Schizophrenia Part 2

Medication used to treat

This is a continuation of last week’s article in which I discussed causes and symptoms of schizophrenia. Last week I described how antipsychotic drugs are the main class of medication used to treat schizophrenia and are broadly divided into two categories; older typical or newer atypical antipsychotics.

Choice of Drug

No one drug can be considered significantly better than the others, however one may be better for one individual than another. For example, some are more sedating than others so may be suitable for patients who are agitated or cannot sleep. If one does not work so well, a different one is tried until a good response occurs. A good response to antipsychotic medication occurs in about 70% of cases. For patients with only one episode of schizophrenia and remain symptom free for two years with treatment, the medication may then be discontinued slowly; closely monitored for relapse when medication is being discontinued.

Side effects of medication

Side effects of older schizophrenia drugs

Anticholinergic side effects are more common with the older typical anti-psychotics and include dry mouth, blurred vision, flushing and constipation. These tend to be worse at the start of treatment and often ease off. Drowsiness is also common but may be reduced by reducing the dose. Extrapyramidal side effects (movement disorders) can occur with typical antipsychotics. Chlorpromazine has a tendency to cause skin photosensitivity when exposed to sunlight. Sunscreen must be used if going out in strong sun while taking chlorpromazine.

Side effects of newer schizophrenia drugs

Reduced risk of movement disorders is the main reason atypical antipsychotic drugs frequently are first choice for treatment. Atypical antipsychotics have their own risks; particularly the risk of weight gain and this increases risk of developing diabetes and heart problems (due to raised cholesterol). Longer term blood sugars and cholesterol levels should be monitored regularly. Weight gain appears to be a particular problem with clozapine and olanzapine. Other medication sometimes used to treat schizophrenia include the likes of antidepressants and mood stabilisers (ask in store for longer version of this article which has more detail on these)

What is the outlook (prognosis)?

In most cases there are recurring episodes of symptoms (relapses). Most people live relatively independently with varying amounts of support. Frequency and duration of each relapse can vary. Some people recover completely between relapses. Some people improve between relapses but never quite fully recover. Treatment often prevents relapses, or limits their number and severity.

Outlook is thought to be better if:

• Treatment is started soon after symptoms begin.
• Symptoms develop quickly over several weeks rather than slowly over several months
• The main symptoms are positive symptoms rather than negative symptoms.
• The condition develops in a relatively older person (aged over 25).
• Medication is taken as advised.
• There is good family and social support which reduces anxiety and stress.
• Abuse of illegal drugs or alcohol does not occur.

Newer drugs and better psychological treatments (discussed in more detail in my longer article) mean that prognosis is now better than it was in the past.

Whelehans Pharmacy, 38 Pearse Street, Mullingar. Tel 04493 34591. Eamonn’s full comprehensive article is available in Whelehans on request. Ask staff for a free copy.