US Pharm. 2023;48(5):15-16.
Complex Mental Illness
Schizophrenia is a serious, chronic mental disease that affects a person’s mood, understanding of reality, and ability to think clearly. Schizophrenia is a lifelong illness that affects over 1% of the U.S. population. Although its cause is unknown, it has a confirmed genetic component as well as an environmental link. Schizophrenia can potentially cause a wide variety of symptoms, which usually appear sometime in the late teens to twenties. Researchers believe that these symptoms are somehow related to abnormalities in brain chemicals, including dopamine and glutamate, and differences in brain structure. Men and women are equally at risk for developing schizophrenia.
Symptoms are initially subtle and progress slowly, marked by social withdrawal, irritability, and trouble sleeping and concentrating. In the early stages, diagnosis may be difficult because many symptoms are similar to those of mood disorders such as depression and anxiety. As the disease progresses, there are more distinguishing features of schizophrenia, including suspicion about others; suicidal thoughts; addiction to nicotine, alcohol, or other drugs of abuse; or problems in making decisions or staying focused.
The three types of symptoms associated with schizophrenia are classified as positive, negative, and cognitive. Positive symptoms are the ones most often associated with schizophrenia, and they include hallucinations, such as hearing voices that do not exist, or delusions, such as the belief that others are controlling a person’s thoughts. Negative symptoms are typically similar to depressive symptoms and may cause a patient to lose interest in everyday activities, including personal hygiene or conversation with others. Cognitive symptoms involve problems in thinking, which can result in illogical connections of random thoughts. Not everyone with schizophrenia experiences all three types of symptoms, although many patients suffer from more than one type.
Drug Therapy and Avoiding Relapse
It is critical that those with schizophrenia receive the correct diagnosis and prompt treatment. Treatment is focused on symptom relief and providing the ability to live an independent and productive life.
Drugs used to treat schizophrenia work to balance the amount of natural chemicals in the brain. These agents include the “typical” or first-generation antipsychotics and the “atypical” or second- and third-generation antipsychotics. First-generation antipsychotics include chlorpromazine, fluphenazine, haloperidol, and perphenazine. Although these drugs are effective, their long-term use can result in a muscle-movement disorder known as tardive dyskinesia, which consists of fine tremor, muscle spasms, and rigidity. Second-generation antipsychotics include aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone. These medications, though less likely to cause movement disorders, have a unique set of side effects, including weight gain, high cholesterol, and an increased risk of diabetes. Anyone taking either type of antipsychotic should be monitored routinely for side effects. Antipsychotics should not be stopped abruptly, and they should always be tapered off slowly and replaced with another drug according to a physician’s directions.
Antipsychotics Are the Most Effective Treatment
Antipsychotics often improve many of the symptoms of schizophrenia within a few weeks of therapy. It is critical that antipsychotics be continued even after symptoms have improved to avoid relapse. If one antipsychotic does not relieve symptoms, it is possible another agent will work. Patients should always tell their physician and pharmacist about any other prescription drugs, OTC products, vitamins, or supplements they are taking, to avoid serious drug interactions.
It is very important that individuals with schizophrenia be monitored for side effects and continue their medication even when their symptoms improve. Patients and their families can also benefit from psychotherapy, specifically cognitive behavioral therapy, to help them understand how to deal with symptoms that do not respond to antipsychotics.
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