drug therapy for schizophrenia

typical antipsychotics

• Antipsychotics drugs are used to treat a range of mental disorders, including schizophrenia

• Typical antipsychotics are also known as first-generation antipsychotics, as they have been in use since the 1950s

• Typical antipsychotics are dopamine antagonists

• Examples of typical antipsychotics include:

  •  chlorpromazine

  • Trifluoperazine

  • Acetophenazine

  • Haloperidol

• Typical antipsychotics are effective at treating the positive symptoms of schizophrenia

• Typical antipsychotics have a tranquillising effect on the brain and the individual - the drowsiness can lead to a loss of animation, lack of participation in the world around them - does it make them more manageable instead of actually treating their symptoms? - ethical implications

• Haloperidol and chlorpomazine come with side effects which can be severe e.g. drowsiness, agitation, dry mouth, blurred vision, lack of emotional response, dizziness, muscle stiffness or spasms

• Over-use of typical antipsychotics may lead to tardive dyskinesia (neurological disorder involving involuntary, repetitive movements often affecting the face, tongue, and limbs) or neuroleptic malignant syndrome (a result of dopamine being blocked in the thalamus)

atypical antipsychotics

• Atypical antipsychotics are second-generation antipsychotics developed in the 1980s as a solution to the potentially damaging side effects of typical antipsychotics

• Atypical antipsychotics are dopamine antagonists, they inhibit dopamine activity by blocking dopamine receptors in the synapse, but they may act as serotonin antagonists as they inhibit serotonin reuptake in the synapse

• Atypical antipsychotics treat both the positive and negative symptoms of schizophrenia

• Examples of atypical antipsychotics:

  • Risperidone

  • Olanzapine

  • Brexpiprazole

  • Clozapine

• Clozapine is prescribed when other antipsychotic drugs have not worked; it also helps to reduce tardive dyskinesia

• Clozapine may act on serotonin receptors, which can help to balance mood

• Risperidone is thought to act in the same way as antidepressants

• Side effects include weight gain, an increased risk of type 2 diabetes, agranulocytosis (deficiency which reduces a body’s ability to combat infection)

economic implications of drug treatments

• Cost

  • How much does it cost the individual - is it short term or long term?

  • How much does it cost the manufacturer

• Side effects

  • Does it allow normal daily function

  • Is the therapeutic effect worth the aversive side effects

• Interactions

  • Does the drug interact with any commonly paired drugs - i.e. the fact that schizophrenia has a high comorbidity rate

• Accessibility to care

  • How accessible is the clinician who can prescribe it?

  • How many times does this clinician need to be visited?

• Social support

  • Do the people around the individual support and check in with them on their drug treatments to avoid non-compliance.

research which investigates drug therapies for schizophrenia

• Marder & Meibach (1994)

  • Found that schizophrenic patients who took risperidone compared to haloperidol or a placebo showed significant improvements in both positive and negative symptoms

• Geddes et al. (2000) conducted a review of research

  • Found that there is no real difference in effectiveness between first and second generation antipsychotics

    • Typical antipsychotics should be prescribed in the early stages of an episode of schizophrenia unless the patient has previously had side-effects including disjointed movement or muscle spasms

• Thornley (2003)

  • Found chlorpromazine to be more effective than a placebo

  • Points to idea that chlorpromazine can also have a therapeutic effect (means that it is better than the placebo)

• Rosenhan & Seligman (1995)

  • Considered drugs to be the most effective therapy for schizophrenia

  • They argue specifically for neuroleptics such as chlorpromazine

  • However, they also see family therapy as being effective - useful for an interactionist approach

• Breslin (1992)

  • Clozapine successfully treats the negative symptoms of schizophrenia as well as the positive symptoms

• Bagnall (2003)

  • Found atypical antipsychotics, such as risperidone, to be more effective than typical antipsychotics

strengths of drug therapies

• There is a body of compelling research evidence which suggests that antipsychotics are an effective treatment for schizophrenia

• Antipsychotics are most effective at treating patients with the most severe symptoms who may not be treatable using non-drug therapies (Furakawa et al. 2015)

  • They are able to significantly improve the quality of life of schizophrenic patients

weaknesses of drug therapies

• Patients with milder, less extreme forms of schizophrenia benefit less from taking antipsychotics and may additionally experience adverse side effects

• It is not clear how effective antipsychotics are in preventing relapses in patients who are in remission

• Typical antispyschotic such as chlorpromazine can be ethically dubious, as it isn’t clear whether these drugs are genuinely benefitting the patient, or just making them more manageable for others

• Typical antipsychotic drugs only work on positive symptoms - not an effective treatment for schizophrenia as a whole

• Drug therapy only treats the symptoms of schizophrenia, and not the cause - means the patient will have to take them for the rest of their life - economic implications

• Significant side effects such as tardive dyskinesia can lead to the patient avoiding medication, which can lead to a relapse in schizophrenic symptoms

links of drug therapies for schizophrenia to issues & debates

• Drug therapies support a biological determinist view, as they assume schizophrenia symptoms are caused by neurochemical imbalances

  • This can undermine the patient’s sense of control over their condition and implies that behaviour is driven by biology, not personal choice or cognitive factors

• Drug therapies take a biologically reductionist approach, treating schizophrenia as purely a chemical imbalance

  • They overlook important psychological and social factors (e.g. cognitive dysfunction, family environment)

  • This limits the explanation’s holistic value and may reduce long-term treatment success if non-biological causes are left unaddressed