Since Schizophrenia is a mental condition known to affect the cognitive development of its victims, psychotropic drugs have been used to treat it through their effects on the central nervous system. Sometimes, psychotropic drugs are used to manage the condition by creating a sense of normalcy on patients’ behavior when schizophrenia cannot be totally eliminated (Preston, 2009, p. 5). Psychotropic drugs are therefore used to positively affect the mind, emotions, and the general behavior of patients suffering from schizophrenia. Psychotropic drugs may however range from illegal drugs such as cocaine to legal drugs such as lithium (used to treat patients suffering from severe depression disorders) (Schatzberg, 2010).
There are numerous arguments regarding the use of psychotropic drugs in the treatment of schizophrenia but in clinical circles, psychotropic drugs have been observed to have positive and negative effects when treating schizophrenia. The debate involving the use of psychotropic drugs is rather controversial and not clearly understood by many researchers, especially because the use of psychotropic drugs has changed over the decades. For this reason, this study seeks to explore the historic and present use of psychotropic drugs and in this quest; we will dissect the historical and current use of psychotropic drugs across time.
In detail, this study will explore the use of psychotropic drugs in the treatment of schizophrenia by analyzing the major categories of psychotropic drugs and by pointing out which method of psychotropic treatment is majorly used to treat schizophrenia. In this regard, we will analyze historical and present forms of medications plus the developments in psychotropic drugs and their use in treating schizophrenic patients. In this manner, this study will comprehensively explore the evolution of psychotropic drugs in the treatment of schizophrenia while focusing on the core areas of treatment and the side effects (or perceptions) associated with each type of treatment.
Furthermore, this study will point out the arguments for and against certain forms of psychotropic treatment and propose various types of alternative treatment based on the reaction of patients to specific psychotropic medications. Part of the issues to be identified in this study incorporates dosages, institutionalization and patient reaction as the major bases for the evolution of psychotropic drug medications. This and other issues identified in this study are treated as important areas of research in psychotropic drug development and may be used to best comprehend the appropriateness of specific types of drugs and the controversies surrounding them. For personal reasons, I will undertake this study with the aim of giving an unbiased insight into the issues and controversies associated with psychotropic drug use in the treatment of schizophrenic patients. Comprehensively, this study will seek to demystify issues and controversies associated with the use of psychotropic drugs in the treatment of schizophrenia.
Goals and Objectives
- To determine the various types of psychotropic treatment used in the treatment of schizophrenia.
- To establish issues, controversies and new grounds of research associated with the use of psychotropic drugs to treat schizophrenic patients
Literature Review
For decades on end, psychotropic drugs have been used to treat schizophrenia because they affect the central nervous system which ultimately calms down the destabilized emotional status of schizophrenic patients. From a broad analysis, psychotropic drugs have been broadly categorized into four main categories of hallucinogens, antipsychotics, depressants and stimulants, although antipsychotic drugs have been the major form of drug used to treat schizophrenia today (Preston, 2009).
Historically, psychotropic drugs were used in medical circles to control the symptoms of schizophrenia, reduce the pain associated with the condition, and reduce nausea while increasing a patients’ appetite for food. In other words, psychotropic drugs were majorly used to suppress the adverse effects of the condition. Historically, large dosages of psychotropic drugs were used to suppress dopamine activity but currently smaller dosages are administered (McGurk, 2007, p. 435). Also, in the past, the administration of psychotropic drugs was almost entirely coupled by institutionalization of schizophrenic patients (especially when there was a likelihood of self injury) but since 1950s, hospital institutionalization has reduced (McGurk, 2007, p. 434). The most common type of historical psychotropic drugs used was marijuana which was medicinally used on patients suffering from AIDS and cancer. Alcohol also falls among the category of historical depressants under psychotropic drugs because it has the ability of improving the mood of schizophrenic patients, cause elation and reduce intense suffering caused by schizophrenia (Ananth, 2004, p. 464).
However, psychotropic drugs have been observed to have significant side effects on patients and this has also been observed to be an important field of study in psychiatry. Antidepressants such as Prozac and Zoloft have been widely used in the past to reduce depression and anxiety among schizophrenic patients but prolonged use was noted to cause anxiety because the drugs are stimulants in nature (Ananth, 2004, p. 465). Mood stabilizers and tranquilizers were therefore historically administered (instead) since they were perceived to be more effective than other types of psychotropic drugs (although they fall into the same category of depressants). These drugs were basically used to control various types of neurological disorders (especially for bipolar patients).
Today, antipsychotic drugs have been primarily undertaken as the basic method of treating schizophrenia although they were historically used in seclusion as the baseline treatment method for schizophrenic patients. Currently, the treatment method is often combined with other psychological and social support services for patients (McGurk, 2007, p. 434). Antipsychotic treatment is normally administered as the first course of treatment because it has the potential of reducing the adverse effects of schizophrenia manifested by psychosis within a matter of a week or two.
