Typical/first generation drugs
These include Chlorprozine (AKA Thorazine), which is used to fight the positive symptoms of schizophrenia (hallucination and delusions), which are linked to a overactive dopamine system. The drug reduces the effect of dopamine and take effect within 48 hours. The drug works by binding to the dopamine receptors (particularly D2 receptors) and block them. By blocking some of the dopamine receptors the positive symptoms of schizophrenia are reduced. They are most useful for 6 months.
The drugs allowed normal lives to be lead, so long hospital stays were no longer needed. They are also very effective against positive symptoms, however, they are less effective against negative symptoms. Also if medication is stopped, then relapses occur. Sampath et al (1992) found that if placebo's were used to replace medication there was a relapse rate of 75%, those who continued with the medication only had a relapse rate of 33%.
Atypical drugs/second generation antipsychotics
Chlozopine (made in the 1970s) and risperidone (1990s) both block D2 receptors, but also serotonin receptors in the brain. Risperidone works mainly on serotonin receptors and provide benefits against negative symptoms.
But the drugs reduce neurotransmitters of dopamine, which is important for a antipsychotic drug, but the need to block serotonin is questioned. Kapur and Reminton (2001) suggest that the drugs only involve dopamine systems, mainly D2. Only temporarily blocking D2 receptors and detaching quickly, so transmission returns to normal.
The new drugs benefit 83% of schizophrenic patients compared to 65% of patients who used the typical drugs. The drugs are also quicker than psychological therapy. DeLima et al (2005) found negative symptoms were also improved by these drugs. However, Leucht et al (1999) found in a meta analysis that 2 atypical drugs were only slightly more effective, 1 was as effective as typical drugs and 1 was slightly worse. There are less side effects with the newer drugs and can avoid the 'revolving door syndrome'.
Side effects of antipsychotics
Conventional drugs can cause very serious side effects, such as tardive dyskinesia (uncontrolled movement of the lips, tongue, face hands and feet). Roughly 30% of anti psychotic users develop tardive dyskinesia. Hill (1986) found 75% of cases were permanent.
Low blood pressure, blurred vision, problems with concentration, grogginess, constipation and Parkinson like symptoms are some other side effects.
A main advantage of atypical drugs is that they are less likely to cause tardive dyskinesia. Jeste et al (1999) found that only 5% of atypical drug users developed tardive dykinesia.
Electroconvulsive therapy (ECT)
Schizophrenia is rare in people with epilepsy, so it was believed in the 1930s that by inducing seizures it could reduce symptoms of schizophrenia. ECT is still used to treat schizophrenia, but its mainly used to treat severe cases of depression.
Electrodes are placed on the temple of the non-dominant side of the brain and another in the middle of the forehead (uni-lateral ECT). Alternatively a electrode can be placed above each temple (bi-lateral ECT). Patients are injected with muscle relaxants and anaesthetic. 70 - 130 volts are passed through the brain for around half a second after the patient is unconscious. The current causes seizures , similar to a epileptic fit for around 1 minute. 2 sessions are usually give a week for 4 - 5 consecutive weeks. The current is assumed to change the neurotransmitters in the brain.
Electroconvulsive therapy (ECT)
Tharyan and Adams (2005) did a meta analysis and found there were short term benefits of ECT, but they were smaller than those of drugs and it is not known whether there are long term benefits.
Bhatia et al (1998) showed that patients that didn't respond to drugs alone were better off when ECT was used with the drugs. Chanpattanna (2007) found that ECT, when used with drugs reduced positive symptoms successfully, but ECT was ineffective on negative symptoms and could even worsen the symptoms.
Tharyran (2005) summarised that the use of drugs and ECT was more effective and a option for those who didn't show signs of improvement when medicine was used alone.
Ethical Issues and side effects of ECT (AO2)
Side effects for ECT are memory loss, brain damage and even death, the use of ECT in the UK between 1979 and 1999 has dropped by 59%.
Little is know about why ECT is effective, it is unclear of what it actually does to the brain, it is thought to affect the neurotransmitters.
ECT is sometimes seen as a punishment as it causes seizures. Many people are put under huge amounts of pressure to receive ECT, therefore full informed consent may not be given.
Ethical Issues (AO2)
Drugs are argued to be 'chemical straight jackets', they dehumanise and take away personal control. The drugs make people compliant and easier to manage. Also schizophrenic patients do not have a choice of whether they wish to undertake therapy/medication, as they would for other illnesses such as cancer, where they can reject treatment.