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.