)
(Typical antipsychotics)

Answer 18

Supports the use of antipsychotic drugs in providing positive change.

They thought that the introduction of antipsychotic drugs brought enormous changes to how patients were treated.

This is because they studied 300,000 schizophrenics, finding that only 3% were permanent residents in mental institutions, (previously all were hospitalised).

This suggests that drug use in schizophrenia patients has allowed their treatment conditions to drastically improve.

Question 19

Outline Davison et al’s study from 2004.

(Challenges the use of antipsychotics drugs in providing positive change)
(Typical antipsychotics)

Answer 19

Challenges the use of antipsychotics drugs in providing positive change.

This is because they found that drug side effects were so uncomfortable that patients stopped taking them, causing them to relapse.

If medication is kept to a minimum to prevent side effects, then a relapse may occur; and if doses are raised to combat relapses, then there is a greater chance of serious side effects.

This suggests that drug therapy may only cause a suffer cycle for the patient.

Question 20

What are atypical antipsychotics?

(Atypical Antipsychotics)

Answer 20

A group of unrelated antipsychotic drugs used to treat psychiatric conditions.

E.g. clozapine and risperidone (unrelated to typicals and eacother).

Question 21

How do atypical antipsychotics work differently from typicals?

Answer 21

Atypicals work differently from typicals in that they only attach to the specific D2 dopamine receptors (with a transient blocking action on excessive perceptionisation).

Question 22

Outline clozapine as an atypical AP in the ’70s.

Answer 22

It was found that some patients died from a blood condition called neutropenia.

Question 23

Outline clozapine as an atypical AP in the ’80s.

Answer 23

In the ‘80s clozapine was discovered to be more effective than typical antipsychotics.

It was then remarketed as a treatment for schizophrenia if other treatments failed; it is still used in this way today.

Question 24

If you take clozapine medication what must you have?

Answer 24

Regular blood tests to ensure they are not developing agranulocytosis.

Question 25

How is clozapine adminstered?

Answer 25

Due to its potentially fatal side effects, it is not given via injection and its dosage is lower than chlorpromazine.

Question 26

Why is clozapine often given to patient's with a suicide risk?

Answer 26

Due to the mood enhancing effects of this drug it is often prescribed if the patient is a suicide risk. This is important as data shows that 30-50% of schizophrenics attempt suicide at some point.

Question 27

How does clozapine work?

Answer 27

It binds to dopamine receptors in the same way that chlorpromazine does, but also works on serotonin and glutamate receptors. It is believed that this action helps improve mood and reduce depression and anxiety in patients, and that it may improve cognitive functioning. It improves the negative symptoms of schizophrenia, e.g. reduced emotional expression.

Question 28

How do the side effects of clozapine compare to typical AP?

Answer 28

There are reduced levels of tardive dyskinesia with atypical antipsychotics, and generally are fewer side effects than typical antipsychotics.

Question 29

What are the side effects of clozapine?

Answer 29

Weight gain. Neuroleptic malignant syndrome (a life-threatening neurological disorder). Increased risk of stroke, blood clot and diabetes and sudden cardiac death.

Question 30

What is risperidone?

Answer 30

More recently developed and aims to overcome to negative side effects linked to clozapine. This drug can be taken in tablet, syrup or injection form. Like Clozapine, Risperidone is believed to bind to dopamine and serotonin receptors. It does bind more strongly to the receptors, and therefore can be given in smaller doses.

Question 31

What are the side effects of risperidone?

Answer 31

Some evidence suggests that it leads to fewer side effects than typical antipsychotics.

Question 32

State 3 evaluative points for atypical antipsychotics.

Answer 32

Atypicals are preferred to conventional antipsychotics because they produce fewer side effects (e.g. tardive dyskinesia). More effective for treating ‘positive’ symptoms than typical antipsychotics, Patients are less likely to drop out of treatment. Is able to also reduce negative symptoms; (affecting serotonin levels as well). However comparative effects on ‘negative’ symptoms of schizophrenia are marginal (Leucht et al, 1999). Although they create fewer motor side effects; there are still some serious side effects e.g. agranulocytosis.

Question 33

Outline Davis' study from 1989. (Supports the use of drugs for schizophrenic patients) (Comparison of first and second generation drugs)

Answer 33

Supports the use of drugs for schizophrenic patients. This is because when they performed a meta-analysis of more than 100 studies - comparing antipsychotics and placebos, they found the drugs to be more effective; (70% of sufferers treated with antipsychotics improving in 6 weeks: compared to 25% taking placebos). This suggests that antipsychotics are a valid treatment.

Question 34

Outline Kahn et al's study from 2008. (Comparison of first and second generation drugs)

Answer 34

Compared typical and atypical antipsychotics in their effectiveness of treating schizophrenia, finding that antipsychotics were effective for at least one year, but that atypical were not necessarily more effective than typical.

Question 35

Outline Stargardt's study from 2008. (Comparison of first and second generation drugs)

Answer 35

Used data from 3,121 patients finding no difference in relapse rate between typical and atypical, but atypical more effective at treating severe cases of schizophrenia.

Question 36

What are the relapse rates for AP use?

Answer 36

40% in the first year, 15% in the subsequent years.

Question 37

Outline Boggs and McGuire's study from 2018. (Supports the idea of CBD as a treatment for schizophrenia)

Answer 37

Supports the idea of CBD as a treatment for schizophrenia. This is because they used small-scale clinical trials, comparing the effects of CBD with those of antipsychotic medication or placebo. They found that the majority reporting positive results and all reporting minimal adverse effects.