Drug Therapy in Treating Schizophrenia

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Drug Therapy

Antipsychotic drugs (drugs used to reduce the intensity of the symptoms) are the most common treatment for schziophrenia.

They involve modifying / interfering with the action of neurotransmitters, in order to increase (agonists) or decrease (antagonists) their activity. 

Medication can be taken as pills, syrups, or injections, and may be taken over a short or long-term.

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Typical Antipsychotics

Typical antipsychotics were developed in the 1950s, for example Chloropromazine. 

They act as dopamine antagonists, attempting to reduce dopamine activity. They block dopamine receptors on post-synaptic neurons, meaning that less dopamine is transmitted across the synapse. This has the effect of reducing dopamine products, and reduces positive symptoms such as hallucinations.

Drugs such as Chloropromazine also have a sedative effect, meaning that they calm patients down and reduce anxiety.

As the drugs block dopamine activity, they tend to have (sometimes severe) side-effects.

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Atypical Antipsychotics

Atypical antipsychotics were developed in the 1970s, as an attempt to find drugs with fewer side effects than typical antipsychotics. 

An example is Clozapine, which is used when other drugs have failed, due to the risk of agranulocytosis (a potentially fatal blood condition). Clozapine acts in a similar way to Chloropromazine, but also acts on serotonin and glutamate receptors. 

The effect of this is, as well as reducing positive symptoms, the reduction of depression and anxiety, and the enhancement of mood. It is therefore prescribed when the patient is at risk of suicide.

Risperidone is another atypical antipsychotics, and is designed to be as effective as Clozapine without the risky side-effects. It binds to dopamine receptors more strongly than Clozapine, and there is some evidence that it produces fewer side-effects.

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Evaluation of Drug Therapy in Treating Schizophren

+ Thornley et al (2003) found in a meta-analysis that Chlorpromazine was associated with better functioning and reduced symptom severity than placebos, supporting that the drug does have a positive effect on schizophrenia patients.

+ Melzer (2012) concluded the Clozapine is effective in 30-50% of cases where other drugs have failed, supporting its use in schizophrenia treatment.

- Antipsychotic drugs are weakened by the fact that they have severe side-effects. For example, some patients on typical antipsychotics develop tardive dyskinesia - a condition where there are uncontrollable facial tics. Even after stopping the use of the drug, this condition can persist. Other side effects are potentially fatal, for example agranulocytosis and neuroleptic malignant syndrome (NMS). Side effects are less severe where patients are taking a reduced dose, as many do today, but this can reduce the effectiveness of the drug as well. The severity of side effects is a weakness, as patients will be reluctant to take them, or may even die as a result of the effect.

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