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Describe and evaluate at least two biological therapies for schizophrenia (8+16)
One biological therapy for treating schizophrenia is the use of drugs that act on neurotransmitter
pathways in synapses in the brain. There are two common types of drugs used to treat schizophrenia:
conventional/typical antipsychotics and atypical antipsychotics.
Typical antipsychotics reduce the effects of dopamine and so reduce the symptoms of schizophrenia.
They are dopamine antagonists in that they bind to dopamine receptors (particularly the D2
receptors) but do not stimulate them, thus blocking their action. By reducing stimulation of the
dopamine system in the brain, antipsychotic drugs such as chlorpromazine can eliminate the
hallucinations and delusions experienced by people with schizophrenia.
Many studies that have evaluated the effectiveness of typical antipsychotic medication have done so
by comparing relapse rates with those on a placebo. For example, a review by Davis et al (1980)
found a significant difference in terms of relapse rates between treatment and placebo in every
study reviewed, thus demonstrating the therapeutic effectiveness of these drugs. However, a more
recent analysis of that study by Ross and Read has suggested that its results were misleading: as all
those studied, including those who took placebos, were on antipsychotics before this study began, it
was, rather than a study comparing treat to non-treatment, a comparison between continued
treatment and withdrawn treatment. Ross and Read suggest a significant proportion of the relapses
in the placebo group can be explained by these withdrawal symptoms, leaving the conclusions drawn
by Davis discredited.
In terms of appropriateness, critics have also pointed to the development of tardive dyskinesia-
uncontrollable movements of the lips, tongue, face, hands and feet- in 30% of patients taking typical
antipsychotics, with only 25% of these cases treatable. Some suggest that given this side effect,
administration of these drugs is unethical, and defies articles regarding harmless treatment in the
Human Right Acts 1988. Therefore, physicians prescribe conventional antipsychotics less frequently
than they used to because of the potential for serious side effects. Instead, physicians often
preferentially prescribe a newer family of antipsychotic medications, known as atypical
Atypical antipsychotics also act on the dopamine system, but are thought to block serotonin
receptors in the brain too. Kapur and Remington however suggest that these drugs do not involve
serotonin or other neurotransmitters, but only the dopamine system and the D2 receptors in
particular. They help by only temporarily occupying the D2 receptors and then rapidly dissociating to
allow normal dopamine transmission. It is this characteristic of atypical antipsychotics that is thought
to be responsible for the lower levels of side effects.
In terms of appropriateness, one of the main advantages of the atypical antipsychotics is that there is
a much lower likelihood of tardive dyskinesia. This claim was supported in a study by Jeste et al who
found just 5% rates of tardive dyskinesia with patients using atypical drugs compared to 30% for
conventional antipsychotics. However, there are side effects that need to be considered with
atypical drugs. For example, Clozapine (an atypical antipsychotic used to treat SZ) has a potentially
life-threatening side effect resulting in damage to the immune system. Other drugs then have to be
administered to counteract the effect and regular blood tests are necessary. Therefore this makes
the treatment very expensive and limits its availability. The other atypical drugs do not have this
effect but they are also very expensive and can cause unwanted weight gain. However, although
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In turn, the fewer side effects mean that patients
are more likely to continue their medications and therefore see more benefits. Therefore, this
implies that atypical antipsychotics would be a better option than the conventional ones.
Also, It is important to note that conventional drugs, though successful in reducing positive
symptoms, have little effect, on negative symptoms (e.g loss of motivation). Atypical drugs, on the
other hand, also seem to improve negative symptoms, again suggesting that atypical antipsychotics
are a better option.…read more
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Also, such a drastic step as deliberately damaging the brain raises significant ethical issues. Critics
argue that once its side effects, deaths and psychological consequences were taken into account, a
cost-benefit analysis of its advantages would most probably be negative.
Furthermore, a very serious problem with this method of treatment is that it is totally irreversible.
Once it has been carried out, it cannot be undone, meaning that the side effects are permanent.…read more