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Discuss biological treatments for schizophrenia (24) – Tabassum RahmanAntipsychotics revolutionised the treatment of schizophrenia. These antipsychotics can be split into two categories;
firstly there are ‘typical varieties’ which work by stopping dopamine production through blocking the receptors in
the synapses that absorb dopamine, thus reducing the positive symptoms of the disorder, e.g. Chlorpromazine.
Secondly there is the ‘atypical varieties’ which work by acting upon serotonin as well as dopamine production
systems and affect negative symptoms of the disorder, e.g. Clozapine. Although atypical drugs are perceived as
having fewer side effects than typical varieties, it is not always known specifically how they affect the brain to
alleviate symptoms.
Supporting research into Antipsychotics is from Kahn who compared the fist an second generation antipsychotics
and found that antipsychotics are effective for at least one year, but after the second generation drugs are not
necessarily any more effective than first generation ones. Furthermore, a meta-analysis of over 100 studies that
compared antipsychotics with placebos by Davis found that more than 70% of sufferers treated with antipsychotics
improved in condition after 6 weeks and less than 25% improved with placebos. This therefore suggests that
antipsychotics do have medical benefit. One strength of his study is that it has a large sample size from over 100
studies, making the findings easier to generalise to other schizophrenics in the wider population.
One critical research into antipsychotics is from Lieberman, who examined the effectiveness of first and second
generation antipsychotics in treating 1432 chronic schizophrenics, finding that 74% of patients discontinued their
treatment within 18 months due to intolerable side effects. The side effects for first generation drugs include
muscular disorders while for the second generation drugs there was a link to weight gain and metabolic effects.
Another study that criticises the use of antipsychotics is from Wahlbeck, who found that about 30% of patients do
not respond to drugs or they are intolerant to them. Clozapine can sometimes be effective with these patients, but
only half of such patients respond favourably. This therefore suggests that there may be a non-biological or
psychological cause for schizophrenia, such as childhood trauma.
Antipsychotics are effective, as they are relatively cheap to produce, easy to administer and have positive effects on
many sufferers, allowing them to live relatively normal lives outside of mental institutions. Less than 3% of people
with schizophrenia in the UK live permanently in hospital. One problem with antipsychotics is the high relapse rate –
around 40% in the first year of treatment and 15% in the subsequent years – generally due to stopping medication
because of the side effects. Antipsychotics have serious side effects, like muscle tremors with first generation drugs,
and even neurological symptoms leading to coma and death. Second-generation antipsychotic were introduced to
reduce such problems; however there I evidence suggesting that they also incur serious side effects, like a reduction
of white blood cells. Second generation drugs, such as clozapine, reduce negative symptoms and incur a lower
dropout rate. Patients taking clozapine may develop a condition in which the immune system is damaged; this can
be counteracted by the use of other drugs and by regular blood monitoring. However, this makes the treatment
expensive and time consuming. There is also a ‘revolving door phenomenon’ with patients relapsing by not taking
medication and returning back into hospital. In order to stop this sometimes patients are given injections of long
lasting antipsychotics which takes away their option to stop taking the tablets. But this may lead to ethical issues as it
can be seen that practitioners may be forcing such treatment onto patients. It has also been found that doses of
medication are sometimes too high because they have not been reduced to maintenance level after the acute stage
is over. However it is sometimes difficult for clinicians to choose the right amount of medication to prescribe. There
is also an issue that drug treatment only treats the symptoms but not the cause, therefore suggesting that both
biological and psychological therapies would work best together for the patient.
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