Given that our discussion in class was based on antipsychotics I thought I would make my post about the role they play in the world of mental illness. So here we see this medication as the last resort of hope in the case of many schizophrenics. Yes, it is true that it in some cases it works like a charm. In other cases, symptoms of psychoses continue to persist and not much of a beneficial change is brought on by the medication, leaving the patient at pretty much the same level of illness. Proceeding in a different direction I began to think of situations in which the use of antipsychotic medication could lead one into a worse off state than that they were in before medication. In other words, I’m basically talking about serious side effects which almost make one reconsider the use of medication at all. In such a case, a trade off is introduced into the picture. Is it worth medicating oneself to treat severe symptoms of illness if the potential risk or cost of doing so is very high?
It is has been proved that antipsychotics are often used for disorders extending beyond schizophrenia. These include bipolar disorder, as well as Alzheimer’s disease and other advanced forms of dementia. Antipsychotics are used as a potential treatment for the behavioral symptoms of dementia which include delusions, hallucinations, aggression, agitation and in some cases violence- all similar to the behavioural symptoms of schizophrenia. However even though a similarity between schizophrenia and dementia in behavioural manifestations could suggest common etiological roots and hence a potential benefit of similar medication, the FDA has speculated the dramatic costs of using this medication in the case of elderly patients suffering from dementia. It is now required for antipsychotic medication to carry a boxed mortality warning of an increased risk of death in this population of elderly people.
It is a fact, that this is a warning addressed particularly to older patients suffering from dementia, and not to older or younger patients suffering from schizophrenia or bipolar disorder (who are also treated with the same medication). My thinking makes me link the increased mortality risk to an interaction of antipsychotics with the conditions of old age and dementia together. I now wonder, what mechanism is it that is specific to both these variables that may cause antipsychotics to be dangerous and fatal?
When I think old age, I think decreased neural plasticity and decreased neurogenesis. When I think dementia, I think decreased cognitive capacities specific to memory and hence hippocampal development. When I think antipsychotics I think primarily about a decrease in dopaminergic receptor action. Putting all together produces a state of decreased neurogenesis, very likely in the hippocampus (among other regions) as well as a potential decreased activity of dopamine in regions connected to the hippocampus. Granted this is a painfully reductionist view of all conditions; but I’m trying to understand the complex idea or mechanism behind an increased mortality rate, only pertaining to this population, by starting with simple reasoning.
Being a novice in this field, maybe there is something I’m completely missing out on, due to my limited understanding of mental illness and pharmacology. My guess is that, it potentially has something to do with increased vulnerability due to decreased neurogenesis. I tried to research the mechanistic reasoning behind this fatalistic occurrence, but it still seems to be blurred in the world of science too. I’m putting it up here, to see if you guys had any potential thoughts/hypotheses or reasoning behind why this medication, if administered to this specific population, could in fact be a prescription for death.
On Psychology and Neuroscience 
It is amazing to me that neurogenesis could manifest itself in so many different ways. There must be a more specific treatment for individual diseases. I know there are many different ways to increase neurogenesis, but decreases in neurogenesis must stem from different malfunctions in the pathway. I unfortunately don’t have a guess as to why intense and sometimes fatal side effects occur with this medication, but more research and a more targeted medication may be able to better treat those who suffer from neural degeneration.
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We did not really talk about the side affects and mortality rate caused by antipsychotic drugs, and I did not realize the drastic affects the medication could have. The video we watched about a man not on drugs trying to refill his subscription led to me to believe the drugs were often very helpful, but how can doctors know exactly how to treat a disease if they do not know exactly what the disease is and what it is caused by? This proves how much more research needs to be done to determine exactly what it is that causes schizophrenia, or if there are possibly different types of schizophrenia the way there are different types of other diseases (such as viral or bacterial bronchitis). If it turns out there are different types of schizophrenia that can be differentiated and categorized, it would be beneficial to create drugs specific to each type of the disorder.
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You bring up a great point. I watched the 20/20 special on childhood schizophrenia today. I was completely taken aback by the girls’s actions. I knew that it is possible to develop schizophrenia as a child, but as the affected population is so small, I had never really thought about how the disease would affect childhood as well as families. I agree with you about the idea of a trade off when one decides to go on anti-psychotic medication. Parents on the show described the amount of drugs their children had to take as a “small pharmacy.” First of all, how can we be sure that the side effects of taking such a large dosage of incredibly potent medications is not doing more harm than actually helping? And secondly, in terms of childhood disorders, how do we make sure the child really understands what medications they are taking and has given consent when they are legally under the control of their parents? Something that really surprised me about the children as they were being interviewed was how much they seemed to know about schizophrenia; one girl was even able to distinguish why her type (paranoid) was different from childhood schizophrenia. If children are able to understand what it is that is happening, should we experiment with adding more psychological counseling and lessening the amount of medication given? As was shown in the documentary, children can change drastically throughout development and are even capable in some cases of seemingly conquering their schizophrenia.
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I think your hypothesis makes a lot of sense. Because individuals with dementia have experienced significant cortical atrophy in the frontal cortex, temporal and parietal lobes, they may be at risk of mortality moreso than schizophrenics due to the nature of anti-psychotic drugs. Since many anti-schizophrenic drugs target hyperactivity in the nucleus accumbens by decreasing dopamine receptor activation pre-synaptically or post-synaptically, any dopaminergic neurons in the aforementioned atrophied regions in dementia patients would be put at more of a disadvantage. This could ultimately decrease brain function drastically, resulting in mortality.
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This paper was a very interesting look into the effects of antipsychotics. I think you got to the core of the issue with antipsychotics when talking about the effects on dopamine in the brain. A lot of people who are older and suffering dementia may already have extreme issues in their brain that are only proliferated by their use of antipsychotics. While it may be less of a problem for younger people, they can certainly run into issues as well. I think the conclusions that you draw about decreased neurogenesis are definitely valid. If these antipsychotics are decreasing neurogenesis even more, it makes the problem that much worse. I would be interesting to look at some of the other possible implications in the future.
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This journal entry is very interesting. I remember watching a documentary on schizophrenia in high school in which the patient never wanted to take his antipsychotic drugs. He claimed that the pills only made his life worse and unbearable, but in reality, he couldn’t function without them. After many failed attempts, his doctors were finally able put together a cocktail of drugs to assess his symptoms. Hopefully, new and better antipsychotics will be developed in a near future.
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I think that the differential effects of drugs on varying ages gives us great insight into how crucial some aspects of the aging process are. While we may not have it all figured out yet, (such as why antidepressants can increase depression and suicidal thoughts in adolescents), it would be beneficial to focus in on exactly how our brains are changing. Knowing how different brains REACT to a drug is just as important as knowing what the drug is supposed to do to the brain.
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I think this is a really interesting point you bring up. I have definitely wondered myself about why these medications would be so detrimental to the elderly. I have never found any compelling evidence as to why, but I am definitely concerned about why this may be happening. I think that if scientists are able to figure out what the mechanisms are that would cause such problems, that we might be able to find some answers for the more specific actions of these drugs. Just a thought.
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