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__NOTOC__ | __NOTOC__ | ||
{{Schizophrenia}} | {{Schizophrenia}} | ||
{{CMG}};{{AE}}{{Vbe}} | {{CMG}};{{AE}}{{Vbe}} {{I.D.}} | ||
==Medical Therapy== | ==Medical Therapy== | ||
The mainstay of [[psychiatric]] [[Treatment-resistant depression|treatment]] for [[schizophrenia]] is an [[antipsychotic]] [[medication]].<ref name="fn_72">The Royal College of Psychiatrists & The British Psychological Society (2003). [http://www.nice.org.uk/download.aspx?o=289559 ''Schizophrenia. Full national clinical guideline on core interventions in primary and secondary care''] (PDF). London: Gaskell and the British Psychological Society. Retrieved on [[2007-05-17]].</ref> These can reduce the "positive" [[symptoms]] of [[psychosis]]. Most [[antipsychotics]] take around 7–14 days to have their main effect. | |||
*The mainstay of [[psychiatric]] [[Treatment-resistant depression|treatment]] for [[schizophrenia]] is an [[antipsychotic]] [[medication]].<ref name="fn_72">The Royal College of Psychiatrists & The British Psychological Society (2003). [http://www.nice.org.uk/download.aspx?o=289559 ''Schizophrenia. Full national clinical guideline on core interventions in primary and secondary care''] (PDF). London: Gaskell and the British Psychological Society. Retrieved on [[2007-05-17]].</ref> | |||
*These can reduce the "positive" [[symptoms]] of [[psychosis]]. | |||
*Most [[antipsychotics]] take around 7–14 days to have their main effect. | |||
[[Image:Risperdal tablets.jpg|thumb|left|150px|[[Risperidone]] (trade name '''Risperdal''') is a common [[atypical antipsychotic]] medication.]] | [[Image:Risperdal tablets.jpg|thumb|left|150px|[[Risperidone]] (trade name '''Risperdal''') is a common [[atypical antipsychotic]] medication.]] | ||
Though expensive, the newer [[atypical antipsychotic]] drugs are usually preferred for [[first-line treatment|initial treatment]] over the older [[typical antipsychotic]]s; they are often better tolerated and associated with lower rates of [[tardive dyskinesia]], although they are more likely to induce weight gain and [[obesity]]-related diseases.<ref name="fn_62">Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. ''[[The New England Journal of Medicine]]'', 353 (12), 1209–23. PMID 16172203</ref> [[Prolactin]] elevations have been reported in women with [[schizophrenia]] taking atypical [[antipsychotics]].<ref name="Dickson_et_al_1995">Dickson RA, Dalby JT, Williams R, Edwards AL. (1995) Risperidone induced prolactin elevations in premenopausal women with schizophrenia. ''American Journal of Psychiatry'',152,1102-1103. PMID 7540803</ref>It remains unclear whether the newer [[antipsychotics]] reduce the chances of developing [[neuroleptic malignant syndrome]], a rare but serious and potentially fatal [[Neurological disorders|neurological]] disorder most often caused by an adverse reaction to [[neuroleptic]] or [[Antipsychotic drugs|antipsychotic]] drugs.<ref name="Ananth_et_al_2004">Ananth J, Parameswaran S, Gunatilake S, Burgoyne K, Sidhom T. (2004) Neuroleptic malignant syndrome and atypical antipsychotic drugs. ''Journal of Clinical Psychiatry'', 65 (4), 464-70. PMID 15119907</ref> | *Though expensive, the newer [[atypical antipsychotic]] drugs are usually preferred for [[first-line treatment|initial treatment]] over the older [[typical antipsychotic]]s; they are often better tolerated and associated with lower rates of [[tardive dyskinesia]], although they are more likely to induce weight gain and [[obesity]]-related diseases.<ref name="fn_62">Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. ''[[The New England Journal of Medicine]]'', 353 (12), 1209–23. PMID 16172203</ref> | ||
*[[Prolactin]] elevations have been reported in women with [[schizophrenia]] taking atypical [[antipsychotics]].<ref name="Dickson_et_al_1995">Dickson RA, Dalby JT, Williams R, Edwards AL. (1995) Risperidone induced prolactin elevations in premenopausal women with schizophrenia. ''American Journal of Psychiatry'',152,1102-1103. PMID 7540803</ref> | |||
*It remains unclear whether the newer [[antipsychotics]] reduce the chances of developing [[neuroleptic malignant syndrome]], a rare but serious and potentially fatal [[Neurological disorders|neurological]] disorder most often caused by an adverse reaction to [[neuroleptic]] or [[Antipsychotic drugs|antipsychotic]] drugs.<ref name="Ananth_et_al_2004">Ananth J, Parameswaran S, Gunatilake S, Burgoyne K, Sidhom T. (2004) Neuroleptic malignant syndrome and atypical antipsychotic drugs. ''Journal of Clinical Psychiatry'', 65 (4), 464-70. PMID 15119907</ref> | |||
