Biological therapies for Schizophrenia (Sz)

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  • Created on: 13-12-12 11:42
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  • Biological therapies for Schizophrenia (Sz)
    • Atypical anti-psychotics
      • A02
        • Effectiveness
          • There is research support for the effectiveness of atypical anti-psychotics, research has found that one third of patients who did not respond to conventional anti-psychotic drugs did respond to clozapine. This suggests that atypical anti-psychotics might be a more appropriate treatment than conventional drugs.
            • However, Leucht et al's (1999) meta-analysis found that atypical drugs are only moderately more effective than conventional anti-psychotics and that the claim that they also deal with negative symptoms of Sz only has marginal support.
              • Leucht et al (1999) found that 2 were slightly more effective, 1 was as effective and 1 was slightly worse than conventional drugs at treating negative symptoms.
        • Appropiateness
          • jeste et al (1999) found tardive dyskinesia rates in 30% of people after 9 months of taking conventional anti-psychotics, 5% for those treated with atypicals.
          • Atypical anti-psychotics may be the most appropiat in treating Sz because of the fewer side effects. Patients are more likely to continue their medication and therefore see more benefit.
    • Conventional anti-psychotics
      • A01
        • Conventional anti-psychotics include drugs such as Chlorpromazine, Thorazine and Haldol. They are dopamine (DA) antagonists which bind to dopamine receptors (D1 and D2) in the brain. They block the actions of DA receptors and can eliminate hallucination and delusions.
          • Haloperidol works slightly differently to other conventional anti-psychotics in that it only attaches to D2 dopamine receptors.
      • A02
        • Appropiateness
          • There are arguments for and against the appropriateness of conventional anti-psychotics to treat sz. On one hand, Sz does appear to have a strong biological basis, so a biological treatment would appear to be appropriate. however, there are many worrying side effects, in particular tardive dyskinesia which involves uncontrollable movements of lips, tongue, face, hands and feet.
            • Hill (1986) found that 30% of people taking the drugs develop tardive dyskinesia and it is irreversible in 75% of cases.This can mean that people stop or refuse to take the medication, sometimes with tragic consequences.
              • Some also argue that there are ethical issues with proscribing conventional anti-psychotics due to the concern over whether the benefits outweigh the moral and financial costs associated with side effects.
        • Effectiveness
          • was supported by Davis et al (1980) who analysed 29 studies (3519 people) and found that relapse occurred in 55% of patients whose drugs were replaced by placebos, versus 19% in people who remained on the drug.
            • Ross & Read (2004) say this finding is misleading as 45% of those on placebo did benefit and therefore a big percentage of those who remained on the drug would also have benefited from a placebo. In addition, those under placebo condition would have been suffering from withdrawal symptoms.
              • They argue that the previously blocked DA systems becomes flooded due to heightened sensitivity and number of DA receptors (due to the medicine) can explain higher number of relapses in the placebo condition leading to relapse.
                • This then questions the validity of placebo studies.
          • A further challenge to the effectiveness of conventional anti-psychotics is shown by Vaughn & Leff (1976) who found that while anti-psychotic medicine did make a difference on relapse rates, they only did so in those with hostility and criticism at home. For example, for those in hostile homes, 92% relapsed whilst taking a placebo compare to 53% on medicine; whereas in non-hostile homes, 15% relapse whilst taking a placebo compared to 12% on medicine.
            • This indicates that conventional anti-psychotics are effective, but only under certain environmental conditions.
  • A group of unrelated anti-psychotic drugs that have a different mode of action to conventional anti-psychotics.
    • Atypicals, bind to other neurotransmitter sites as well as to DA (e.g. clozapine binds to D1, D4, serotonin & weakly to D2).
      • Unlike conventional anti-psychotics they only briefly occupy DA receptors, allowing more rapid return of normal DA transmission which might explain the lower side effects with atypicals, such as lower levels of reported tardive dyskinesia.
    • A01
      • Atypical anti-psychotics
        • A02
          • Effectiveness
            • There is research support for the effectiveness of atypical anti-psychotics, research has found that one third of patients who did not respond to conventional anti-psychotic drugs did respond to clozapine. This suggests that atypical anti-psychotics might be a more appropriate treatment than conventional drugs.
              • However, Leucht et al's (1999) meta-analysis found that atypical drugs are only moderately more effective than conventional anti-psychotics and that the claim that they also deal with negative symptoms of Sz only has marginal support.
                • Leucht et al (1999) found that 2 were slightly more effective, 1 was as effective and 1 was slightly worse than conventional drugs at treating negative symptoms.
          • Appropiateness
            • jeste et al (1999) found tardive dyskinesia rates in 30% of people after 9 months of taking conventional anti-psychotics, 5% for those treated with atypicals.
            • Atypical anti-psychotics may be the most appropiat in treating Sz because of the fewer side effects. Patients are more likely to continue their medication and therefore see more benefit.
  • A02
    • Appropiateness
      • There are arguments for and against the appropriateness of conventional anti-psychotics to treat sz. On one hand, Sz does appear to have a strong biological basis, so a biological treatment would appear to be appropriate. however, there are many worrying side effects, in particular tardive dyskinesia which involves uncontrollable movements of lips, tongue, face, hands and feet.
        • Hill (1986) found that 30% of people taking the drugs develop tardive dyskinesia and it is irreversible in 75% of cases.This can mean that people stop or refuse to take the medication, sometimes with tragic consequences.
          • Some also argue that there are ethical issues with proscribing conventional anti-psychotics due to the concern over whether the benefits outweigh the moral and financial costs associated with side effects.
    • Effectiveness
      • was supported by Davis et al (1980) who analysed 29 studies (3519 people) and found that relapse occurred in 55% of patients whose drugs were replaced by placebos, versus 19% in people who remained on the drug.
        • Ross & Read (2004) say this finding is misleading as 45% of those on placebo did benefit and therefore a big percentage of those who remained on the drug would also have benefited from a placebo. In addition, those under placebo condition would have been suffering from withdrawal symptoms.
          • They argue that the previously blocked DA systems becomes flooded due to heightened sensitivity and number of DA receptors (due to the medicine) can explain higher number of relapses in the placebo condition leading to relapse.
            • This then questions the validity of placebo studies.
      • A further challenge to the effectiveness of conventional anti-psychotics is shown by Vaughn & Leff (1976) who found that while anti-psychotic medicine did make a difference on relapse rates, they only did so in those with hostility and criticism at home. For example, for those in hostile homes, 92% relapsed whilst taking a placebo compare to 53% on medicine; whereas in non-hostile homes, 15% relapse whilst taking a placebo compared to 12% on medicine.
        • This indicates that conventional anti-psychotics are effective, but only under certain environmental conditions.
  • Criticisms of conventional anti-psychotic drugs are that they do not work for all patients for example research suggests that chlorpromazine helps just 1 in 7; and are only effective at relieving the positive symptoms of the illness. This suggests that the effectiveness of conventional anti-psychotics has significant limitations.

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