Treatment

Since the exact pathophysiology of schizophrenia is still not understood, the treatment options for those living with schizophrenia focus on the symptoms of the illness, mainly hallucinations. Antipsychotic medications are the first choice for helping people with schizophrenia deal with their hallucinations. The World Federation of Societies of Biological Psychiatry (WFSBP) has done extensive research on long-term treatments for those living with schizophrenia and has come up with a set of guidelines for treating this illness. The goals for "long-term treatment include maintenance therapy to stabilise [sic] remission, prevent relapse, and provide symptom suppression or even continued symptom improvement."1 Treating the symptoms of schizophrenia is an involved process between the individual and his/her provider. This process includes assessing side effects, effectiveness of the current dose of medication, and the risk of relapse or a relapse if one has occurred.1 I will not go into all the specifics included in long-term treatment of schizophrenia, but if you are interested I strongly suggest reading the article published by the WFSBP, which is included in the reference list below.

Typical Antipsychotics

Antipsychotics can be extremely effective at eliminating the psychotic symptoms of schizophrenia and can give people the opportunity to live a normal life, even with this illness. The first wave of antipsychotics came about in the 1950s, and these include common medications like haloperidol (Haldol), chlorpromazine (Thorazine) and fluphenazine (Prolixin).2 In general this class of antipsychotics are dopamine antagonists. What this means is that the drug will bind to postsynaptic receptor sites prohibiting dopamine from binding to these sites.3 If you remember in the pathophysiology post I explained that one problem people with schizophrenia have is too much dopamine in their brains. Too much dopamine is what causes psychosis. By inhibiting dopamine from binding to receptors, psychotic symptoms are then decreased.

As with any medication, antipsychotics have side effects, which can lead to patient nonadherence if severe enough. Some of the more serious side effects associated with typical antipsychotics are sedation, orthostatic hypotension (feeling dizzy or lightheaded when going from laying/sitting to standing), dry mouth, blurred vision, and extrapyramidal symptoms (EPS).3 EPS includes tremors and other uncontrollable movements, especially of the face, which is known as tardive dyskinesia.

Atypical Antipsychotics

The second generation of antipsychotics was developed during the 1990s and includes drugs such as olanzapine (Zyprexa), aripiprazole (Abilify), and risperidone (Risperdal).2 These medications are both dopamine and serotonin antagonists, and, unlike the typical antipsychotics, these not only help eliminate psychotic symptoms, they also help with the negative symptoms of schizophrenia.3

As far as effectiveness of long-term treatment of schizophrenia, there is not a marked difference between the typical and atypical antipsychotics.1 The differences come in the price tag, atypicals are much more expensive, and the side effects. The atypical antipsychotics have fewer EPS, but can still cause sedation. However, the major disadvantage of this class of drugs is they can cause what is called metabolic syndrome. Metabolic syndrome is uncontrollable weight gain and can lead to diabetes, dyslipidemia (high cholesterol), and even heart problems.3

As with any disease or illness the pros and cons of various medications need to be taken into account when starting medications for treating the symptoms of schizophrenia. An open dialogue needs to be maintained with the provider so he/she is aware of positive or negative changes the patient is experiencing. This is very crucial for long-term treatment of this illness.

If you are interested in further reading on schizophrenia, I suggest this article from The American Scholar titled "Living with Voices" found at this link: https://theamericanscholar.org/living-with-voices/#.VN0ZK-bF91Y

References:

1: Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W. F., & ... Möller, H. (2013). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, Part 2: Update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. The World Journal Of Biological Psychiatry, 14(1), 2-44. doi:10.3109/15622975.2012.739708

2: Schizophrenia. (n.d.). Retrieved February 11, 2015, from http://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml#pub7

3: Stuart, G. (2013). Chapter 20: Neurobiological Responses and Schizophrenia and Psychotic Disorders. In Principles and practice of psychiatric nursing (10th ed., pp. 549-555). Maryland Heights, Mo.: Elsevier Saunders.