Biological treatment (SZ) Drug therapy (chemotherapy)

Antipsychotic medication To help alleviate symptoms associated with a psychotic episode (positive symptoms) i.e. delusions and hallucinations 1950’s first antipsychotic drug was developed Now called ‘typical’ antipsychotics Chlorpromazine, haloperidol, fluphenazine Unpleasant side effects Task in pairs – How do these drugs work? What are the side effects?

Drag the items into the correct places Example of receptor antagonists Receptor (D2) Dopamine Blocking of receptors

Antipsychotic medication D2 receptor antagonists (substance which interferes with or inhibits the physiological action of another) Antagonists bind to the receptor (blocking action) Stops dopamine from binding and therefore it cannot stimulate the receptor

Haloperidol (typical) Extrapyramidal - drug-induced movement disorders Tardive dyskinesia – involuntary movements of face & jaw Haloperidol (typical) Constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; loss of appetite; nausea; restlessness; stomach upset; trouble sleeping. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision or other vision changes; chest pain; confusion; dark urine; decreased or difficult urination; decreased sexual ability; dehydration; difficulty speaking or swallowing; drooling; enlarged breasts; excessive or unusual sweating; fainting; fast or irregular heartbeat; fever, chills, or persistent sore throat; hallucinations; mental or mood changes (eg, abnormal thinking, agitation, anxiety, depression); missed menstrual period or other menstrual changes; nipple discharge; prolonged, painful erection; rigid or stiff muscles; seizures; severe or persistent dizziness, headache, or vomiting; shortness of breath or unusual cough; shuffling walk; uncontrolled muscle movements (eg, of the arms, legs, tongue, jaw, cheeks; tremors; twitching); yellowing of the skin or eyes

Chlorpromazine (typical) Less serious side effects may include: dizziness, drowsiness, anxiety, sleep problems (insomnia); breast swelling or discharge; changes in menstrual periods; weight gain, swelling in your hands or feet; dry mouth or stuffy nose, blurred vision; constipation; 

Chlorpromazine (typical) Extrapyramidal - drug-induced movement disorders Chlorpromazine (typical) twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs; tremor (uncontrolled shaking), drooling, trouble swallowing, problems with balance or walking; feeling restless, jittery, or agitated; feeling like you might pass out; seizure (black-out or convulsions); nausea upper stomach pain, itching, and jaundice (yellowing of the skin or eyes); pale skin, easy bruising or bleeding, fever, sore throat, flu symptoms; high fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing; unusual thoughts or behaviour; decreased night vision, tunnel vision, watery eyes, increased sensitivity to light; urinating less than usual or not at all; joint pain or swelling with fever, swollen glands, muscle aches, chest pain, vomiting, and patchy skin colour; or slow heart rate, weak pulse, fainting, slow breathing (breathing may stop).

‘Atypical’ antipsychotic medication Girgis et al. (2011) Compared the 9-year outcomes of individuals initially randomised to clozapine or chlorpromazine groups The clozapine group was more likely than the chlorpromazine group to remain on the medication to which they were originally assigned (26% v. 10%, P = 0.01) Developed in the 1990s (Brar et al.,1997) Clozapine (atypical) Highly effective at alleviating positive symptoms And some negative symptoms (i.e. diminished emotional expression) Fewer side effects than ‘typical’ antipsychotics However increases risk agranulocytosis (recued white blood count – increase of infections) Must have blood tests every 2 weeks Common clozapine side effects may include: weight gain; tremor, dizziness, spinning sensation; headache, drowsiness; fast heart rate; nausea, constipation; dry mouth, or increased salivation; blurred vision; or increased sweating.

Olanzapine (Atypical) Drowsiness, dizziness, lightheadedness, stomach upset, dry mouth, constipation, increased appetite, or weight gain may occur. Prologed use of olanzapine can instead be associated with tardive dyskinesia/dystonia (Ananth & Kenan, 1999)

How do they work? Social control? Ethics? Helps to reduce the level of dopamine in areas of the brain associated with the symptoms Primary mechanism of action: blocking the dopamine receptors (mainly D2) Prevents dopamine binding to receptors Atypical Do not bind to receptors as tightly as typical psychotics They also block 5GT2a (serotonin receptors) This difference in action is thought to reduce side effects (Seeman, 2002) Less risk of movement disorders (uncontrollable movements) Tablet form Or injections (especially when there is a risk that a patient will not comply with the treatment regimen themselves Social control? Ethics?

Why do extrapyramidal side effects occur? Extrapyramidal - drug-induced movement disorders Nigrostriatal pathway (one of four dopamine pathways) This pathway is involved in motor planning, dopaminergic neurons stimulate purposeful movement. D2 antagonism induces extrapyramidal symptoms. High-potency D2 antagonists such as haloperidol (typical) frequently cause movement disorder E.g. Tardive Dyskinesia - involuntary movements of the face and jaw.

Why do atypical drugs produce less sever extrapyramidal side effects? Typical - tight binding to receptor sites and bind for long periods of time Atypical - bind and then move on and move off Will allow some stimulation

How does the medication work https://www.youtube.com/watch?v=nGqo7ZQc6Sg

Drug therapy Each patient is usually only put on one antipsychotic drug at a time Antidepressants and anticonvulsants may be prescribed at the same time Some clinicians prefer certain drugs Some people respond differently to different drugs No single drug that is always prescribed They can reduce the positive symptoms in about 2 weeks Typical – have little effect on negative symptoms

Diagram to consolidate information Biological treatments – chemotherapy (drugs)

Describe a biological treatment of schizophrenia. 4 marks

Evaluation Supporting evidence (effective?) Opposing evidence (not effective?) Different Theories Applicability Reductionism + Ethics + Social Control

Social control – discuss 2 minutes Making people more manageable? Older medication (typical) made patients very passive – why is this useful for staff in institutions? Pharmacological ‘straight jackets’ Pharma companies? Financial gain? Short term treatment and not long term

Ethics – discuss 2 minutes Section 3 Mental Health Act (1983) Treatment can be given without consent from the patient Drug therapy in one of only three treatments that can be given in this way Current state of mind must be considered – others or themselves in danger? Unable to know what is best for them? Receiving treatment forcibly may be the most positive course of action?

Use resources on the learning space to complete this section Evaluation - sheet Use resources on the learning space to complete this section