Drug Treatment

Question 1

What is the most common treatment for schizophrenia?

Answer 1

Antipsychotic drugs

Question 2

What are antipsychotic drugs?

Answer 2

They are drugs used to reduce the intensity of symptoms, in particular positive symptoms, of psychotic conditions like schizophrenia.

Question 3

What are typical antipsychotic drugs?

Answer 3

These were the first enervation of antipsychotic drugs, and have been used since the 50’s. They work as dopamine antagonists.

There is a strong association between how these drugs work and the dopamine hypothesis.

Question 4

What is the maximum daily dosage of typical antipsychotic drugs?

Answer 4

1000mg per day

Question 5

Give an example of a typical antipsychotic drug?

Answer 5

Chlorpromazine

Question 6

Typical drugs are ‘dopamine antagonists’, what does this mean they do?

Answer 6

They work by reducing the action if the neurotransmitter dopamine. They do this by:
• Blocking D2 dopamine receptors at the postsynaptic neuron
• This then reduces the action of dopamine
• Which consequently normalises neurotransmission was n key areas of the brain, reducing symptoms such as hallucinations.

Question 7

What else is Chlorpromazine other than a dopamine antagonist?

Answer 7

Chlorpromazine is also a mild sedative and used to calm anxious patients with schizophrenia who have just been admitted to hospital. It is not clear how they lead to sedation but it is thought to be related to its effect on histamine receptors.

Question 8

EVALUATION OF TYPICAL ANTIPSYCHOTIC DRUGS

Is there any evidence to show that antipsychotic drugs are effective?

Answer 8

Typical antipsychotic drugs have proven highly effective in reducing acute symptoms of schizophrenia.

They are very effective in reducing positive symptoms such as hallucinations and delusions.

Cole et al compared drug treatment with a control group. The drug group took chlorpromazine for 6 weeks while control took a placebo. The drug group showed a significant improvement (75%) compared to the placebo group (25%). This shows that typical antipsychotics are highly effected be in reducing positive symptoms such as hallucinations and delusions.

Question 9

EVALUATION OF TYPICAL ANTIPSYCHOTIC DRUGS

Do typical antipsychotics provide a complete treatment method?

Answer 9

Typical antipsychotics do not provide a complete treatment method.

One quarter of patients do not respond to typical antipsychotics.
Loebel et al found 16% failed to recover within 12 months of the first treatment. This means that they are not effective for all and other forms of treatment need to be considered.

Another issue with typical antipsychotics is that they are not effective in treating negative symptoms of schizophrenia so do not provide a complete treatment for schizophrenia.

Question 10

EVALUATION OF TYPICAL ANTIPSYCHOTIC DRUGS

Do typical antipsychotics have side effects?

Answer 10

A problem with typical antipsychotic drugs is that they can lead to traumatic side effects.

They are associated with dizziness, agitation, sleepiness, stiff jaw and weight gain. Long term effects can include TARDIVE DYSKINESIA which involved involuntary movements of the face and tongue.
This is thought to be due to the role that dopamine plays in controlling motor activity. These distressing side effects often lead patients to stop taking their medication before they see the benefitted of the antipsychotic effect. In some cases symptoms can return with great severity and can lead to relapse.

So calls into question whether they are an appropriate and effective way of treating schizophrenia.

Question 12

What are atypical antipsychotics?

Answer 12

Drugs for schizophrenia developed after typical antipsychotics (1970’s). They target a range of neurotransmitters such as dopamine and serotonin and the aim in developing them was to improve the effectiveness of drugs in suppressing symptoms whilst minimising side effects.

Question 13

Give two examples of atypical drugs

Answer 13

• Clozapine

* Risperidone

Question 14

What is clozapine?

Answer 14

Clozapine was marketed as a treatment for schizophrenia to be used when other treatments failed.

Question 15

What is the daily dosage of clozapine?

Answer 15

It’s lower that chlorpromazine at typically 300 to 400mg a day.

Question 16

How does clozapine work?

Answer 16

As with typical antipsychotics, these drugs work on the dopamine system, however, they only temporarily occupy dopamine receptors and the rapidly detach to allow normal dopamine transmission.

It is this characteristic that is thought to be responsible for the lower levels of side effects compared to conventional drugs.

Question 17

As well as the dopamine system, what else are atypical drugs thought to work on?

Answer 17

They are thought to block serotonin receptors in the brain too.

It is believed that this action helps to improve mood and reduce depression and anxiety in patients. This is why they are often prescribed when a patient is considered at high risk of suicide.

Question 18

EVALUATION OF ATYPICAL ANTIPSYCHOTIC DRUGS

Is there any research evidence for atypical antipsychotic drugs?

Answer 18

Research evidence supports the benefits of A-typical drugs over typical drugs.

Meltzer et al reviewed the effects of clozapine and found it is effective in 30-50% of treatment resistant cases where typical antipsychotics have failed. This suggests that atypical drugs are more effective than typical antipsychotics.

Question 19

What is risperidone?

