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Drug Therapy - Coggle Diagram
Drug Therapy
Typical antipsychotics
Work by arresting dopamine production through blocking the receptors in synapses that absorb dopamine, therefore reducing positive symptoms of the disorder such as hallucinations and delusions
It is now thought that they may also affect other neurotransmitter systems such as the cholinergic, histaminergic, alpha-adrenergic and serotonergic mechanisms
Side effects associated with anti cholinergic systems include dry mouth, urinary problems, constipation and visual disturbance
Side effects associated with noradrenergic systems are low blood pressure, problems with sexual function and nasal congestion
Long term use leads to 15% of sufferers developing tardive dyskinesia - uncontrollable muscle movements especially around the mouth
Atypical antipsychotics
Introduced in the 1990s such as clozapine
Work by acting on serotonin as well as dopamine production systems, affecting negative symptoms of the disorder such as reduced emotional expression
It is not specifically known how they relieve symptoms
Side effects include weight gain, neuroleptic malignant syndrome (high fever, sweating, unstable blood pressure, muscular rigidity), increased risk of stroke, sudden cardiac death, blood clots and diabetes
Sufferers can also experience muscle tremors
Evaluation
They are relatively cheap to produce, easy to administer and have positive effects on many sufferers, allowing them to live relatively normal lives outside of mental institutions. Less than 3% of people with SZ in the UK live permanently in hospital
There is a high relapse rate - 40% in the first year and 15% in later years - generally due to the side effects and the reduced quality of life
Typical antipsychotics incur side effects such as muscle tremors. Atypical antipsychotics were introduced to reduce these problems but they have side effects of their own, some of which are fatal such as coma and death
There are some in the psychiatric community who see the widespread use of antipsychotics as fueled by the powerful influence of drug companies which make profits from their use, especially the replacement of typical with atypical antipsychotic drugs
Antipsychotics do not cure sz but they dampen symptoms to allow more normal functioning
Can be taken in a tablet form, as a syrup or by injection and are divided into typical antipsychotics (first generation) and atypical antipsychotics (second generation)
Atypical antipsychotics were introduced as they are more effective than typical ones and incurred fewer side effects. There is discussion about these claims however
Symptoms such as hallucinations and feelings of agitation tend to reduce within a few days and delusions after a few weeks
After about 6 weeks many patients see a lot of improvements but there are wide individual differences in levels and types of responses to the drugs. Patients often have to try several types before they find the best one
Some sufferers have to take a course of antipsychotics only once while others have to take regular doses in order to prevent symptoms re appearing
There is a minority of patients who do not respond to drug treatment
Antipsychotics can be used a combination therapy where drugs are administered to reduce the symptoms of the disorder so that other psychological treatments such as CBT can be more effective
Davis - Meta analysis of more than 100 studies that compared antipsychotics to placebos, finding drugs to be more effective, with over 70% of sufferers treated with antipsychotics improving after 6 weeks whilst less than 25% improved with placebos
Marder - Reported that atypical antipsychotic clozapine is as effective as typical antipsychotics in relieving the positive symptoms of SZ, and is effective in 30-61% of patients who are resistant to typical antipsychotics, suggesting that it is superior
The prime treatment for SZ is antipsychotics, the first being chlorpromazine introduced in 1952. This has an effect of enabling people to live relatively normal lives outside mental institutions
Lieberman - Examined the effectiveness of typical and atypical antipsychotics in treating 1432 people with chronic SZ, finding that 74% of patients discontinued their treatment within 18 months due to intolerable side effects. These drop out rates were similar for atypical and typical but discontinuation for atypical was associated with muscle disorders and typical was associated with weight gain and metabolic effects