Schizophrenia- Biological therapies for schizophrenia: Drug therapy

Question 1

Antipsychotics -

Answer 1

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

Question 2

Typical antipsychotics -

Answer 2

The first generation of antipsychotic drugs, having been used since the 1950s. They work as dopamine antagonists and include Chlorpromazine.

Question 3

Atypical antipsychotics -

Answer 3

Drugs for schizophrenia (a psychotic disorder) developed after typical antipsychotics. They typically target a range of neurotransmitters such as dopamine and serotonin.
Examples include Clozapine and Risperidone.

Question 4

What is the most common treatment for schizophrenia?

Answer 4

The most common treatment for schizophrenia involves the use of antipsychotic drugs.

Question 5

How can antipsychotics be administered?

Answer 5

Antipsychotics can be taken as tablets, syrup, or injections.

Question 6

Why are injections of antipsychotics used?

Answer 6

Injections are used for individuals at risk of not taking their medication regularly, as they can be administered every 2-4 weeks.

Question 7

Are antipsychotics always required long-term?

Answer 7

No, some people may only need a short course of antipsychotics, while others may require them for life to prevent recurrence of symptoms.

Question 8

What are the two main categories of antipsychotics?

Answer 8

Antipsychotics are divided into typical (traditional) and atypical (second-generation) drugs.

Question 9

When were typical antipsychotics developed?

Answer 9

Typical antipsychotics have been around since the 1950s.

Question 10

What is an example of a typical antipsychotic?

Answer 10

Chlorpromazine is an example of a typical antipsychotic.

Question 11

How is Chlorpromazine administered?

Answer 11

Chlorpromazine can be taken as tablets, syrup, or by injection.

Question 12

What is the typical dosage range for Chlorpromazine?

Answer 12

The dosage typically ranges from 400 to 800 mg daily, with a maximum of 1000 mg.

Question 13

How do typical antipsychotics like Chlorpromazine work?

Answer 13

They act as dopamine antagonists, blocking dopamine receptors in the brain and reducing dopamine activity.

Question 14

What is the dopamine hypothesis in relation to schizophrenia?

Answer 14

The dopamine hypothesis suggests that schizophrenia is associated with higher than usual levels of dopamine activity in the brain.

Question 15

What additional effect does Chlorpromazine have besides being an antipsychotic?

Answer 15

Chlorpromazine also has sedative properties.

Question 16

Why is Chlorpromazine used as a sedative?

Answer 16

It is believed to affect histamine receptors, though the exact mechanism leading to sedation is not fully understood.

Question 17

When are atypical antipsychotics typically used?

Answer 17

Atypical antipsychotics have been used since the 1970s and aim to minimize side effects while maintaining effectiveness.

Question 18

What is Clozapine and when was it developed?

Answer 18

Clozapine is an atypical antipsychotic developed in the 1960s and first trialed in the early 1970s.

Question 19

Why was Clozapine withdrawn temporarily?

Answer 19

It was withdrawn in the 1970s due to deaths from a blood condition called agranulocytosis.

Question 20

Why is Clozapine still used today?

Answer 20

Clozapine is used because it is more effective than typical antipsychotics, particularly in treatment-resistant cases.

Question 21

What precautions are taken with Clozapine?

Answer 21

Patients taking Clozapine undergo regular blood tests to monitor for agranulocytosis.

Question 22

How does Clozapine differ from typical antipsychotics in its mechanism?

Answer 22

Clozapine binds to dopamine, serotonin, and glutamate receptors, which may improve mood, reduce depression, and enhance cognitive functioning.

Question 23

Why is Clozapine sometimes prescribed for high suicide risk?

Answer 23

Its mood-enhancing effects make it suitable for individuals at high risk of suicide.

Question 24

What is Risperidone and when was it developed?

Answer 24

Risperidone is an atypical antipsychotic developed in the 1990s.

Question 25

How is Risperidone administered?

Answer 25

It can be taken as tablets, syrup, or an injection lasting around two weeks.

Question 26

What is the typical daily dose of Risperidone?

Answer 26

The typical daily dose is 4-8 mg, with a maximum of 12 mg.

Question 27

How does Risperidone compare to Clozapine in binding to receptors?

Answer 27

Risperidone binds more strongly to dopamine receptors than Clozapine, making it effective in smaller doses.

Question 28

What evidence supports the effectiveness of antipsychotics?

Answer 28

Studies, such as those reviewed by Ben Thornley et al. (2003), show that Chlorpromazine improves overall functioning and reduces symptom severity.

Question 29

What did Herbert Meltzer (2012) conclude about Clozapine?

Answer 29

Meltzer concluded that Clozapine is more effective than typical antipsychotics and other atypical antipsychotics, particularly in treatment-resistant cases.

Question 30

What are some side effects of typical antipsychotics?

Answer 30

Side effects include dizziness, agitation, sleepiness, stiff jaw, weight gain, and itchy skin.

Question 31

What is tardive dyskinesia?

Answer 31

Tardive dyskinesia is a long-term side effect of antipsychotics, causing involuntary facial movements like grimacing and lip smacking.

Question 32

What is neuroleptic malignant syndrome (NMS)?

Answer 32

NMS is a serious side effect of typical antipsychotics, causing high temperature, delirium, coma, and potentially death.

Question 33

How have atypical antipsychotics addressed side effects?

Answer 33

Atypical antipsychotics were developed to reduce side effects, though they still exist, such as the risk of agranulocytosis with Clozapine.

Question 34

What is the relationship between antipsychotics and the dopamine hypothesis?

Answer 34

Antipsychotics are dopamine antagonists, which aligns with the dopamine hypothesis that schizophrenia involves excessive dopamine activity.

Question 35

What challenges exist regarding the dopamine hypothesis?

Answer 35

Evidence suggests dopamine levels may be too low in some brain areas, raising questions about how antipsychotics, which reduce dopamine activity, can be effective.

Question 36

What criticisms have been raised about the evidence for antipsychotic effectiveness?

Answer 36

David Healy (2012) suggests some trials have been published multiple times, exaggerating positive effects, and that studies often focus on short-term benefits rather than long-term outcomes.

Question 37

What is the "chemical cosh" argument?

Answer 37

The argument suggests antipsychotics are used to calm patients for staff convenience rather than for the patients' benefit, raising ethical concerns.

Question 38

What ethical issues are associated with using antipsychotics to calm agitated people?

Answer 38

While short-term use is recommended by NICE, some view it as a human rights abuse, questioning the balance between patient care and control.