- Antipsychotic Drugs – you need to know this one well!
There are two types – traditional antipsychotic drugs and modern antipsychotic drugs.
Traditional Antipsychotic Drugs:
- Based on the medical model – biochemical theory i.e. dopamine hypothesis.
- The first drugs, neuroleptics were first introduced in the early 1950’s. They are major tranquillisers and were originally developed to reduce anxiety in people undergoing surgery.
- These drugs were found to have a calming effect and became the preferred treatment for schizophrenic patients.
- Phenothiazine is the most commonly used neuroleptic. The phenothiazine called Chlorpromazine was first used in 1954 in the USA.
- They work by blocking the D2 dopamine receptors, thus reducing the negative effects of dopamine activity on thoughts, emotions and behaviours.
- By 1970, 85% of patients in state psychiatric hospitals were receiving chlorpromazine as the preferred method of treatment.
Evaluations:
- Before the 1950’s, over 50% of patients were permanently hospitalised. The drugs have eliminated this ‘patient warehousing’ and revolutionised patient care and management.
- They rapidly reduce serious and disturbing symptoms and are highly effective at reducing positive symptoms of schizophrenia. Therefore, they are appropriate for the treatment of patients with positive symptoms.
- Patients can receive ‘maintenance doses’. These are just enough to have a therapeutic effect and stabilise the symptoms.
- They have significantly decreased the durations of hospitalisation for a large number of patients.
- These drugs have very little effect on negative symptoms, therefore they are not appropriate for patients that only have negative symptoms.
- Approximately 30% of schizophrenics do not respond to these drugs favourably.
- Patients receiving the ‘maintenance dose’ may be able to live in the community but may not be able to hold down a job, relationships and may need daily support and supervision. Consequently, they cannot live completely independently.
- Cost-benefit dilemma – if medication is kept to a minimum, side effects are reduced but the chances of relapse increase.
- Some patients struggle to self-administer drugs and this can lead to a relapse and the ‘revolving door’ pattern. For these patients, it can be very disrupting to their lives and it is very expensive to keep hospitalising them.
- The drugs do not treat the cause of schizophrenia, they just simply relieve the symptoms.
Side effects:
There are less serious side effects such as a dry mouth, low blood pressure and dizziness, blurred vision and sexual dysfunction.
More serious and less frequent side effects include acute dystonia (involuntary muscle contractions), tardive dyskinesia (abnormal muscle movements), akathisia (inability to remain still) and finally, neuroleptic malignant syndrome that effects 1% of consumers and can lead to a coma and death.
Due to these side effects approximately 50% of patients stop taking the drugs after one year. 75% after two years. These patients can be administered long-lasting antipsychotics via injection.
Modern Antipsychotic Drugs:
These are atypical neuroleptics such as:
- Clozapine (Trade Name – Clorazil)
- Aripiprazole (Trade Name – Abilify)
- Risperidone (Trade Name – Risperdal)
Evaluations:
- These produce therapeutic benefits for schizophrenic patients that don’t respond favourably to the traditional neuroleptics.
- They have been proven to be more effective in reducing positive symptoms and they have an added advantage in that they can also reduce negative symptoms.
- Fewer side effects, especially on motor movements.
- They further reduce hospitalisation rates.
- They seem to improve short-term memory function which is important in enabling some patients to participate in rehabilitation programmes to learn social skills.
- Kane (2001) reported that patients on clozapine are less likely to drop out of treatment.
- Discharged patients maintain medication – relapse rates reduced.
- Biological and psychological therapies can complement each other to produce the most appropriate and effective therapies.
- 1-2% of patients are affected by agranulocytosis which is an immune system impairment/lowered white blood cell count.
- Critics refer to antipsychotic medication as “pharmacological straitjackets”.
- It is believed that the newer drugs affect serotonin receptors but precise biochemical mechanisms of therapeutic effects are not fully understood.
- There is an ethical debate about the use of these antipsychotic drugs.
- The psychiatric profession neglects the importance of psychosocial factors as a cause and potential therapy for schizophrenia.
Other Biological Treatments – you don’t need to know a lot about these!
- ECT – Electroconvulsive Therapy
- Developed by Cerletti and Bini (1938)
- Involves sending an electric impulse to induce a seizurein anesthetized patients for therapeutic effect.
- The therapy can be successful at reducing catatonia (a symptom of schizophrenia).
- Less effective than antipsychotic drugs.
- Not particularly successful in reducing other symptoms of schizophrenia.
- Its use has declined since the advent of antipsychotic drugs.
- Not considered an appropriate treatment for schizophrenia and very rarely used today.
- Psychosurgery
- Pre-frontal lobotomy was pioneered by Moniz (1935).
- It destroys nerve tracts connecting frontal lobes to lower brain centres.
- It is a much more refined procedure and uses a much more sophisticated surgical technique today but it is still only used in severe cases where it is a last resort.
- Moniz claimed high success rates but many people were left brain damaged and some patients died as a result of the surgery.
- Its use declined with the advent of drugs and it has now largely disappeared.