Biological therapies

How did we used to treat schizophrenia?

  • Now we have drug treatment. Old antipsychotics (typical) since the 1950s and newer (atypical) antipsychotics since the 1970s.

How are antipsychotics drugs better?

  • Effects not necessarily permanent (unlike a lobotomy)

  • There is no surgery - less danger of surgery going wrong

  • More ethical, less dehumanising

  • Drugs are easier to take

  • The patient has more motivation to take drugs than having invasive surgery/dehumanising treatments

What are biomedical therapies?

  • Aim to psychologically change the brain’s electrochemical state with psychotropic drugs, magnetic impulses or even electrical currents and surgery

What is another name for drugs?

  • Pharmacotherapy

Which category of psychotropic drugs treat schizophrenia?

  • Antipsychotics

How do they work?

  • Block receptor sites, blocking neurotransmitter re-uptake

What is a significant drawback of drugs?

  • Side effects

What should drugs be used with to make them more a holistic treatment?

  • Psychotherapy

How would we treat a schizophrenic?

  • Drugs in the form of tablets or medicine and can be taken long or short term

  • Anti-psychotic drugs - typical (traditional) and atypical (newer)

  • It is thought that schizophrenics produce too much dopamine or have more dopamine receptors than non-schizophrenics. We cannot decrease the amount of dopamine or reduce the number of receptors, so the next best thing is to block the receptors = typical anti-psychotics.

Typical antipsychotic drugs

  • Have been around since the 1950s

  • Used primarily to treat positive symptoms (e.g. hallucinations and delusions).

  • Work by acting as antagonists (chemicals which reduce the action of a neurotransmitter) in the dopamine system

  • E.g. Chlorprozamine

    • Can be taken as tablets, syrup or by injection

    • Normalises transmission in brain to reduce positive symptoms - block action of neurotransmitter dopamine in the brain by binding to, but not stimulating, dopamine receptors

    • Has an effect on histamine receptors - lead to sedative effect - calms down anxious patients

    • Effectiveness of dopamine antagonists = development of dopamine hypothesis

    • Can produce tardive dyskinesia - parkinson’s-like symptom

    • Therefore declined in popularity over last 50 years

Atypical antipsychotic drugs

  • e.g. Clozapine and Risperidone

  • Used since 1970s

  • Act by only temporarily occupying dopamine receptors and then rapidly dissociating to allow normal dopamine transmission.

  • Typically target range of neurotransmitters including dopamine and seratonin

  • May explain why such atypical antipsychotics have lower levels of side effects compared to conventional antipsychotics.

  • Also have beneficial effect on negative symptoms and cognitive impairment and are suitable for treatment-resistant patients

Two years ago Jenny was diagnosed with schizophrenia. She has been taking a typical antipsychotic drug and there have been improvements in her positive symptoms. However, she still suffers negative symptoms and side effects. Her psychiatrist wants to change her medication from typical antipsychotics to one of the atypical antipsychotics and has also suggested cognitive behavioural therapy.

With one reference to the item above, explain why Jenny’s psychiatrist wants to move her on to one of the atypical antipsychotics.

  • Tardive dyskinesia - Parkinson’s like symptoms in