The most common form of treatment for schizophrenia is drug therapy.
There are two types of drugs which are typical antipsychotic and atypical antipsychotic drugs.
Antipsychotics can be taken in tablet form, syrup or injection and can be divided into ﬁrst generation (typical) and second generation (atypical) varieties.
Typical antipsychotics, introduced in 1950’s such as chlorpromazine are dopamine antagonists as they bind to dopamine receptors and block their activity in the brain.
By reducing stimulation at these receptors, they can eliminate positive symptoms of schizophrenia such as hallucinations and delusions.
Atypical antipsychotics introduced in 1990’s such as Clozapine work by acting upon serotonin as well as dopamine production systems.
They target both positive and negative symptoms of the disorder such as reduced emotional expression.
Although atypical drugs are perceived as having fewer side-eﬀects, it is not always known speciﬁcally how they aﬀect the brain to alleviate symptoms.
Davis et al performed a meta-analysis of over 100 studies that compared antipsychotics with placebos ﬁnding drugs to be more eﬀective, with over 70% of suﬀerers treated with antipsychotics improving in condition after 6 weeks while fewer than 25% percent improved with placebos, suggesting antipsychotics have a beneﬁcial effect.
Sampath et al found 75% of schizophrenics who had previously been on the typical drugs for 5 years relapsed within a year when switched to a placebo compared to only 33% in the control group who continued on the typical drugs.
This showed that typical drugs are effective in treating schizophrenia as less people relapsed on the real drugs than the placebos.
However there are problems when assessing the effectiveness of drugs when using placebo studies because the patients on the placebo are in drug withdrawal state which means they are now producing excess dopamine because receptors are no longer blocked thus drug withdrawal may be responsible for relapse.
Hill et al highlighted another concern for conventional anti-psychotics; the side- eﬀects, one of which is Tardive dyskinesia which results in uncontrollable movements of the lips, face, hands and feet, this arises ethical issues.
About 30% of people taking antipsychotic drugs develop Tardive Dyskinesia and it is irreversible in 75% of cases therefore this needs to be considered when considering the appropriateness of drug therapies.
Ross & Read also argue that being prescribed medication reinforces the view that there is “something wrong with you” with patients.
They argue that this prevents the individual from thinking about possible stressors that might be a trigger for their condition and in turn reduce their motivation to look for other possible solutions beyond drug therapies that might alleviate stressors and suﬀering.
The introduction of the new atypical anti- psychotics raised expectations for the outcomes possible with medication.
Leucht et al conducted a meta-analysis of studies and found that the superiority of atypical drugs over conventional anti- psychotics was only marginal and only slightly more eﬀective.
The claim the atypical antipsychotics are more eﬀective in dealing with negative symptoms of Schizophrenia was also found to only be slightly more eﬀective in Leuchts study.
One of the main claims of atypical drugs was that side eﬀects such as Tardive Dyskinesia was less likely.
Jeste et al supported this claim by his study in which he which found people on conventional anti-psychotics had rates of 30% for Tardive Dyskinesia after 9 months while those on atypical antipsychotics had only 5%.
Therefore Atypical antipsychotics may be more appropriate in the treatment of schizophrenia as there are fewer risks of side eﬀects meaning patients are more likely to continue their medications and thus see more beneﬁts.
However a serious potential side effect of atypical drugs is…