TREATMENT OF SCHIZOPHRENIA

Schizophrenia is a chronic condition and patient needs to continue to take medications even when they feel that they are doing better. Treatment can be mostly done as an outpatient however some patients might need to be hospitalized especially if there is any question about their stability with hallucinations, delusions or any suicidal or homicidal ideation making the patient incapable to taking care of themselves.

Medications
Medications are the cornerstone of schizophrenia treatment. But because medications for schizophrenia can cause serious but rare side effects, patients may be reluctant to take them. Also if the patient has poor insight into their mental illness they might not believe that they need the medication Antipsychotic medications are the most commonly prescribed medications to treat schizophrenia. They're thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin. There are two main types of antipsychotic medications:

Conventional or typical, antipsychotic
These medications have traditionally been very effective in managing the symptoms of schizophrenia. These medications have frequent and potentially severe neurological side effects, including the possibility of tardive dyskinesia .The most common medications of this class that are used are:

Haloperidol (Haldol)
Thioridazine
Fluphenazine


These typical antipsychotic are often cheaper than newer counterparts, especially the generic versions, which can be an important consideration when long-term treatment is necessary.

New generation, also called atypical antipsychotic. These newer antipsychotic medications are effective at managing all the symptoms of schizophrenia and have been shown to actually improve the cognitive functioning of the patients. Some of the newer medications are :

Clozapine (Clozaril) –is the gold standard as far as efficacy is concerned but its side effect profile is not good and is usually relegated to the last place as far as trying different medications is concerned.

Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Paliperidone (Invega)

Risperidone (Risperdal) is the only atypical antipsychotic medication that's been approved by the Food and Drug Administration (FDA) to treat schizophrenia in children ages 13 to 17. Atypical antipsychotic medications pose a risk of metabolic side effects, including weight gain, diabetes and high cholesterol.

If one medication doesn't work well has intolerable side effects, the doctor may recommend combining medications, switching to a different medication or adjusting your dosage. Antipsychotic medication needs to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms. The idea is to take the medication that takes care of the most symptoms at the least dose .There are many new medications in the pipeline with improved side effect profiles that are being investigated even as we speak.

More about the psychosocial treatments and prevention next week…

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