Schizophrenia

 


Treatments

  
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How is it treated?

Schizophrenia symptoms are thought to be the result of an imbalance/dysregulation of neurotransmitters and degenerative brain changes.  Medications to treat schizophrenia work by either decreasing the availability of the neurotransmitters or decreasing production of them.  There are several classes of medications used, each with significant side effects.  The following is by no means a comprehensive list, but can provide general information about schizophrenia medications.   Any medication used to treat schizophrenia should never be stopped abruptly because it can trigger a severe relapse.

Typical Antipsychotics:  this class of medications blocks dopamine transmission in the brain.  This class of medications has many side effects, some of which can lead to long-term problems or death.  As a medication class, the following side effects exist:  akathisia (a burning desire to move a body part), oculogyric crisis (the eyes roll back into the head), torticollis (the neck is pulled to one side), retrocollis (the neck is pulled back, forcing the person to continually look up), tardive dyskinesia (movements that include lip smacking, sucking, puckering, tongue protrusion, choking sensation, jerking movements of the fingers or toes), orthostatic hypotension (a drop in blood pressure when sitting up in bed or standing that can cause dizziness or falls), lactation, gynecomastia (breast development in men), menstrual irregularities, sedation, blood dyscrasias (essentially problems with blood elements that can lead to significant, life threatening infections), neuroleptic malignant syndrome (muscle rigidity, high fever, changes in heart beats-life threatening) and weight gain.  Due to the extensive side effects of this class of drugs, they aren’t as frequently prescribed as they were in the past.  For each individual drug there are additional side effects that are specific to that drug.

Brand name/Generic name

Typical use

Side effects

Thorazine/chlorpromazine

   

Symptom management for schizophrenia to control excessive anxiety, agitation and hallucinations/delusions/illusions

Generalized swelling, lupus-like symptoms, changes in heart beat, heartburn, headache, insomnia, blurred vision, urinary retention (have to pee, but can’t), hives.

Haldol/haloperidol

   

Symptom management for schizophrenia to control excessive anxiety, agitation and hallucinations/delusions/illusions

Euphoria (feeling really good), depression, agitation, hyperthermia (feverish), grand mal seizures, in some cases can make symptoms worse.

Trilafon/perphenazine

   


 

Symptom management for schizophrenia to control excessive anxiety, agitation and hallucinations/delusions/illusions

Blurred vision, near-sightedness, constipation, abnormal liver function, photosensitivity, itching, fever, sterile abscesses, congestion, decreased sweating.

Prolixin/fluphenazine

Symptom management for schizophrenia to control excessive anxiety, agitation and hallucinations/delusions/illusions

Depression, impaired body temperature regulation (the person may not recognize the need for a coat for example), photosensitivity, congestion, dry mouth, nausea, urinary retention.


 

   

Atypical Antipsychotics:  these blocks dopamine and serotonin transmission in the brain.  As a class of medications, this group is known to cause significant weight gain which leads to the development of type II diabetes.  Cardiac arrhythmias and dysrhythmias (missed or skipped heartbeats) and blood dyscrasias (anemias which can be fatal) have also been linked with this class of drugs.

Brand name/Generic name

Typical use

Side effects

Zyprexa/olanzapine

Symptom management for schizophrenia to control excessive anxiety as well as treat problems with depression, motivation, apathy and anhedonia

Back & chest pain, swelling of the fingers, toes, or legs, joint pain, muscle twitching, stuttering, hypotension, constipation, dry mouth, increased saliva, vomiting, PMS, bloody urine, incontinence cough or rash.

Seroquel/quetiapine

   


 

Symptom management for schizophrenia to control excessive anxiety as well as treat problems with depression, motivation, apathy and anhedonia

Swelling of the hands and feet, flu-like symptoms, dry mouth, joint pain, constipation, lack of interest in eating, cough, difficulty breathing, rash, sweating, headache, dizziness, stomach pain.

Risperdal/risperidone

   

Symptom management for schizophrenia to control excessive anxiety as well as treat problems with depression, motivation, apathy and anhedonia

Sedation, drowsiness, headache, blurred vision, sweating, increased dreaming, anxiety, insomnia.

Geodon/ziprasidone

   

Symptom management for schizophrenia to control excessive anxiety as well as treat problems with depression, motivation, apathy and anhedonia

Muscle aches, flu-like symptoms, facial swelling, low body temperature (chills), tremor, confusion, double vision, nausea, vomiting, stomach pain, heartburn, cough, difficulty breathing, rash, photosensitivity, hypertension.

Abilify/aripiprazole

   

Symptom management for schizophrenia to control excessive anxiety as well as treat problems with depression, motivation, apathy and anhedonia

Headache, tingling, fever, flu-like symptoms, swelling of the hands, feet, or legs, chest pain, hostility, suicidal thoughts, depression, nervousness, anxiety, muscle cramps, blurred vision.

Clozaril/clozapine

   


 

Limited to control of schizophrenia symptoms in patients who have not responded to other medications.

Risk of developing infections in the heart muscle or heart sac within the first month of use, developing fluid around the heart, heart failure, heart attack, heart valve problems, nausea, dry mouth, constipation, increased saliva, agranulocytosis (a potentially fatal blood disease where the building blocks of blood cells aren’t produced), fever, urinary retention.  This medication is a last resort medication due to its significant adverse effects.

   

   

More medication information?

All of the medications used to treat schizophrenia have undesirable side effects.  Finding the right one requires a partnership with the physician.  If one medication helps the symptoms but worsens quality of life, it isn’t the right medication for the individual.  Taking the medicine is the most important thing a person with schizophrenia can do to prevent further decline and manage their lives independently.  Abruptly stopping any of the medications can trigger a relapse with significant symptoms.  It is possible to relapse even while taking the medication as prescribed, however, these relapses tend to be mild and more easily managed.

 It is possible for a person with schizophrenia to live a normal life.  They are not any more crazy, dangerous, or destructive than someone who has a diagnosis of diabetes.  The stigma associated with schizophrenia has a misguided, historical basis that is slowly starting to wane.

Are there any other treatments in addition to medication?

Yes.  Many people with schizophrenia benefit from support groups run by a qualified psychiatrist.  Through the group people prevent isolation, socialize, and address issues that are stressful in their daily lives.  Cognitive-behavioral therapy is a tool used to help with problems stemming from a lack of motivation like hygiene issues, learning job skills, grocery shopping, etc.  Assertive Community Treatment is a program available to teach job skills and provide employment, as well as coordinate services within the community.