Drug therapy

Question 1

What are typical antipsychotics?

Answer 1

Developed in 1950s, basic mechanism is to reduce the effects of dopamine and so reduce the symptoms of schizophrenia

Question 2

How do typical antipsychotics work?

Answer 2

Dopamine antagonists that bind to but DO NOT STIMULATE dopamine receptors, thus blocking their action

Question 3

What is an example of a typical antipsychotic?

Answer 3

Chlorpromazine

Question 4

What does Kapur et al suggest about dopamine receptors?

Answer 4

60-75% of D2 receptors must be blocked in the mesolimbic pathway for these drugs to be effective however other areas of the brain are also effected=side effects

Question 5

What are atypical antipsychotics?

Answer 5

Carry a lower risk of extrapyramidal side effects, have a beneficial effect on negative symptoms/cognitive impairment and are suitable for treatment resistant patients

Question 6

How do atypical anti-psychotics work?

Answer 6

Block D2 receptors temporarily then rapidly dissociate to allow normal dopamine transmission (this is what is thought to cause less side effects)

Question 7

What is another major difference between typical and atypical antipsychotics?

Answer 7

Atypical also have a strong affinity for serotonin receptors

Question 8

What evidence is there for the effectiveness of drug therapy?

Answer 8

Support for the effectiveness of antipsychotics = Leucht et al, meta-analysis of 65 studies between 1959-2011 (6000 patients)
Some taken off meds and put on placebo
within 12 months, 64% of those who had been given the placebo related compared to 27% of those who stayed on medication
Clearly work - what about side effects - is this ethical?

Question 9

Are typical antipsychotics ethical?

Answer 9

US - a large out of court settlement was awarded to a tar dive dyskinesia sufferer on the basis of Human Rights Act ‘no one shall be subjected to inhuman or degrading treatment or punishment’ Chari et al
This suggests that if side effects, deaths and psychosocial consequences were taken into account a cost-benefit analysis would likely be negative

Question 10

Why can drugs lead to motivational deficits?

Answer 10

Ross & Read - reinforces idea something is ‘wrong with them’
Prevents individual from thinking about possible stressors that might be contributing to condition - reduces motivation to look for solutions that might alleviate these stressors
Human misery is largely inflicted by other people then the best solutions are human rather than chemical or electrical interventions