The two classes of [[antipsychotics]] are generally thought equally effective for the treatment of the positive symptoms. Some researchers have suggested that the atypicals offer additional benefit for the negative [[symptoms]] and [[cognitive]] deficits associated with [[schizophrenia]], although the [[clinical]] significance of these effects has yet to be established. Recent reviews have refuted the claim that atypical [[antipsychotics]] have fewer extrapyramidal side effects than typical antipsychotics, especially when the latter are used in low doses or when low potency antipsychotics are chosen.<ref name="fn_36">Leucht S, Wahlbeck K, Hamann J, Kissling W (2003). New generation antipsychotics versus low-potency conventional antipsychotics: a [[systematic review]] and meta-analysis. ''[[The Lancet]]'', 361(9369), 1581–9. PMID 12747876</ref> | *The two classes of [[antipsychotics]] are generally thought equally effective for the treatment of the positive symptoms. | ||
*Some researchers have suggested that the atypicals offer additional benefit for the negative [[symptoms]] and [[cognitive]] deficits associated with [[schizophrenia]], although the [[clinical]] significance of these effects has yet to be established. | |||
*Recent reviews have refuted the claim that atypical [[antipsychotics]] have fewer extrapyramidal side effects than typical antipsychotics, especially when the latter are used in low doses or when low potency antipsychotics are chosen.<ref name="fn_36">Leucht S, Wahlbeck K, Hamann J, Kissling W (2003). New generation antipsychotics versus low-potency conventional antipsychotics: a [[systematic review]] and meta-analysis. ''[[The Lancet]]'', 361(9369), 1581–9. PMID 12747876</ref> | |||
Response of [[symptoms]] to mediation is variable; "Treatment-resistant schizophrenia" is a term used for the failure of [[symptoms]] to respond satisfactorily to at least two different [[antipsychotics]].<ref>{{cite journal | author = Meltzer HY | title = Treatment-resistant schizophrenia--the role of clozapine | journal = Current Medical Research and Opinion | volume = 14 | issue = 1 | pages = 1–20 | date = 1997 | pmid=9524789 }}</ref> Patients in this category may be prescribed [[clozapine]],<ref>{{cite journal | author = Wahlbeck K, Cheine MV, Essali A | title = Clozapine versus typical neuroleptic medication for schizophrenia | journal = The Cochrane Database of Systematic Reviews | volume = | issue = 2 | pages = | publisher = John Wiley and Sons, Ltd. | date = 2007 | pmid=10796289 | doi = 10.1002/14651858.CD000059 | id = ISSN 1464-780X}}</ref> | *Response of [[symptoms]] to mediation is variable; "Treatment-resistant schizophrenia" is a term used for the failure of [[symptoms]] to respond satisfactorily to at least two different [[antipsychotics]].<ref>{{cite journal | author = Meltzer HY | title = Treatment-resistant schizophrenia--the role of clozapine | journal = Current Medical Research and Opinion | volume = 14 | issue = 1 | pages = 1–20 | date = 1997 | pmid=9524789 }}</ref> | ||
*Patients in this category may be prescribed [[clozapine]], a [[medication]] of superior effectiveness but several potentially lethal side effects including [[agranulocytosis]] and [[myocarditis]].<ref>{{cite journal | author = Wahlbeck K, Cheine MV, Essali A | title = Clozapine versus typical neuroleptic medication for schizophrenia | journal = The Cochrane Database of Systematic Reviews | volume = | issue = 2 | pages = | publisher = John Wiley and Sons, Ltd. | date = 2007 | pmid=10796289 | doi = 10.1002/14651858.CD000059 | id = ISSN 1464-780X}}</ref><ref>{{cite journal | author = Haas SJ, Hill R, Krum H | title = Clozapine-associated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993–2003 | journal = Drug Safety | volume = 30 | pages = 47–57 | date = 2007 | pmid=17194170 }}</ref> | |||
*[[Clozapine]] may have the additional benefit of reducing propensity for substance abuse in [[schizophrenic]] patients. <ref>{{cite journal |author = Lee M, Dickson RA, Campbell M, Oliphant J, Gretton H, Dalby JT. |title = Clozapine and substance abuse in patients with schizophrenia |journal = Canadian Journal of Psychiatry |volume = 43 |pages = 855-856 |date = 1998 }}</ref> | |||
*For other [[patients]] who are unwilling or unable to take [[medication]] regularly, long-acting [[Typical antipsychotic#Depot injections|depot]] preparations of [[antipsychotics]] may be given every two weeks to achieve control. | |||
*America and Australia are two countries with [[Outpatient commitment|laws]] allowing the forced administration of this type of [[medication]] on those who refuse but are otherwise stable and living in the community. | |||
*Nevertheless, some findings indicate that in the longer-term many individuals do better without taking antipsychotics.<ref>Harrow M, Jobe TH. (2007) Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. ''J Nerv Ment Dis.'' May;195(5):406-14. PMID 17502806</ref> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2] Irfan Dotani
Medical Therapy
- The mainstay of psychiatric treatment for schizophrenia is an antipsychotic medication.[1]
- These can reduce the "positive" symptoms of psychosis.
