Download Biological Treatment of Schizophrenia Keys Terms Agonists: Drugs

Biological Treatment of Schizophrenia
Keys Terms
Agonists: Drugs that increase Neurotransmitter availability, e.g. stimulants.
Antagonist: Drugs that reduce Neurotransmitter availability, e.g. Blockers.
Anti psychotics: Drugs that reduce Neurotransmitter availability, e.g. Antagonists or Blockers.
Neuroleptics: Another name for Antipsychotics. There subtle differences between Neuroleptics and
Antipsychotics, e.g. on which Dopamine receptors they work on: D1, D2, D3 etc. If you are interested ‘Google’ what’s
the difference between them, AQA will be very impressed if you are aware of D1, D2 etc. Don’t worry if you are confused
enough already, you can impress AQA in other ways.
Typical Antipsychotic drugs: Conventional Antipsychotics (1950’s) that reduce Dopamine only. Also they
usually only reduce positive symptoms. They are very likely to cause the side effect of Tardive Dyskinesia in 20-30 % of
users.
Atypical Antipsychotic drugs:
Newer Antipsychotics (1990’s) that reduce Dopamine and Serotonin. Also
they reduce positive and negative symptoms. They are much less likely to cause the side effect of Tardive Dyskinesia.
Although more likely to cause Agranulocytosis.
Tardive Dyskinesia: is a difficult-to-treat form of Dyskinesia (disorder resulting in involuntary, repetitive body
movements) that can be Tardive (having a slow or belated onset).It frequently appears after long-term or high-dose use of
Typical antipsychotic drugs. Tardive Dyskinesia is characterized by repetitive, involuntary, purposeless movements, such
as grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of
the extremities may also occur. Impaired movements of the fingers may also appear. For comparison, patients with
Parkinson's disease have difficulty moving, while patients with Tardive Dyskinesia have difficulty not moving.
Agranulocytosis:
A lowered number of white blood cells (remember these are vital for fighting infection and made in
bone marrow. Agranulocytosis may be asymptomatic or it may clinically present with sudden fever, rigors and sore throat.
Infection of any organ may be rapidly progressive (e.g., pneumonia, urinary tract infection). Septicaemia may also progress
rapidly. Neutrogena and Agranulocytosis is associated with gum diseases, such as gingival bleeding, saliva increase,
halitosis, osteoporosis, and destruction of periodontal ligament Causes: A large number of drugs have been associated with
Agranulocytosis, including some antipsychotics (the Atypical antipsychotic clozapine. Clozapine users in the US must be
nationally registered for monitoring of low white blood cell counts.
Neuroleptic Malignant Syndrome: (NMS) is a life- threatening neurological disorder most often caused by an
adverse reaction to Neuroleptic or Antipsychotic drugs. It generally presents with muscle rigidity, fever, autonomic
instability and cognitive changes such as delirium, and is associated with elevated Creatine Phosphokinase (CPK).
Incidence of the disease has declined since its discovery (due to proactive prescription habits), but it is still dangerous to
patients being treated with antipsychotics. Because of its unpredictability, there is no one set course of action to treat the
syndrome, but generally, removal of the antipsychotic drug treatment, along with medical management, lead to a positive
outcome.
Biological Treatment of Schizophrenia
Typical Drugs
Typical drugs block Dopamine only.
Antipsychotics are the primary medications for treating Schizophrenia. Conventional or
Typical Antipsychotics were introduced in the 1950's and all had similar ability to relieve the
positive symptoms of Schizophrenia. This medicine reduces disturbing symptoms like
hallucinations and delusions. Typical Antipsychotics help relieve the positive symptoms of
Schizophrenia by helping to correct an imbalance in the chemicals that enable brain cells to
communicate with each other. As with drug treatments for other physical illnesses, many
patients with severe mental illnesses may need to try several different antipsychotic
medications before they find the one, or the combination of medications, that works best for
them.
Doctors will usually prescribe a Typical Anti-psychotic medication, such as Chlorpromazine
or Haloperidol, following the first psychotic episode of Schizophrenia. There are many
Typical drugs available (see tables below for examples).Doctors will only try one drug at a
time and monitor the patient carefully for changes in symptoms and any side effects. Drug
treatments need to be started quickly in order to be most effective, and those patients who
remain untreated for many years often do not benefit when treatments is finally started.
