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Medications used to treat schizophrenia are called antipsychotics. They help relieve the hallucinations, delusions, and thinking problems associated with the disease. These medications seems to work by correcting an imbalance in the chemicals that help brain cells communicate with each other.
A number of new medications have recently been developed for schizophrenia. These are called atypical antipsychotics because they are less likely to cause extrapyramidal side effects (EPS), which are the most disabling and distressing side effects associated with the conventional antipsychotics (see below). Also, many patients experience better positive and/or negative symptom control with the atypical antipsychotics. Examples of atypical antipsychotics are:
Because of side-effect problems, clozapine is reserved for situations in which other antipsychotics medications have failed. All of the other atypical antipsychotics can be used at any time for the appropriate reason(s).
Antipsychotics that have been in use for a long time are called conventional antipsychotics. Some of the most common conventional antipsychotics are:
How are antipsychotics given? Antipsychotic drugs are usually taken daily in tablet or liquid form. Fluphenazine, (Prolixin) and Haloperidol (Haldol) can also be given in “depot formulations” by injection at 1-4 week intervals. With depot formulations, medication is stored in the body and slowly released. This can be especially helpful for patients who have a hard time sticking with their treatment.
Selecting medications for a first episode of schizophrenia. Most experts suggest treating the first episode of schizophrenia with one of the newer atypical antipsychotics. This is to decrease the overall side-effect burden for the patient. There is no agreement, though, on which of the first-line atypical should be tried first; each of these medications has its own strengths and weaknesses relative to the others. It is too early to tell for sure whether starting with the newer medications will improve the prognosis for the first-episode patients with schizophrenia, but many doctors are optimistic that the newer antipsychotics will help many patients do better than had ever been thought possible on the older medications.
Selecting medication for later, recurrent episodes. The first thing the doctor will want to find out is whether the patient has been taking the medication in the recommended doses and if not, why not. Very often breakthrough episodes result from medication noncompliance, which is often related to troubling EPS. If the patient stopped medication because of side effects, the doctor may consider switching to an atypical antipsychotic that has fewer EPS than the previous medication. If the noncompliance is due to problems other than side effects, such as a lack of insight into the illness, the doctor may suggest switching to a depot formulation.
Medications for patients who continue to have symptoms. There are a lot of choices for patients who don’t respond to the first antipsychotics tried. The newer medications can often help patients whose symptoms don’t respond completely to the conventional antipsychotics. Patients who don’t respond to one of the newer medications will often respond to one of the other newer antipsychotics. There is no agreement yet on which “first line” atypical antipsychotic. Should other medications fail, clozapine should be tried.
Medication during the recovery period. It is very important that patients stay in treatment even after recovery. If patients stop taking their medications after a first episode of schizophrenia, four out of five will have another relapse within one year. Even first episode patients who fully recover from their acute episode should stay on antipsychotic medication for at least 12 months. If patients have more than one episode of schizophrenia or have not recovered fully from a first episode, treatment will usually continue indefinitely. Patients with schizophrenia have to take their medications for a long time, frequently all of their lives.
How successful are treatments for schizophrenia? Schizophrenia is a highly treatable disease. Like diabetes, a cure has not yet been found, but the symptoms can usually be controlled with medication. Prospects for the future are constantly brighter through the pioneering exploration s in brain research and the development of the newer medications. To achieve these results however, patients must stick to their treatment, take medicine as directed, and avoid substance abuse. Even if you have felt better for a long time, you can still have a relapse if you go off your medication.
What are the possible side effects of antipsychotic medications? Because people with schizophrenia have to take their medications for a very long time, often for their whole life, it is very important to recognize and try to treat and side effects they may have from these medications.
Of most concern are a group of side effects known as extrapyramidal side effects (EPS). EPS are much more of a problem with the older conventional antipsychotics. Antipsychotics can make patients feel slowed down and stiff, or shake with a tremor. They can also make people feel so restless that they walk around all the time and cannot sit still. Long-term use of antipsychotic medications can sometimes cause a side effect called tardive dyskinesia, which is a writhing movement often in the tongue or mouth. Fortunately, although there still are some EPS problems, the newer atypical antipsychotics are much less likely to cause EPS.
After discharge. When patients are discharged from inpatient care, they are usually not fully recovered. This can be a difficult time with increased risks for relapse, substance abuse, and suicide. Medications are almost always recommended for after discharge. Inpatient staff will provide the patient with enough medication to last until the first outpatient appointment. They will usually schedule this appointment for the patient, ideally within a week after discharge.
During the maintenance phase of treatment, outpatient staff should provide education for patient and family about the illness. The outpatient staff should also teach the family skills for coping with the difficulties of having a relative with schizophrenia and encourage them to recognize early warning signs of relapse.