- Most antipsychotics take around 7–14 days to have their main effect.
- Though expensive, the newer atypical antipsychotic drugs are usually preferred for initial treatment over the older typical antipsychotics; they are often better tolerated and associated with lower rates of tardive dyskinesia, although they are more likely to induce weight gain and obesity-related diseases.[2]
- Prolactin elevations have been reported in women with schizophrenia taking atypical antipsychotics.[3]
- It remains unclear whether the newer antipsychotics reduce the chances of developing neuroleptic malignant syndrome, a rare but serious and potentially fatal neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs.[4]
- The two classes of antipsychotics are generally thought equally effective for the treatment of the positive symptoms.
- Some researchers have suggested that the atypicals offer additional benefit for the negative symptoms and cognitive deficits associated with schizophrenia, although the clinical significance of these effects has yet to be established.
- Recent reviews have refuted the claim that atypical antipsychotics have fewer extrapyramidal side effects than typical antipsychotics, especially when the latter are used in low doses or when low potency antipsychotics are chosen.[5]
- Response of symptoms to mediation is variable; "Treatment-resistant schizophrenia" is a term used for the failure of symptoms to respond satisfactorily to at least two different antipsychotics.[6]
- Patients in this category may be prescribed clozapine, a medication of superior effectiveness but several potentially lethal side effects including agranulocytosis and myocarditis.[7][8]
- Clozapine may have the additional benefit of reducing propensity for substance abuse in schizophrenic patients. [9]
- For other patients who are unwilling or unable to take medication regularly, long-acting depot preparations of antipsychotics may be given every two weeks to achieve control.
- America and Australia are two countries with laws allowing the forced administration of this type of medication on those who refuse but are otherwise stable and living in the community.
- Nevertheless, some findings indicate that in the longer-term many individuals do better without taking antipsychotics.[10]
References
- ↑ The Royal College of Psychiatrists & The British Psychological Society (2003). Schizophrenia. Full national clinical guideline on core interventions in primary and secondary care (PDF). London: Gaskell and the British Psychological Society. Retrieved on 2007-05-17.
- ↑ Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. The New England Journal of Medicine, 353 (12), 1209–23. PMID 16172203
- ↑ Dickson RA, Dalby JT, Williams R, Edwards AL. (1995) Risperidone induced prolactin elevations in premenopausal women with schizophrenia. American Journal of Psychiatry,152,1102-1103. PMID 7540803
- ↑ Ananth J, Parameswaran S, Gunatilake S, Burgoyne K, Sidhom T. (2004) Neuroleptic malignant syndrome and atypical antipsychotic drugs. Journal of Clinical Psychiatry, 65 (4), 464-70. PMID 15119907
- ↑ Leucht S, Wahlbeck K, Hamann J, Kissling W (2003). New generation antipsychotics versus low-potency conventional antipsychotics: a systematic review and meta-analysis. The Lancet, 361(9369), 1581–9. PMID 12747876
- ↑ Meltzer HY (1997). "Treatment-resistant schizophrenia--the role of clozapine". Current Medical Research and Opinion. 14 (1): 1–20. PMID 9524789.
- ↑ Wahlbeck K, Cheine MV, Essali A (2007). "Clozapine versus typical neuroleptic medication for schizophrenia". The Cochrane Database of Systematic Reviews. John Wiley and Sons, Ltd. (2). doi:10.1002/14651858.CD000059. PMID 10796289. ISSN 1464-780X.
- ↑ Haas SJ, Hill R, Krum H (2007). "Clozapine-associated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993–2003". Drug Safety. 30: 47–57. PMID 17194170.
- ↑ Lee M, Dickson RA, Campbell M, Oliphant J, Gretton H, Dalby JT. (1998). "Clozapine and substance abuse in patients with schizophrenia". Canadian Journal of Psychiatry. 43: 855–856.
- ↑ Harrow M, Jobe TH. (2007) Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. J Nerv Ment Dis. May;195(5):406-14. PMID 17502806