Schizophrenia – Biological Therapies 2 Drug Therapy (chemotherapy)

Typical Antipsychotics For this subtopic: We need to distinguish between the positive and negative symptoms of schizophrenia the positive symptoms include delusions and hallucinations the negative symptoms include lack of motivation, lack of emotion, social withdrawal Eg. Chlorpromazine

AO1: Typical Antipsychotics Known as Neuroleptic Drugs Developed in 1950s, originally used to slow metabolism during surgery Examples: Chlorpromazine and Haldol Block activity of Dopamine (DA) by occupying active sites in D 2 receptor neurones – prevents impulse from crossing synapse Usually administered orally but can be deep- muscle injected for slow release, useful for non- voluntary cases

AO1: Atypical Antipsychotics Developed more recently in the second wave of antipsychotic meds, introduced in 1970s More recent and thus more expensive Examples: Clozapine and Olanzapine Also reduces DA activity but thought to target different DA receptors (eg. D 1,D 4 ), and dissociates more quickly creating less of a block at the synapse Some research has indicated that it also targets serotonin receptors, though others disagree

Typical Antipsychotics - Effectiveness Effectiveness is greater in reducing positive symptoms than negative ones More effective treatment for S than any of the other approaches used alone (Comer, 2001) Most beneficial within the first 6 months

Sampath (1992) studied patients with S who had been taking neuroleptic drugs for 5 years One group then switched to a placebo (an inactive substance), whereas the other group continued to take the drug In the placebo group, 75% of the patients relapsed within 1 year, compared with 33% of patients who continued to receive the drug Shows that these drugs are effective at keeping symptoms of S at bay but study is correlational so can’t infer causality. Typical Antipsychotics - Effectiveness

Another study showing it works Typical Antipsychotics - Effectiveness

Seem to have an beneficial effect on both positive and negative symptoms. Some research suggests this is because it targets serotonin receptors as well as DA ones Fewer side effects than neuroleptic drugs, eg. less likely to causing extrapyramidal motor control disabilities in patients (that can persist even after treatment has ended) Benefit 85% of patients compared to 65% for neuroleptics (Voruganti, 1999) Meltzer (1999) found that about one-third of patients who had shown no improvement with neuroleptic drugs responded well to clozapine Atypical Antipsychotics - Effectiveness

Typical vs. Atypical Mustn’t be too quick to say atypical are better than typical – this is a reductionist approach Using a number of parameters to assess quality of life, NHS researchers found typical anti-psychotics were no worse than atypical anti-psychotics (Jones, 2006) Because each medication (whether typical or atypical) has its own profile of desirable and adverse effects, the doctor may recommend one of the older ("typical" or first generation) or newer ("atypical" or second generation) antipsychotics alone or in combination with other medications, based on the symptom profile, response pattern, and adverse effects history of the individual patient.

How are these drugs Appropriate? Lots of evidence that S results from abnormality in DA system, so a solution that targets this seems appropriate In some cases drug therapy is a quick and painless way to manage symptoms BUT we are not entirely sure how they work so some question their appropriateness for this reason Antipsychotics - Appropriateness

How are these drugs Inappropriate? Chlorpromazine side effects: Grogginess, visual problems, insomnia, sexual dysfunction (Windgassen, 1992). AO3: many of these side FX reported in a hospital setting – would it be same for those living in the community? Big side effect: Tardive Dyskinesia - muscle spasms etc in mouth & throat, leads to speech probs & in extreme cases breathing difficulties Affects ~30% of those taking Chlorpromazine within 5 years, and is permanent in about 75% of these cases Typical Antipsychotics - Appropriateness

How are these drugs Inappropriate? Clozapine side effects: Increased risk of developing diabetes or obesity compared to Chlorpromazine Big side effect: Agranulocytosis, a disorder of the bone marrow affecting 1-2% of takers Reduces white blood cell count and leads to reduced immune system performance Atypical Antipsychotics - Appropriateness