Treatment of Schizophrenia

Antipsychotics, rehabilitation with community support services, and psychotherapy are the major components of treatment.

When treated early, schizophrenia patients tend to respond more quickly and fully. Without ongoing use of antipsychotics after an initial episode, 70 to 80% of patients have a subsequent episode within 12 months. Continuous use of antipsychotics can reduce the 1-year relapse rate to about 30%. Because schizophrenia is a long-term and recurrent illness, teaching patients self-management skills is a significant overall goal.

Antipsychotic Medication for Treating Schizophrenia

Psychiatrists have found a number of antipsychotic medications that help bring biochemical imbalances closer to normal. The medications significantly reduce the hallucinations and delusions and help the patient maintain coherent thoughts. Like all medications, however, antipsychotic drugs should be taken only under the close supervision of a psychiatrist or other physician.

Antipsychotics are broken down into two categories: Typical or conventional antipsychotics are the older antipsychotic medications. These include Chlorpromazine, Thioridazine, Trifluoperazine, Fluphenazine, Haloperidol and others. About 30% of patients with schizophrenia do not respond to conventional antipsychotics, but they may respond to Atypical or second-generation antipsychotics. These include Abilify, Clozaril, Geodon, Risperdal, Seroquel, and Zyprexa.

The reported advantages of atypical antipsychotics is that they tend to alleviate positive symptoms; may lessen negative symptoms to a greater extent than do conventional antipsychotics (although such differences have been questioned); may cause less cognitive blunting; are less likely to cause extrapyramidal (motor) adverse effects; have a lower risk of causing tardive dyskinesia; and for some atypicals produce little or no elevation of prolactin.

Side Effects of Antipsychotic Medications

Like virtually all other medications, antipsychotic agents have side effects. While the patient's body adjusts to the medication during the first few weeks, he or she may have to contend with dry mouth, blurred vision, constipation and drowsiness. One may also experience dizziness when standing up due to a drop in blood pressure. These side effects usually disappear after a few weeks.

Other side effects include restlessness (which can resemble anxiety), stiffness, tremor, and a dampening of accustomed gestures and movements. Patients may feel muscle spasms or cramps in the head or neck, restlessness, or a slowing and stiffening of muscle activity in the face, body, arms and legs. Though discomforting, these are not medically serious and are reversible.

Weight gain, hyperlipidemia, and development of type 2 diabetes are among the more serious side effects of atypical antipsychotics such as Zyprexa, Risperdal, Abilify and Seroquel. Clozaril's most serious adverse effect is agranulocytosis, which can occur in about 1% of patients. Clozaril is generally reserved for patients who have responded inadequately to other drugs. Patients should be routinely monitored for all these conditions.

Because some other side effects may be more serious and not fully reversible, anyone taking these medications should be closely monitored by a psychiatrist. One such side effect is called tardive dyskinesia (TD), a condition that affects 20 to 30 percent of people taking antipsychotic drugs. TD is more common among older patients.

It begins with small tongue tremors, facial tics and abnormal jaw movements. These symptoms may progress into thrusting and rolling of the tongue, lip licking and smacking, pouting, grimacing, and chewing or sucking motions. Later, the patient may develop spasmodic movements of the hands, feet, arms, legs, neck and shoulders.

Most of these symptoms reach a plateau and do not become progressively worse. TD is severe in less than 5 percent of its victims. If medication is stopped, TD also fades away among 30 percent of all patients and in 90 percent of those younger than 40. There is also evidence that TD subsides eventually, even in patients who continue with medication. Despite the risk of TD, many suffering with schizophrenia accept medication because it so effectively ends the horrifying and painful psychoses brought on by their illness. However, the unpleasant side effects of antipsychotic medication also leads many patients to stop using medication against the advice of their psychiatrist. The refusal of patients with schizophrenia to comply with psychiatrists' treatment recommendations is a serious challenge to those specializing in the treatment of chronically mentally ill people. Psychiatrists treating people with schizophrenia must often practice with tolerance and flexibility to overcome this resistance.

continue: Non-Medication Treatments for Schizophrenia