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'older antipsychotics'

First developed in 1950s

Example - chlorpromazine

Affects neurotransmission

Blocks dopamine

Acts as an antagonist of D2 receptors

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'newer antipsychotics'

First developed in 1990s

Example - Clozapine

same mechanism as conventional

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Atypical received at fewer dopamine D2 receptors ( more at D1 and D4)

Atypical antagonise serotonin at same degree as Dopamine

Atypical occupy D2 receptors for less time than conventional

Atypical half life is of less time

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Effectiveness - Conventional antipsychotics 

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Effectiveness - Conventional antipsychotics 

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Jonathan Cole et al (1964)

Psychiatry could treat mental disorders in the same way that physical disorders are treated.

75% of those given a conventional antipsychotic were considered to be 'much improved' compared with only 25% of those given a placebo.

None of the patients given the antipsychotic were considers to have gotten worse, in comparison to 48% of those given a placebo.

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Effectiveness - comparing conventional and atypical 

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Effectiveness - comparing conventional and atypical 

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'Atypical are generally considered more effective than conventional'

Ravanic et al (2009)

Compared effectiveness of Clozapine, Chlorpromazine and Haloperidol in 325 individuals with schizophrenia, over 5 years.

Found significant differences in psychometric scores measuring schizophrenic symptoms, favouring clozapine.

Clozapine had fewer adverse effects (0.9 events per patient) than haloperidol (2.7) and Chlorpromazine (3.2)

This suggests that atypical antipsychotics are more effective and preferable when treating schizophrenia.

:( More research need to be done based on individual differences

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Effectiveness - difficulty of assessing the effectiveness of antipsychotics 

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Effectiveness - difficulty of assessing the effectiveness of antipsychotics 

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:( Non compliant

Those with chronic schizophrenia lack the necessary insight into their own condition. They don't believe they have a problem and therefore don't take their medication.

Rettenbacher et al (2004)

Found full compliance in only 54.2% of those with schizophrenia, non compliance in 37.5%.

This suggests that in the real world antipsychotics may not be as effective as they are in closely controlled clinical studies.

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Tardive dyskinesia - a neurological disorder characterised by involuntary movements of the face and jaw

Agranulocytosis - a deficiency of granulocytes in the blood, causing increased vulnerability to infection.

Seizures - occur after an episode of abnormal electrical activity in the brain. Convulsions can also occur when a person's body shakes rapidly and uncontrollably.

Parkinsonianism - tremors and instability.

:( therapist has to make decision for the patient as to whether or not the treatment is worth the side effects that the patient may suffer from.

:( no valid consent - not of a sound mind

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It has been argued by some psychiatrists that antipsychotics are little more than chemical straitjackets, in that it keeps people quiet and under control.

Szasz (1960)

physical treatments is no more sophisticated than believing in demonology.

Concept of metal illness was a way of excluding non conformists from society

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Social - Asylums or care in the community

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Social - Asylums or care in the community

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Stephen Lawrie (2011)

Antipsychotics have revolutionised the care of schizophrenia

Changed from an incurable condition which required institutionalised, to one that could be treated in the community, with the potential for independent living and recovery

:) introduction of medication allowed patients to live a more normal life with their loved ones in their home environment

:) beneficial due to the avoidance of the expense of hospitalisation

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Nature of the disease = risk that the sufferer can pose a threat to themselves or others

Tiihonen et al (2006)

Found a 37-fold increase in suicide in patients who stopped taking their medication

NCISH (2015)

346 homicides committed in England with a history of schizophrenia between 2003 and 2013 - 6% of the total homicide rate)

29% of these individuals had been non-adherent with drug treatment in the month before the homicide

:( cannot determine cause and effect here

:) still strong enough to be considered as a risk factor