Answer 19

It has been used since the 90’s and was developed to be as effective as clozapine but without its serious side effects. It can be taken in syrup, tablet or as an injection that lasts around 2 weeks.

Question 20

What is the maximum daily dosage of resperidone?

Answer 20

12mg per day

Question 23

How resperidone work?

Answer 23

Like clozapine it is believed to bind to both dopamine and serotonin receptors. However it binds more strongly to dopamine receptors and is therefore effective in much smaller doses that most antipsychotics.
There is some evidence to suggest that this leads to fewer side effects than is typical for most antipsychotics.

Question 24

EVALUATION OF ATYPICAL ANTIPSYCHOTIC DRUGS

Is there any research evidence to support their effectiveness?

Answer 24

Research evidence supports the benefit of A-typical drugs over typical drugs.

Meltzer et al reviewed the effects of clozapine and found it is effective in 30-50% of treatment resistant cases where typical antipsychotics have failed. This suggests that atypical drugs are more effective than typical antipsychotics.

Atypical drugs have also been found to be effective for negative symptoms as well as positive. This means that they have the added benefit over typical drugs providing a more complete treatment for schizophrenia.

HOWEVER research evidence for the benefits of atypical over typical is mixed. A meta-analysis of studies revealed that the superiority of these drugs compared to conventional drugs was only moderate.

Question 25

EVALUATION OF ATYPICAL ANTIPSYCHOTIC DRUGS

Are there any side effects?

Answer 25

Atypical drugs are often preferred by patients as they have fewer side effects than typical antipsychotic drugs.

The lower the risk of Tardive Dyskinesia and may ultimately be more appropriate in the treatment of schizophrenia, which in turn means the patient is more likely to continue with their medication and therefore see more benefits.

However, Atypical antipsychotic drugs are POTENTIALLY LIFE THREATENING - a minority of patients have developed a disorder in which levels of white blood cells drop dramatically. This is a problem for the patient as these drugs require regular blood monitoring.

Question 26

EVALUATION OF DRUG TREATMENT

Evaluate the evidence for drug treatment

Answer 26

There are problems with the evidence for effectiveness.

Although there is a large amount of evidence for the effectiveness of antipsychotic drugs there are strong challenged to their reported effectiveness.
• In some cases, studies are published more than once - leading to an exaggeration in the evidence for positive effects
• Antipsychotic drugs act as a sedative - this makes it too easy to demonstrate that they have some poster be effect on the patient. This does not necessarily mean they were of being fit in reducing the severity of psychosis
• Most published studies assess the short term benefits rather than long term benefits.

The effectiveness may therefore be overstated/exaggerated by drug companies who profit from their sale. More independent research is required.

Question 27

EVALUATION OF ATYPICAL ANTIPSYCHOTIC DRUGS

Are there any ethical issues associated with drug treatment?

Answer 27

It is widely believed that antipsychotics have been used in hospitals to calm the patients and make them easier to work with, rather than for the patients themselves.

Although short term use of antipsychotics to calm agitated patients is recommended by NICE, this is seen by some as a human rights abuse. Some have likened them to a chemical straight jacket.

Also need to weigh up the potentially life threatening side effects with overall benefits seen.

Question 28

EVALUATION OF ATYPICAL ANTIPSYCHOTIC DRUGS

How have antipsychotic drugs revolutionised the treatment of schizophrenia?

Answer 28

Before antipsychotics, schizophrenia was mainly untreatable and many were resigned to a life in a mental institution. In comparison, with antipsychotics, less than 3% of patients now live permanently in hospital. Living outside allows patients to develop social skills and live a relatively normal life.

This shows how antipsychotic drugs have made a dramatic effect to the lives of sufferers as they have given many the opportunity to lead a relatively normal life.

Question 29

EVALUATION OF ATYPICAL ANTIPSYCHOTIC DRUGS

How is drug treatment sometimes described as a ‘passive treatment’?

Answer 29

A weakness is that drug treatment is a passive treatment.

Some argue that being prescribed antipsychotics reinforces the view that there is ‘something wrong with you’. This causes people to have reduced motivation to look for possible solutions to alleviate stressors and reduce their suffering.

They are classed as ‘passive treatment’ as the patient is not actively doing something change the circumstances or get better.

This is a weakness as they simply take the drug and wait for its effect.

Question 30

EVALUATION OF ATYPICAL ANTIPSYCHOTIC DRUGS

Do antipsychotic drugs cure schizophrenia?

Answer 30

A weakness is that antipsychotic drugs do not cure schizophrenia.

Antipsychotics are only used to control symptoms, they are not a cure. They have to be taken regularly for long periods of time even if no positive symptoms are being currently experienced otherwise there is a risk of symptoms recurring and urgent hospitalisation as a consequence.

This can lead to revolving door syndrome - stop taking drugs, relapse, go back to hospital, put on drugs, released.

This is a weakness as although they are more effective than any other single form of treatment, drugs alone are not sufficient for most patients. Nevertheless, combines with some form of psychological treatment can help people to lead relatively normal lives.