Schizophrenia: Biological Treatment - Drug Therapy Flashcards
(24 cards)
Why would drug therapy be suggested as a biological treatment for schizophrenia?
If it is assumed that psychological disorders occur biologically, then treatment should also originate biologically.
What type of drugs are used to treat schizophrenia?
Antipsychotics
What type of antipsychotics are used for patients with schizophrenia?
Dopamine antagonists- such as chlorpromazine.
How can antipsychotics be taken?
- Tablet
- Syrup
- Injection
Briefly describe how antipsychotics help reduce symptoms of a schizophrenic patient.
- work by binding to the D2 receptors to sedate the patient
- reduce the intensity and frequency of their symptoms to allow for functioning in their life.
- don’t stimulate the D2 receptors- just bind to them
- reducing stimulation of dopamine receptors in the brain= eliminate hallucinations and delusions
- primarily used to combat positive symptoms
Why does binding to the D2 receptors help?
Due to excess dopamine being correlated with schizophrenia, they reduce the amount of activity in parts of the brain that rely on dopamine to eliminate positive symptoms such as hallucinations.
Give an example of a first generation antipsychotic.
Chlorpromazine
How does a first generation drug work to reduce symptoms of schizophrenia.
They block dopamine receptors to prevent over-activity which improves disturbed thoughts and behaviours through a calming effect.
Give an example of a second generation antipsychotic.
Clopazine
How does a second generation drug work to reduce symptoms of schizophrenia.
- work on multiple neurotransmitters such as the serotonin and dopamine receptors
- by temporarily binding with them and disappearing to allow normal activity
- therefore combats positive and negative symptoms with little side effects.
What problem may multiple people with schizophrenia face with drug therapy?
They can only be placed on one antipsychotic at a time either short-term or for the rest of their lives and different people respond to drugs differently, leaving some not responding to any at all.
Different treatment
Assertive Community Therapy can be used as an alternative treatment. This focuses on the patient learning social skills to improve their functioning in life, with 24/7 care by a team of psychiatrists and staff with a staff to patient ratio of 10:1, creating more personalised, individual care, which makes the indivisible more likely to continue with treatment. ACT has no side effects, meaning the drop out rates are lower- making its treatment more effective. Therefore it helps the patient in the long-term for rehabilitation into society instead of only treating their symptoms.
Supporting evidence for its effectiveness
Hartling et al conducted a meta analysis of 114 studies on the effectiveness of FGA & SGA and found there were very few differences in the treatment of core symptoms. Haloperidol was highlighted to be an effective drug, but SGA were seen as more effective in reducing negative symptoms. Additionally, Hartling found that tardive dyskinesia had a higher risk in FGA (9%) when compared to SGA (5%). Therefore,, because they carry a lower risk and higher efficacy in treating both sets of symptoms, SGA are advised to be used more than FGA.
‘supporting studies’.
Meltzer et al (2004) supports the effectiveness of drugs as a therapeutic technique for the treatment of sz. Meltzer found in a double blind study that an antipsychotic showed significant improvements in all aspects of functioning compared to control. Therefore, this shows the effectiveness of drugs at reducing symptoms and allowing patients to function in their life.
Additionally, Schooler et al (2005) supports the effectiveness of drug therapy. He found a 75% reduction in symptoms when taking antipsychotics. Therefore, this shows the effectiveness at reducing symptoms for patients
side effects
Some antipsychotics can reduce the quality of life more tan the symptoms, which means patients affected may stop taking the drug- reducing its effectiveness as the patient is ultimately responsible in drug treatment. Hill et al found that FGA’s can produce tardive dyskinesia (involuntary movement of the lips and the tongue). Therefore incidence as side effects in conventional antipsychotics is 30% and is irreversible in 75% of these cases. This may therefore deter patients from taking the medication, which would may their symptoms worse- reducing the efficacy of the treatment.
ethics
A weakness of using drug therapy is the high social control. Antipsychotics have been called ‘chemical straitjackets’ due to their control over the patients behaviours, by minimising symptoms but takes away part of who you are. They are a quick way of controlling patient, but not necessarily in their best interests. Therefore patients may be less likely to take medication and compromises their rights if a psychiatrist forces them to take these drugs.
mask
A weakness of drug therapy is that it does not treat the core problem of what causes sz. Drug therapy only masks the symptoms. Drugs do not cure schizophrenia due to it being incurable- simply suppressing the symptoms is not a way of controlling them and so such studies looking at the effective’s of antipsychotics may lack validity due to not accurately assessing the actual effectiveness of antipsychotics may lack-psychotics n treating the proximal cause of sz. By only masking symptoms, patients may lack motivation to continue taking medication or seek it due to not finding methods that get rid of their disorder completely- reducing its efficacy.
Using the acronym ‘DESSERT’, evaluate a ‘time commitment’ point.
Patients must commit to taking the drugs regularly. For some the treatment plan may be short-term however some are placed on it for life and so taking medication takes up a lot of time. Therefore this may result in demotivation for taking medication and result in a relapse
Any other evaluation points?
A weakness of this treatment method is that it is reductionist. It only focuses on treating symptoms caused by biological reasons such as a chemical imbalance of neurotransmitters like dopamine. Therefore it doesn’t account for environmental factors that may be influencing relapse of a patient, such as a drop in income, which could cause biological predispositions to be triggered.
What specifically does clozapine do?
- blocks dopamine in the same way as FGA’s
- additionally acts on serotonin and glutamate
- blocks serontin receptors (antagonistic effect)
- so reduces positive and negative symptoms
What ares one of the side effects of chlorpromazine?
- tardive dyskinesia
- decrease in emotional spontaneity and motivation
- motor restlessness + fidgeting
What study supports the effectiveness of FGA
Chlorpromazine= Barlow and Durand
- chlorpromazine is an effective treatment method in reducing sz symptoms in about 60% of cases
- most impact on positive symptoms
- patients may still suffer from severe negative symptoms
What side effects come from clozapine
- tardive dyskinesia
- fewer side effects that typical FGA
- rare side effect= agranulocytosis- dangerously low levels of WBC- which can be fatal
What study supports effectiveness of SGA
Clozapine= Pickar et al
- compared clozapine with other neuroleptics and found clozapine was most effective in reducing symptoms
- even in those who had previously been resistant to treatment