However, since schizophrenia manifests in adverse forms of cognitive impairment, antipsychotic drugs often fail to mitigate these effects and equally fail to minimize the negative effects of its use (McGurk, 2007, p. 434). There are a number of antipsychotic drugs to use but the choice of drugs to administer is usually based on a number of key parameters such as costs, benefits and effects of the drugs. The choice of drugs to use often falls between typical and atypical antipsychotic drugs but both have been observed to have the same level of relapse and drop out rates when administered to patients for a given period of time (Schultz, 2007, p. 1821).
Studies done to show the effectiveness of this course of treatment have often registered success rates of between 40% -50% (Smith, 2010, p. 338). In terms of partial responsiveness, the same studies have shown that antipsychotic drugs register successive rates of between 30% – 40% (Smith, 2010, p. 338). Other studies have noted that antipsychotic treatment may potentially fail to register the desired results after approximately six weeks of administration in less than 20% of schizophrenic patients (Smith, 2010, p. 338). In such circumstances, it has been established that clozapine treatment which is a new type of antipsychotic drug treatment, may be a good remedy for patients resistant to antipsychotic drugs (McGurk, 2007, p. 435). However, this course of treatment has serious side effects in terms of agrunolocytosis (McGurk, 2007, p. 434). Approximately 1% – 4% of patients who’ve received this treatment method suffer such side effects (Smith, 2010, p. 338).
The different types of antipsychotic drugs administered to patients suffering from schizophrenia have been noted to register different side effects. Typical antipsychotic drugs have been observed to cause extrapyramidal side effects but atypical antipsychotic drugs lead to increased chances of weight gain, increased likelihood of patients suffering from diabetes and ultimately affecting the metabolic activity of the body (Kane, 2010, p. 345). Atypical psychotic drugs are commonly known as the second generation types of drugs developed in the 1990s and apart from clozapine, it includes other drugs such as Risperidone, Olanzapine, Ziprasidone among others (McGurk, 2007, p. 434). Their effects have been observed to be modest among most patients but researchers have easily pointed out that atypical antipsychotic drugs are better than typical drugs because they cause fewer extrapyramidal effects (McGurk, 2007, p. 434). However, in the same category of atypical antidepressants, there is an increased likelihood of death when atypical antipsychotic drugs such as quetiapione and risperidione are used; although other atypical drugs such as perphernazine pose less danger when analyzed on the same parameters (Chwastiak, 2009, p. 590). Clozapine has however been identified to pose the lowest risk of death to the patients.
New studies and points of view on the use of antipsychotic drugs have however failed to show a clear relation between patient healing and the likelihood of patients developing other neurological problems such as the neuroleptic malignant syndrome (Ananth, 2004, p. 464). Depot preparations of antipsychotics have therefore been recommended for patients unwilling or unable to take drugs for long periods (although its effectiveness has often been identified to improve when it is combined with certain psychosocial interventions) (McEvoy, 2006, p. 15). Such psychosocial interventions may involve cognitive behavioral therapy and such like interventions (Wykes, 2008, p. 523). However, in cases where patients may have less tolerance for certain types of psychotropic drugs, new studies show that aripiprazole should be used because patients are more tolerant to it (especially when treating bipolar disorder and schizophrenia) (McGurk, 2007, p. 434). In fact, the drug has been approved by the US Food and Drug Administration as appropriate for the treatment of schizophrenia (McGurk, 2007, p. 434). Its uniqueness comes about because it can treat acute manic and mixed episodes of schizophrenia, an attribute which was discovered as late as November 2002 by some Japanese and American scientists.
References
Ananth, J. (2004). Neuroleptic malignant syndrome and atypical antipsychotic drugs. Journal of Clinical Psychiatry, 65(4), 464–70.
Chwastiak, L. (2009). The unchanging mortality gap for people with schizophrenia. Lancet, 374(9690), 590–2.
Kane J. (2010). Dialogues. Clin Neurosci, 12(3), 345–57.
McEvoy, J. P. (2006). Risks versus benefits of different types of long-acting injectable antipsychotics. J Clin Psychiatry, 67(5), 15–8.
McGurk, S. (2007). Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. American Journal of Psychiatry, 164(3), 437–41.
Preston, J. (2009). Clinical Psychopharmacology Made Ridiculously Simple (6th ed.). Miami, FL: Medmaster, Inc.
Schatzberg, A. (2010). Manual Of Clinical Psychopharmacology (7th ed.). Washington, DC: American Psychiatric Publishing, Inc.
Schultz, S. H. (2007). Schizophrenia: a review. Am Fam Physician, 75(12), 1821–9.
Smith, T. (2010). Schizophrenia (maintenance treatment). Am Fam Physician. 82(4), 338–9.
Wykes, T. (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophr Bull, 34(3), 523–537.