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Year 13: Clinical Psychology 2010 Drug treatments for schizophrenia Name of drug Chlorpromazine Typical or atypical? Typical How does it work Side effects/risk of relapse? Research studies Blocks dopamine receptor sites and thus decreases dopamine activity Muscle tightening in neck and jaw, tardive dyskinesia, decrease of spontaneous movement, decrease in emotional spontaneity and motivation, motor restlessness and fidgeting, sedation, dry mouth, constipation, weight gain, neuroleptic malignant syndrome (can be fatal); 25% relapse rate (WHO 2001) Barlow & Durand (1995) chlorpromazine is effective in reducing schizophrenic symptoms in about 60% of cases. Most impact on positive symptoms; treated patients may still suffer from severe negative symptoms. Haloperidol Typical Blocks dopamine receptor sites and thus decreases dopamine activity 55% relapse rate in Schooler et al (2005) study. Side effects same as above. Clozapine Atypical Blocks both dopamine and serotonin receptor sites. Similar side effects to typical anti-psychotics but tardive dyskinesia much reduced. Fewer side effects than typical or first generation anti-psychotics. Rare side effect: agranulocytosis, (dangerously low levels of white blood cells) can be fatal. Risperidone Atypical Blocks both dopamine and serotonin receptor sites. Lower relapse rate than haloperidol, 45% compared with 55%, (Schooler et al 2005); Also fewer side effects than haloperidol; similar side effects to typical antipsychotics; weight gain, severe anxiety, sedation, insomnia, sexual dysfunction, low blood pressure, muscle stiffness, muscle pain, tremors, increased salivation, and stuffy nose. Also associated with diabetes, increased risk of suicide and tumors. Schooler et al (2005) randomly allocated 555 patients in first episode of schizophrenia, to either treatment with haloperidol or risperidone. In both groups 75% showed a reduction in symptoms. Pickar et al (1992) compared clozapine with other neuroleptics and a placebo and found clozapine to be the most effective in reducing symptoms, even in patients who had previously been treatment resistant. Emsley (2008) found that patients who were injected with risperidone early in course of disorder had low relapse rates and high remission rates; 84% of patients showed at least a 50% reduction in both +ve and –ve symptoms and 64% went into remission.
