Recovery From Schizophrenia: Psychiatry And Political Economy

ANTIPSYCHOTIC DRUGS: USE, ABUSE AND NON-USE 221effect of the neurotransmitter serotonin. 5 More recently other medications with asomewhat similar mode of action to that of clozapine have been introduced andhave become widely prescribed for patients with schizophrenia. The patients inall but one of the studies on outcome from schizophrenia reported in Chapter 3,however, entered treatment before the introduction of these novel antipsychoticdrugs, so it is the action of the standard drugs that must be considered inexplaining why long-term outcome has not improved since the advent of drugtreatment.GOOD-PROGNOSIS SCHIZOPHRENIAThere is a subgroup of people with schizophrenia for which there are grounds tobelieve that drug treatment may be unnecessary or even harmful in the long run.These are the people with good-prognosis schizophrenia—the patients who showsome indication that the course of their illness will be benign. Generally speaking,these are people whose psychotic illness began with sudden onset later in life thanis usual in schizophrenia, whose previous work history and social functioninghave been good and whose illness has not yet become long-lasting. To understandwhy standard antipsychotic drugs may have a negative effect on such patients,however, we must review some of what is known of the neurochemistry ofschizophrenia and of the action of the drugs.DOPAMINE ACTIVITY IN SCHIZOPHRENIAMessages flow through the central nervous system as impulses in the nerve cells, orneurons. Where neurons link up, at the synapse, a chemical mediator is releasedfrom one cell that transmits the impulse to the next cell by its influence on aspecific receptor. A number of these neurotransmitters have been identified; some,because of their particular importance in areas of the brain concerned with theemotions, have been quite intensively studied and have been implicated in theorigin of various neurological and psychiatric disorders. Deficiencies of serotoninat brain synapses, for example, are thought to underlie the development ofdepressive illness. The neurochemical disturbances in schizophrenia are various,but a link in the chain of brain events appears to be a relative over-activity ofcertain tracts of neurons in which the chemical mediator is dopamine(dopaminergic tracts).The importance of dopamine in schizophrenia 6 is based upon two main piecesof evidence:(1) The standard antipsychotic drugs block the ability of dopamine receptors inthe synapse to respond to dopamine and thus reduce the activity indopaminergic tracts. The relative antipsychotic potency of the differentstandard antipsychotic drugs, furthermore, appears to be directly proportionalto the capacity of each drug to block dopamine receptors-specifically, the