This is Psych boost, in this video we'll be looking at the biological drug therapies
that are used to treat schizophrenia. They are known as Typical and Atypical antipsychotics
and both work by different mechanisms, have different effects and importantly side effects.
As well as discussing all of that we will evaluate the use of drug therapy
in the treatment of schizophrenia. Let's begin! So both of the drug treatments in this video are
classified as antipsychotics or neuroleptics, and work by interfering with neurotransmitter systems.
They can be taken in pill form or injection. Typical antipsychotics are known as
first generation, they were the first drug treatment to be developed back in the 1950's.
These are less popular now due to the development of A-typical antipsychotics
which as we will see have less severe side effects.
Typical antipsychotics work by interfering with the dopamine system. They are what is known as a
dopamine antagonist, meaning they take the place of dopamine in the receptors on the postsynaptic
neuron, reducing the effectiveness of dopamine resulting in a calming effect. An example of a
typical antipsychotic is chlorpromazine. These drugs only seem to be effective
at reducing the positive symptoms of schizophrenia, so hallucinations and delusions.
As these drugs affect the dopamine pathway across the brain
there are a range of unintended side effects. Some examples are dry mouth, constipation,
low energy and in some cases after extended use an unpleasant symptom called tardive dyskinesia,
this is uncontrollable repetitive movements that tend to affect the face such a lip movement.
In the 1970's a second generation of antipsychotics were developed
known as atypical. It was found these drugs could reduce the positive but also negative
symptoms of schizophrenia, additionally these drugs have more manageable side effects.
An example of an atypical antipsychotic is clozapine. These drugs also affect the dopamine
system but also influence other neurotransmitter systems including serotonin and glutamate.
However these drugs also have side effects such as weight gain and cardiovascular problems
however a significant advantage is Atypical drugs are very unlikely to cause tardive dyskinesia.
So that is the two classes of drug treatment, an example of a drug in each family,
the neurochemical systems they interact with and side effects. Let's consider some evaluations.
Firstly Leucht Who conducted a meta-analysis on 212 studies that compared the effectiveness
of antipsychotics that work by normalising levels of dopamine to placebos. The findings
showed the drugs were much more effective at the treatment of schizophrenia than placebos.
This suggests antipsychotic drugs are effective and should be used
as part of a treatment plan for schizophrenia. A second meta-analysis of 212 studies by Bagnall
compared the effectiveness of different types of antipsychotics,
typical and atypical. It was found that A-typical drugs were more effective than typical
antipsychotics in reducing symptoms and they produced fewer movement disorder side effects.
Very importantly fewer people discontinued treatment on the Atypical antipsychotics.
Out of all the antipsychotics tested clozapine was found to be the most effective, especially
in treating negative symptoms and treating people who are resistant to other antipsychotics.
These results suggest that the development of the A-typical drugs
has improved the lives of many people who have suffered from the symptoms of schizophrenia,
but also the severe side effects of typical antipsychotics. But as A-typical drugs influence
a range of neurotransmitters it may cast some doubt on the dopamine hypothesis of schizophrenia.
A third research study by Tarrier shows there are improvements that can be made
with standard drug therapy, this research placed patients randomly into routine care,
antipsychotics or anti-psychotics in addition to CBT for psychosis. It was found that in
the combined treatment plan patients had fewer and less severe positive symptoms,
as well as spending fewer days in hospital receiving care this suggests that actually an
interactionist approach to treating schizophrenia is a better option than drug therapy alone.
A useful evaluation to consider is the effect the development of effective antipsychotics
has had on the economy. Reducing the symptoms of schizophrenia in patients has allowed them
to return to the workplace and directly contribute to the economy. Drugs are
also a much cheaper treatment than working with a trained therapist,
saving health services money. And drugs have allowed people to be treated in the community,
saving the expense of treating people full time in institutions.
We could criticise drug therapies as potentially just suppressing some of the symptoms, not really
treating the true cause of schizophrenia symptoms return quickly when the drugs have stopped
Also many studies look at the short term effects of drugs treatment, not long term effects.
Drugs treatment has resulted in the end of large scale institutionalisation,
basically locking sufferers into specialised hospitals. Now people are far more likely
to be treated in the community, living independently or with their families.
An ethical concern with drug treatment is drugs are occasionally given by force to people with
severe symptoms. It can be questioned if we should be forcibly injecting people against their will,
especially with the serious side effects these drugs have.
And on that point of side effects, we see a revolving door with two thirds of people taking
antipsychotics quitting their treatment plan mostly often to avoid side effects,
leading to the return of symptoms, then needing to start drug therapy again. We
may suggest that drug therapy is ultimately not effective with such a high dropout rate.