PSYC 210 Chapter Notes - Chapter 9.3: Extrapyramidal Symptoms, Thought Disorder, Antipsychotic
30 Apr 2018
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9.3$Treatment$of$Schizophrenia$
!!
Lack!of!insight!
• A!problem!with!any!kind!of!treatment!for!schizophrenia!is!lack!of!insight!into!their!impaired!
condition!and!refusing!treatment!
• Gender!(female)!and!age!(older)!are!predictors!of!better!insight!among!people!in!their!first!
episode!of!the!illness!
o May!help!account!for!why!women!tend!to!respond!better!to!treatment!
• Those!who!lack!insight,!and!thus!don't!believe!they!have!an!illness,!don't!see!the!need!for!
professional!help,!especially!hospitalization!or!drugs!
• Family!members!face!a!big!challenge!getting!their!relatives!into!treatment!
!!
Medications!
• Several!medications!collectively!referred!to!as!antipsychotic+drugs!!were!found!to!help!with!some!
of!the!symptoms!of!schizophrenia!
o Antipsychotic/drugs:!psychoactive!drugs!that!reduce!psychotic!symptoms!but!have!long-
term!side!effects!resembling!symptoms!of!neurological!diseases!
o Also!called!neuroleptics!because!they!produce!similar!side!effects!similar!to!the!symptoms!of!
a!neurological!disease!!
• For!the!first!time,!many!people!did!not!need!to!stay!in!a!hospital!for!long!periods!of!time!and!
could!instead!go!home!with!a!prescription!
o Some!people!did!and!still!do!need!treatment!in!a!hospital!
o Difficult!to!receive!such!treatment!today!due!to!the!cost!and!limited!availability!
o Medications!have!made!it!possible!for!some!people!with!schizophrenia!to!lead!lives!outside!
of!a!hospital!
!!
First-Generation!Antipsychotic!Drugs!and!Their!Side!Effects!
• First-generation/antipsychotic/drugs:!these!drugs!can!reduce!the!positive!and!disorganization!
symptoms!of!schizophrenia!but!have!little!or!no!effect!on!the!negative!symptoms!
• First-generation!are!the!broad!classes!of!medications!first!discovered!
• Can/reduce/the/positive/and/disorganization/symptoms,!but!have!little!to!no!effect!on!the!
negative!symptoms!
o Probably!because!their!primary!mechanism!of!action!involves!blocking!dopamine!D2!
receptors!
• About!30%!of!people!do!not!respond!well!to!these!
o About!half!quit!after!1!year!and!3/4!quit!before!2!years!because!of!the!side!effects!
• People!who!respond!positively!are!typically!kept!on!so-called!maintenance+doses!of!the!drug!–!just!
enough!to!continue!the!therapeutic!effect!
• Symptoms!may!go!away,!but!some!lives!are!still!not!fulfilling!
o Some!people!on!medication!still!have!difficulty!with!day-to-day!functioning!
• Unable!to!live!independently,!hold!jobs!they!would!be!qualified!for,!sparse!social!
relationships!
• Side!effects:!
o Most!common!side!effects:!sedation,!dizziness,!blurred!vision,!restlessness,!and!sexual!
dysfunction!
o Extrapyramidal+side+effects!resemble!symptoms!of!Parkinson's!disease!
• Tremors!of!the!fingers,!shuffling!walk,!drooling!
o Other!side!effects:!
• Dystonia:!a!state!of!muscular!rigidity!
• Dyskinesia:!abnormal!motion!of!voluntary!and!involuntary!muscles!
• Akasthesia:!an!inability!to!remain!still;!often!pace!and!fidget!
o Rare!side!effects:!
• Tardive/dyskinesia:!the!mouth!muscles!involuntarily!make!sucking,!lip-smacking,!and!
chin-wiggling!motions!
§ In!more!severe!cases,!the!whole!body!can!be!subject!to!involuntary!motor!
movements!
§ Observed!mainly!in!older!people!
• Neuroleptic/malignant/syndrome:!can!be!fatal;!severe!muscle!rigidity!develops,!
accompanied!by!fever,!heart!rate!increase,!blood!pressure!increase,!and!may!lapse!
into!a!coma!
§ Occurs!in!about!1%!of!cases!
• Because!of!these!side!effects,!some!clinicians!believe!it!is!unwise!to!prescribe!high!doses!for!
extended!periods!of!time!
o Use!the!smallest!possible!doses!
o Difficult!for!clinicians:!
• If!medication!is!reduced,!chance!of!relapse!increases!
• If!medication!is!continued,!serious!and!untreatable!side!effects!may!develop!
!!
Second-Generation!Antipsychotic!Drugs!and!Their!Side!Effects!
• Second-generation/antipsychotic/drugs:!any!of!several!drugs!used!to!treat!schizophrenia!that!
produce!fewer!motor!side!effects!than!traditional!antipsychotics!while!reducing!positive!and!
disorganized!symptoms!at!least!as!effectively;!may!be!associated!with!increased!and!serious!side!
effects!of!other!varieties!
• Started!with!Clozapine!produce!therapeutic!gains!in!people!who!did!not!respond!well!to!first-
generation!antipsychotic!drugs!produce!fewer!side!effects,!and!lead!to!less!relapse!and!treatment!
noncompliance!
o Side!effects:!seizures,!dizziness,!fatigue,!drooling,!and!weight!gain!
o More!severe!side!effect:!
• Agranulocytosis:!immune!system!dysfunction!(1%!of!people)!by!lowering!white!blood!
cells!!
§ Makes!people!vulnerable!to!infection!and!can!even!cause!death!
• Early!studies!of!the!drugs!indicate!that!they!produces!fewer!side!effects!than!first-generation,!but!
later!studies!have!not!replicated!this!
• No!differences!in!relapse!or!adverse!side!effects!between!long-acting!first!and!second-generation!
drug!
• Effective!in!improving!aspects!of!cognition,!such!as!attention!and!memory,!that!are!known!to!be!
deficient!in!many!people!with!schizophrenia!
o May!be!more!effective!than!first-generation!
• Associated!with!poor!social!functioning!
• May!make!possible!more!thoroughgoing!changes!in!schizophrenia!and!its!behavioral!
consequences!than!do!drugs!that!do!not!help!with!these!cognitive!abilities!
o Psychological!treatments!are!also!effective,!and!maybe!more!so,!at!alleviating!cognitive!
deficits!
• Clinical+Antipsychotic+Trials+of+Intervention+Effectiveness+(CATIE)!compared!four!second-generation!
drugs!and!one!first-generation!drug!and!found!
Document Summary
Those who lack insight, and thus don"t believe they have an illness, don"t see the need for professional help, especially hospitalization or drugs. Family members face a big challenge getting their relatives into treatment. First-generation antipsychotic drugs: these drugs can reduce the positive and disorganization symptoms of schizophrenia but have little or no effect on the negative symptoms. Symptoms may go away, but some lives are still not fulfilling: some people on medication still have difficulty with day-to-day functioning, unable to live independently, hold jobs they would be qualified for, sparse social relationships. Side effects: most common side effects: sedation, dizziness, blurred vision, restlessness, and sexual dysfunction, extrapyramidal side effects resemble symptoms of parkinson"s disease. In more severe cases, the whole body can be subject to involuntary motor movements. Observed mainly in older people: neuroleptic malignant syndrome: can be fatal; severe muscle rigidity develops, accompanied by fever, heart rate increase, blood pressure increase, and may lapse into a coma.
