Biological therapies for schizophrenia: drug therapy

Drug therapy

Involves the treatment of schizophrenia through the use of antipsychotic medication to reduce symptoms

All antipsychotics work by reducing dopamine transmission - reducing the actions of the neurotransmitter dopamine areas of the brain associated with the symptoms of schizophrenia

Types of antipsychotics

Typical

Atypical

Typical antipsychotics

Work as dopamine antagonists: reduce dopamine activity by blocking dopamine receptors at the synapse

• Bind to dopamine receptors but do not stimulate them, reducing the action of dopamine

• Initially dopamine levels build up, but then production is reduce

• This normalises neurotransmission in key areas of the brain, reducing positive symptoms

Side effects: CHLORPROMAZINE

• dry mouth

• Lethargy

• Tardive dyskinesia - uncontrollable muscle movements usually affecting the face

Atypical antipsychotics

• Block dopamine receptors, but only temporarily occupy and then rapidly dissociate to allow normal dopamine transmission

• Also act on other neurotramitters, targeting negative symptoms: serotonin and glutamate

Side effects: CLOZAPINE/RISPERIDONE

• Cardiovascular problems

• Arangulocytosis: fatally low levels of neutrophil

Negative evaluations (3)

Likelihood of side effects ranging from mild/serious/fatal is extremely high

Critics argue if side effects were taken into account a cost-benefit analysis of its advantages would be negative

• In the USA a large out of court settlement was awarded to a tardive dyskinesia sufferer on the basis of HRA , that no one should be subject to inhumane treatment

• Widely believed that antipsychotics have been used in hospital situations to make patients calmer and easier to deal with - patients with severe symptoms may not be able to give fully informed consent

Healey 2012 - argued that some results of clinical trials have had their data published multiples times in order to exaggerate the positive effects

Positive evaluations (2)

Enhance the quality of life for patients as they allow them to live independently of institutional care.

Leucht 2012 - meta-analysis of 65 studies involving 6000 patients with some taken off antipsychotics

12 months: 64% placebo relapsed VS. 27% drugs