Biological Therapies for Sz

Chlorpromazine

• Developed in 1950s
• Can be taken as syrup, tablets or injection
• Syrup is absorbed faster than tablets
• Dosages start small and increase to mamimum 1000 mg
• Most patients take 400-800 mg
• Prescribed doses decreased over past 50 years
• Antagonists - blocks dopamine receptors at postsynaptic neuron to stop dopamine being uptaken
• Initially dopamine levels build up but production is reduced 
• Reduces symptoms like hallucinations
• Also a sedative - reduces anxiety and calms patients with Sz and other conditions

Clozapine

• Developed in 1970s
• Not available as an injection
• Daily dosage of 300-450 mg
• More effective than typical drugs
• To be used when other treatments fail
• Binds to receptors and works with dopamine, serotonin and glutamate, which improves mood by reducing depression and anxiety
• Sometimes prescribed to high risk patients - 30-50% of Sz patients attempt suicide

Rispendone

• Developed in 1990s
• Can be taken as syrup, tablets or injection
• Daily dose of 4-8 mg, maximum 12 mg
• Binds to dopamine and serotonin

Effectiveness - Thornley

• Effects of chlorpromazine on 1121 Sz patients compared to control group
• Chlorpromazine associated with better overall functioning and reduced symptom severity
• Data from 512 Ps showed that relapse rate was lower when the drug was taken
• Effective at reducing Sz symptoms

Side Effects

• Tardive dyskinaesia is a result of long-term use
• Caused by DA sensitivity and manifests as involuntary facial movements, e.g. grimacing, blinking, lip biting
• Other side effects include dizziness, sleepiness and weight gain
• Neuoleptic malignant symdrome (NMS) is most serious side effect
• Drug blocks dopamine action in the hypothalamus, which is responsible for regulating many  body systems
• Results in high temperature, delirium, going into a coma, can be fatal

Effectiveness - Meltzer

• Clozapine is effective in 30-50% of treatment-resistant cases where typical antipsychotics have failed
• Results comparing Clozapine and Risperidone are inconclusive, perhaps some patients respond better to one drug than the other
• Clozapine is more effective than typical and other atypical drugs, with atypical drugs being generally effective

Side Effects

• Agranoulocytosis - when bone marrow fails to produce enough white blood cells
• Patients on these drugs have to have regular blood tests to check for early signs of this illness

• Injections given every 2 - 4 weeks slowly released into the body 
• Someone with Sz doesn't have to remember to take tablets - a nurse/GP administers the injection
• Injection made into shoulder or buttocks
• Injection site has to be alternated to try to avoid side effects
• Taken less frequently than tablets
• Could cause side effects - bleeding, bruising, irritation
• Later into the illness, patients may not give informed

• 'Chemical straitjackets'
• Typical drugs are sometimes used to sedate patients when they are in hospital to make them easier for nurses/doctors to handle
• Done for the benefit of the hospital staff rather than the patient themselves
• Puts patients into a zombie-like state rather than curing symptoms
• Use of drugs to calm agitated patients in the short term is recommended by the National Institute for Health and Clinical Excellence (NICE)
• Some say this is against human rights and is a violation of human rights
• Considered unethical as it takes away personal control and individual responsibility
• However, can be considered necessary if the patient is at risk of harming themselves or others
• May not be in a state to give informed consent