These conventional Typical Antipsychotics (Neuroleptics) have similar ability to relieve the
positive symptoms of Schizophrenia. Most of these older "conventional" antipsychotics
differed slightly in the side effects they produced. These conventional antipsychotics
include Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol),
Thiothixene (Navane), Trifluoperazine (Stelazine), Perphenazine (Trilafon), and
Thioridazine (Mellaril). Individual patients react differently to different treatments and
doctors have their own preferences which they develop through experience with many
patients and hence, it is not as simple as there being one drug per disorder.
Atypical Drugs
Atypical drugs block Dopamine and Serotonin.
In the last decade new "Atypical" antipsychotics have been introduced. Compared to the
older "conventional" antipsychotics these medications appear to be at least equally effective
for helping reduce the positive symptoms like hallucinations and delusions - but may be better
Biological Treatment of Schizophrenia
than the older medications at relieving the negative symptoms of the illness, such as
withdrawal, thinking problems, and lack of energy. There is however no concrete evidence of
how effective they are at relieving negative symptoms. The Atypical antipsychotics include
risperidone (Risperdal), Clozapine (Clozaril), Olanzapine (Zyprexa), Quetiapine
(Seroquel), and Ziprasidone (Geodon).
If symptoms do not improve with the use of typical anti-psychotics, then an Atypical -antipsychotic such as Zyprexa, Risperidone or Clozapine might be used. The reason they were
not given first is Atypical drugs can a cause life threatening condition called Agranulocytosis
(esp. Clozapine). These suppresses the development of bone marrow, in turn reducing white
blood cells which can lead to infection, blood tests are taken for the first six months on this
medication
Clozapine was the first Atypical antipsychotic in the United States and seems to be one of
the most effective medications, particularly for people who have not responded well to other
medications. Treatment-resistant schizophrenia" is a term used for the failure of symptoms to
respond satisfactorily to at least two different Antipsychotics for other patients who are
unwilling or unable to take medication regularly, long-acting depot preparations of
antipsychotics may be given every two weeks to achieve control. America and Australia are
two countries with laws allowing the forced administration of this type of medication on those
who refuse but are otherwise stable and living in the community.
However, in some people it has a serious side effect of dramatically lowering the number of
white blood cells produced (Agranulocytosis). People taking Clozapine must have their
blood monitored every one or two weeks to count the number of white blood cells in the
bloodstream. For this reason Clozapine is usually the last Atypical antipsychotic
prescribed, and is usually used as a last line treatment for people that do not respond well to
other medications or have frequent relapses.
Current treatment guidelines recommend using one of the Atypical antipsychotics other
than clozapine as a first line treatment option for newly diagnosed patients. However, for
people already taking a conventional antipsychotic medication that is working well, a change
to an Atypical may not be the best option. People thinking of changing their medication
should always consult with their doctor and work together to develop the safest and effective
treatment plan possible.
Biological Treatment of Schizophrenia
A02
Positive A02 points specific to Typical and Atypical Antipsychotic drugs
Before Antipsychotic drugs, 50% of patients admitted to hospital stayed there for life. The
treatment of inmates in lunatic asylums was brutal or non existent (ECT, psycho surgery,
insulin shock therapy etc.) and the living conditions were disgraceful. Hospital staff mainly
used methods to control, contain and restrain patients not treat them: straight jackets,
padded cells. In comparison, today only 3% of Schizophrenics are in hospital and usually
only for a few weeks. Therefore the treatment of the mentally ill in western/individualistic
societies has changed radically for the better.
Antipsychotic drugs decreased many of the most disturbing symptoms, e.g. delusions and
hallucinations (Typical and Atypical) and Atypical decreased some of the negative
symptoms as well; although it should be noted that only with limited degrees of success
As a result, the lives of Schizophrenic patients may have been revolutionized. They enable
people to get on better with their lives, jobs and relationships to a certain degree! It is
disputed how much they are able to live normal lives.
They enable patients to respond more rationally to psychological therapies.
