Biological therapies

Anti-psychotic drugs

• most common treatment for schizophrenia

• Can be taken as tablets, syrup or by injection

• May be required in the short term or the long term

• Some people can take a short course and stop without the return of symptoms, whilst others may be required to take them for life

Typical antipsychotics - example and when developed

Chlorpromazine, developed in the 1950s

How do typical antipsychotics work?

The basic mechanism of a typical antipsychotic drug is to reduce the effects of dopamine and so reduce the symptoms of schizophrenia.

Typical antipsychotics are dopamine antagonists in that they bind to but do not stimulate dopamine receptors in the synapses of the brain (particularly D2 receptors), thus blocking their action.

By reducing the stimulation of the dopamine system, antipsychotic drugs remove the positive symptoms e.g. hallucinations and delusions

Side effects of typical antipsychotic drugs

• typical antipsychotics tend to block all types of dopamine activity which causes side effects and may be harmful

• They can have some particularly bad side effects, including constipation, lethargy and confusion, and long term use can result in involuntary sudden, jerky or slow twisting movements of the face and/or body (tardive dyskinesia)

Atypical antipsychotics- when developed, why developed and example

Used since the 1970s, developed to improve upon the effectiveness of drugs in suppressing symptoms and to lower the risk of side effects. For example, clozapine

Pros of atypical antipsychotics over typical antipsychotics

• lower risk of side effects than typical antipsychotics

• has a beneficial effect on both positive and negative symptoms

• suitable for treatment resistant patients.

How do atypical antipsychotics work?

• As with typical antipsychotics these drugs also act on the dopamine system by blocking D2 receptors (dopamine antagonists). - reducing positive symptoms

• atypical antipsychotics also have a stronger effect on serotonin and glutamate receptors . They act as an antagonist for serotonin and an agonist for glutamate receptors- helping improve mood and reduce negative symptoms (such as avolition, reduce disorganised thinking)

• This explains the difference between the effects of typical and atypical antipsychotics

Side effects of atypical antipsychotics

• atypical antipsychotics have very little effect on the dopamine systems that control movement so do not tend to cause tardive dyskinesia (like typical)

• However come with their own side effects including weight gain, increased risk of diabetes

AO3 (typical antipsychotics)- effectiveness

P- Research evidence to suggest that typical antipsychotics reduce symptoms of schizophrenia

E- Thornley- reviewed studies that compared the effects of chlorpromazine with a control group where patients received a placebo. Data from 13 trials and 1121 patients.

E- chlorpromazine associated with: better overall functioning, reduced symptom severity, lower relapse rates

L- Supports use of typical antipsychotics

AO3 atypical antipsychotics- effectiveness/appropriateness

P- Support for the benefits of atypical antipsychotics, particularly clozapine

EE- Meltzer: clozapine is more effective than typical antipsychotics as well as other atypical antipsychotics. Also effective in 30-50% of treatment resistant cases where other treatments had failed.

L- atypical antipsychotic drugs could be seen as a more effective drug therapy in comparison to typical antipsychotics as well as a more appropriate drug treatment for certain individuals who do not respond well to typical antipsychotics

AO3- appropriateness (both typical and atypical)

P- Problem with antipsychotics is the likelihood of side effects, ranging from mild to serious

E- typical antipsychotics: number of side effects, e.g. dry mouth, constipation, lethargy and confusion. Long term use - leads to tardive dyskinesia (involuntary muscle movement, often of facial muscles) due to dopamine oversensitivity

E- atypical antipsychotics: developed to reduce the frequency of side effects and have generally succeeded. However, there are still side effects e.g. weight gain, cardiovascular problems and an increased risk of diabetes.

L- Problem for 2 reasons: reduction in quality of life if symptoms are severe, and it can lead to sufferers stopping taking the treatment and therefore experiencing relapse

AO3- application/economic implications

P- drug therapies have positive applications and therefore economic implications

E- both typical and atypical antipsychotics can reduce distress and lead to the ability to carry out everyday tasks, socialise, go to work etc. (for typical- reduces positive symptoms, reducing distress, atypical- reduces both positive and negative symptoms) - positive applications to people’s lives

E- people with schizophrenia are often prevented from working and are sometimes hospitalised which has significant implications on the economy

L- if anti-psychotics lead to symptom reduction they could enable individuals to return to work/prevent them from being hospitalised- reduces negative impact these factors have on economy and has positive impact on people’s lives

AO3- interactionalism -can use for both

P- might be best to consider an interactionalist approach to treatment

E- use typical/atypical and CBTp

E- combination of both biological and psychological treatments will treat both the diathesis (chemical imbalance) and the stress (faulty thinking)

L - can treat both neurochemical imbalance and challenge irrational beliefs. Offers a more holistic approach to treating schizophrenia