Please Support the Monkey! Tell All your Friends and Teachers
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Please Support the Monkey! Tell All your Friends and Teachers |
During the 1950s, a radical change was recorded in the clinical outlook of patients in mental institutions previously thought to be hopelessly psychotic by the development of neuroleptics, which are antipsychotic drugs. Psychotherapy was made possible by controlled delusions resulting from daily medication. Many who earlier had no chance of returning to society left institutions. Now physicians have learned that there is a price to be paid for these benefits. A group of symptoms, tardive dyskinesia were developed by about 10 to 15 percent of the patients undergoing long term treatment with antipsychotic drugs. Involuntary repetitive movement of the tongue, mouth, and face and sometimes the limbs and trunk were the most common symptoms. These drugs hinder the action of dopamine, an important neurotransmitter in the brain, by binding to the dopamine receptors of nerve cells, and dopamine is a prime suspect in the pathophysiology of schizophrenia. Large doses of drugs such as amphetamines, lead to the stimulation of the secretion of dopamine, producing a psychosis resembling schizophrenia. The delusions, which cause psychotic behavior, are alleviated if the activity of this neurotransmitter is reduced. Researchers are of the view that the central nervous system in certain patients adapts to long term therapy by increasing the number of specific dopamine binding sites, though the inhibition of dopamine activity can control psychotic behavior. Finally it results in dopamine hypersensitivity, which is correlated with the subsequent appearance of tardive dyskinesia. The doctors have not yet considered abandoning the usage of antipsychotic drugs as the risk of developing tardive dyskinesia is not very great. The physical side effects are very mildly bothersome, though the abnormal movements are troublesome and may hinder social adjustment. But the movement disorders can be decreased by early diagnosis and prompt discontinuation of the neuroleptics. Regrettably the psychotic behavior returns when the administering of neuroleptic drugs is stopped. By lowering the dosage to a level , which both minimizes movement disorders and yet controls psychosis the researchers have attempted to achieve a satisfactory balance between the two effects. In a five-year study of twenty-seven psychiatric patients treated with neuroleptics representing all classes of antipsychotic drugs, researchers attempted to decrease drug doses to their lowest effective levels. The studies have shown that both low and moderate doses of antipsychotic drugs can control psychoses as effectively as high doses and that tardive dyskinesia exhibited a stabilizing, a gradual diminishing or a complete disappearance. A drug more specifically affecting the mechanism of psychoses might not cause movement disorders this is suggested by the fact that psychoses can be controlled at the same time that tardive dyskensia symptoms are reduced. Sulpiride, a drug not available in the United States but widely used in Europe, where it was developed, may be one such alternative. Sulpiride selectively blocks D-2 dopamine receptors, probably especially in the limbic area of the brain, which is connected to emotions and behavior. It does not adversely affect the adenylate eyelase-linked D-1 dopamine receptors. Researchers have not been able to say whether sulpiride suppresses tardive dyskenesia over a long period of treatment, though it has proven effective in the short term. |
Index
Test 1
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