Apparently anti psychotics have success rates at “benchmark” and above. (E.g.
schizophrenia 60% )
Negative A02 points specific to Typical and Atypical Antipsychotic drugs
Tolerance – needing more of the drug to get the same effect
Addiction/Dependence – needing the drug, either physically, or for a feeling of
psychological well being
Withdrawal – sometimes coming off the drug produces symptoms far worse than the original
ones
Risk of “pharmacological straitjackets”-keeping patients ‘zombied’ for the benefit of the
hospital and family
Risk of side effects
Biological Treatment of Schizophrenia
However, people may stop treatment because of medication side effects, disorganized
thinking, or because they feel the medication is no longer working. Apparently, people with
Schizophrenia who stop taking prescribed medication are at a high risk of relapse into an
acute psychotic episode.
50% of patients stop taking their medication after the first year
75% of patients stop taking their medication by the second year.
Of those still taking drugs, 40% relapse in the first year and 15% each subsequent year.
These figures imply that chemotherapy is not very effective as most patients discontinue
treatment (because of medication side effects, disorganized thinking, or because they feel
the medication is no longer working). Plus a significant amount of patients are not symptom
free.
All the Antipsychotic medications have side effects. Different medications produce
different side effects, and people differ in the amount and severity of side effects they
experience. Side effects can often be treated by changing the dose of the medication,
switching to a different medication, or treating the side effect directly with an additional
medication. Common inconvenient side effects of all antipsychotic drugs used to treat
Schizophrenia include: dry mouth, constipation, blurred vision, and drowsiness. Some
people experience sexual dysfunction or decreased sexual desire, menstrual changes, and
significant weight gain (100 pounds) = Diabetes, .Other common side effects relate to
muscles and movement problems. These side effects include: restlessness, stiffness, tremors,
muscle spasms, and one of the most unpleasant and serious side effects, a condition called
Tardive Dyskinesia. Tardive Dyskinesia most common with Typical anti psychotics but can
still occur with Atypical. Anti psychotics too.
This condition usually develops after several years of taking antipsychotic medications and
more predominantly in older adults. Tardive Dyskinesia affects 20 to 30 percent of people
taking conventional antipsychotic medications. Tardive Dyskinesia can be treated with
additional medications or by lowering the dosage of the antipsychotic if possible.
Some findings indicate that drugs may not even be necessary. In the long term, many
schizophrenic individuals function better without antipsychotic medicine so perhaps this
Biological Treatment of Schizophrenia
indicates nurture may be more important.. In a 2007 study, only 28% of patients who were not
being treated medicinally showed signs of psychotic activity, while 64% of those on
antipsychotics had psychotic activity.
Furthermore, people who suffer from schizophrenia in the Third World are twice as likely to
recover as sufferers in the West, according to a report by the World Health Organisation
WHO). The World Health Organization conducted two long-term follow-up studies
involving more than 2,000 people suffering from schizophrenia in different countries. These
studies found patients have much better long-term outcomes in developing countries (India,
Colombia and Nigeria) than in developed countries (USA, UK, Ireland, Denmark, Czech
Republic, Slovakia, Japan, and Russia),despite the fact antipsychotic drugs are typically
not widely available in poorer countries, raising questions about the effectiveness of such
drug-based treatments.
In many non-Western societies, schizophrenia may only be treated with more informal,
community-led methods. Multiple international surveys by the World Health Organization
over several decades have indicated that the outcome for people diagnosed with
schizophrenia in non-Western countries is on average better there than for people in the
West Many clinicians and researchers suspect the relative levels of social connectedness
and acceptance are the difference, although further cross-cultural studies are seeking to
clarify the findings.
Professor Leff, of the Institute of Psychiatry in London said the outcome was better in the in
non western countries because of strong support networks, the opportunity to work and lack
of stigma in areas where beliefs in witchcraft and karma mean the condition is accepted more
easily. "The large number of people in households [in developing countries] means that there
is a network of people who can share the responsibility for the patient's care and recovery.
There is a strong sense of duty and they all share the burden. In the West you are more
likely to find a middle- aged person with schizophrenia being cared for by one carer and the
burden of emotional and physical care falls on one person."
Cultures that avoid confrontation also worked in schizophrenics' favour.