Drug Therapy

 Although the causes of schizophrenia are still largely unknown, treatment for it focuses on lessening the type one and type two symptoms that can cause so much distress and dysfunction in the life of a schizophrenic.  So the first line of schizophrenia therapy is medication to treat the psychotic symptoms.  There are five types of drugs:  Anti-anxiety  Anti-depressants  Anti-psychotics  Anti-manic  Stimulant

 Once someone with schizophrenia is stabilized on medication, psychosocial therapy can help him or her learn to cope with this illness and live as independently as possible.  Older antipsychotic drugs, such as chlorpromazine, typically affect dopamine levels, and have many unpleasant side effects that cause muscle spasms and tremors.  Newer drugs, such as Clozapine, are usually more refined and are much safer with fewer unwanted side effects — although the effects that remain can still have a big impact on quality of life.

 Atypical drug → Less common/More specialised  Blocks both Dopamine and Serotonin receptor sites  Fewer side effects than typical drugs  Similar side effects to typical drugs:  Muscle stiffness  Weight gain  Restlessness  Rare side effects:  Agrnulocytosis (dangerously low levels of white blood cells) which can be fatal

 One of the main strengths is that the patient is able to live in society, thus avoiding institutionalisation which can occur from a long period of time in hospital.  Also the ability to remain in society gives the patient access to other therapies, which may improve the recovery process.

 Emsley (2008) studied the effect of injecting the antipsychotic drug risperidone. He found that those who had the injection early in the course of their disorder had high remission rates (64%) and low relapse rates.  Picklar et al. (1992) compared the effectiveness of clozapine with other neuroleptics and a placebo drug. He found that clozapine was the most effective in treating symptoms, even in patients who did not respond to previous drugs, the placebo was the least effective.

 A large barrier to treating schizophrenia is non or partial compliance to taking the drugs. These can lead to relapses and readmittance to hospital. The more relapses in a patient, the higher risk of never getting back to their original functioning state.  Rosa et al. found that approximately 50% of patients comply with their drug therapy, and even if they do comply it was found that 50% still have distressing symptoms

 A negative with all drugs is the side effects that can occur; e.g. sedation, weight gain, decrease in emotional motivation: these in many cases can be enough to put people off taking them.  Drug treatments cannot be seen as a cure, as patients have to be kept on maintenance doses of the drug to maintain the therapeutic effect.

 Social control is a formal way of making individuals conform to society’s rules.  Drug therapy can be considered a form of social control as they are used to help make patients behave more ‘normally’, according to the society’s social norms.

 As identified, compliance rates are low which leads to increased relapse rates, and the fact that anti-psychotics only treat symptoms and not the causes may mean drug therapy is not an effective means of controlling abnormal behaviour.  It is, however, relatively cost-effective to society, allowing behaviour to be controlled away from the institution setting.

 Anti-psychotic drugs can have many distressing and possibly painful side-effects, which the patient is not protected from.  The patient can become addicted to and dependent on the drug prescribed, which limits the control they have over the treatment process.  Both of these points mean informed consent must be gained.

 The key ethical issue with drug therapy is determining whether the patient has the mental capacity to give informed consent. According to the Mental Capacity Act, 2005, this is decided by the health professional in charge of the patient’s case.  This means that the patient’s control over their situation is taken from them, and they may be forced to continue the treatment against their wishes.  Should practitioners have this power over patients?