Treatments for Schizophrenia
What Is Schizophrenia?
Schizophrenia is a severe and chronic mental disorder that can affect how an individual feels, thinks, and behaves. Individuals with schizophrenia can appear as though they have lost their grasp on reality. Although schizophrenia is less common than other mental disorders, the symptoms of this condition can be highly debilitating.
Some of the symptoms that have been linked to schizophrenia are:
Behavioral:
- Disorganized behavior
- Social isolation
- Aggression
- Compulsive behavior
- Agitation
- Lack of restraint
- Self-harm
Cognitive:
Mood:
- Anxiety
- Anger
- Apathy
- Feeling detachment from self
- Loss of interest in activities
- General discontent
- Elevated mood
Psychological:
- Paranoia
- Hallucinations
- Hearing voices
- Fear
- Depression
- Religious delusions
- Persecutory delusions
The exact cause of this disorder is unknown. However, a combination of environmental factors, genetics, and altered brain structure and chemistry could play a part in the development of schizophrenia.
Managing schizophrenia is often a tricky process. Typically, the main issues that doctors will attempt to manage are psychotic symptoms, such as hallucinations and delusions, using medications that are called anti-psychotics. The treatment for schizophrenia is often a lifelong process involving a mixture of psychotherapy and medications.
Types of Anti-Psychotics
Anti-psychotics can be broken up into older drugs, sometimes called First Generation Anti-psychotics (FGA). These drugs are also called Typical and the newer drugs are called Second Generation Anti-psychotics (SGA), these can also be called Atypical. Most of these work by blocking a specific type of receptor called Dopamine Receptor D2.
The blocking of these receptors has been known to help with psychotic symptoms. It is obvious that they are helpful for most of the individuals’ that take these drugs. SGAs are usually preferred over FGAs because they usually have less side effects that cause movement disorders, like Parkinsonism. These movement type side effects are also called extra-pyramidal side effects.
The Difference Between FGAs and SGAs
The main difference between FGAs and SGAs is thought to be that SGAs have a tendency to block Serotonin Receptor 5HT2 with a higher potency than FGAs and block Dopamine Receptors less than FGAs. This has been shown to result in less extra-pyramidal side effects. That's not to say that there are no side effects at all though. Depending on the stage, schizophrenia can be managed using different treatments. In treating someone in their first episode of psychosis, who is said to be in their acute phase, or when they are relapsing after not experiencing episodes of psychosis for some time; the main goal should be to reduce the severity of psychotic thoughts and behaviors. Patients experiencing their first episodes will often respond better than patients who are relapsing, and so they might be able to take lower doses of their medication. Since everybody responds so differently to anti-psychotic medications, they will often be trialed to find the right anti-psychotic for each person. One of the FGAs can be administered to a patient, which seems to help with their psychotic symptoms, meaning symptoms like delusions and hallucinations tend to be reduced, but they are experiencing spasms and movements as a side effect. Knowing this, switching to SGAs that tend to produce less movement related side effects should be recommended. After these trials of different medications, the right ones are found for the patient and their symptoms are reasonably controlled.
At this point, the patient is essentially recovered from the acute phase and enters the stable/maintenance phase. The goal in this phase is to prevent a relapse by minimizing symptoms and trying to improve any areas of life that have been impaired, like relationships or work capabilities. During this time, therapy might be added into the treatment plan to help. It is also necessary to focus on things like stress reduction as well as creating support networks of family and friends. Finally, emphasizing the importance of minimizing the use of drugs and alcohol.
Managing Side Effects of Anti-Psychotics
In this phase of treatment, even though psychotic symptoms might be under control, managing side effects of the medications themselves is a really important part of managing Schizophrenia and improving quality of life. One helpful mnemonic that might assist us in looking for side effects is SHEWA, which stands for the following:
- Sedation: which is a state of being calm or sleeping.
- Hypotension: which is low blood-pressure.
- Extra-pyramidal: which is movement related.
- Weight: as in weight gain.
- Anticholinergic: things like dry mouth, blurred vision, constipation, sexual dysfunction, metabolic or glucose tolerance and endocrine, such as hyperprolactinemia, which is high levels of prolactin in the blood.
Most of the time, schizophrenia also comes with other symptoms, besides psychosis. Symptoms such as depression and manic-depression can be noticed in a schizophrenic patient. Depression will usually be treated with antidepressants, where manic-depressive episodes can be treated with mood stabilizers.
Relapses in Schizophrenic Patients
Relapse is relatively common. Even those that are on anti-psychotic medications experience relapses about 20% of the time. However, those who are not being treated with anti-psychotics have about a 75% chance of relapse. Thus, the risk of relapse is significantly higher for those who are not being treated with anti-psychotics. Additionally, after each relapse, the stable baseline of functioning usually gets worse. If a patient is currently stable and being treated, but still has some side effects and symptoms after an episode of psychosis in relapse, he might come back to a baseline that is worse than before. There are a couple of factors that seems to be associated with a worse prognosis, and simply being male is one of them. An early onset seems to also be associated with worse prognosis. Another factor for worse prognosis is a strong family history of schizophrenia, meaning the more family members that have schizophrenia, the worse the outlook on your prognosis is.
The Bottom Line
In summary, positive symptoms, like delusions, hallucinations, disorganized thinking, and behavior typically improve over time with treatment. Unfortunately, negative symptoms that tend to be socially debilitating, such as apathy or ‘flat affect’, have a tendency to get worse over time. It is unclear at this point why this is the case. Finally, another difficulty with treating schizophrenia is non-compliance with medications and treatments. About 50% of patients within the first one to two years will be non-compliant in some way, which tends to make the prognosis even worse.
