Medical Management of Schizophrenia

By

Linda Wasmer Andrews

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There isn’t a cure for schizophrenia yet. But there are treatments that can make it much easier to live with the disease. Medications are a mainstay of schizophrenia treatment, helping lessen the severity and frequency of symptoms.

The primary medications used to treat schizophrenia are antipsychotics. These medicines often make a huge difference in a person’s ability to function in daily life. They may not completely eliminate all symptoms, however.

Psychosocial treatments can help manage any symptoms that remain. They can also improve the patient’s knowledge about the illness, increase cognitive performance, and help the person take his or her medication consistently. But when still more help is needed, other types of medications may be added to the mix, including antidepressants, mood stabilizers, and anti-anxiety drugs.

Below is a quick look at the medications commonly used for treating schizophrenia. Just keep in mind that everyone’s response to these drugs is a little different. It’s important to work with your doctor to find the best treatment for you.

Antipsychotic Medications

Antipsychotic medications can be divided into two groups: older, first-generation drugs (also called conventional or typical) and newer, second-generation drugs (also called atypical). These are some of the more widely prescribed ones:
Newer antipsychotics

  • Aripiprazole (Abilify)

  • Asenapine (Saphrys)
  • Brexapiprazole (Rexult)
  • Cariprazine (Vraylar)

  • Clozapine (Clozaril)

  • Iloperidone (Fanapt)

  • Lurasidone (Latuda)

  • Olanzapine (Zyprexa)

  • Paliperidone (Invega)

  • Quetiapine (Seroquel)

  • Risperidone (Risperdal)

  • Ziprasidone (Geodon)

Older antipsychotics

  • Chlorpromazine (Thorazine)

  • Fluphenazine (Prolixin)

  • Haloperidol (Haldol)
  • Loxapine (Loxitane)

  • Perphenazine (Trilafon)

Antipsychotics are usually taken by mouth every day. But some can be taken via long-acting injections given once or twice a month instead. This eliminates the need for daily medicine. Long-acting injections are available for aripiprazole (Abilify Maintena), olanzapine (Zyprexa Relprevv), palperidone (Invega Sustenna), risperidone (Risperdal Consta), fluphenazine, (Prolixin depot) and haloperidol (Haldol depot).

Benefits of Antipsychotics

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If your doctor has prescribed psychosocial therapy, make sure you participate.

Once an antipsychotic is started, hallucinations—experiences of hearing or seeing things that aren’t really there—often go away within days. Delusions—beliefs that are clearly false and seem strange to others—may lessen within a few weeks. Older and newer antipsychotics work about equally well against these symptoms.

However, for treating problems with showing emotion and relating to others, newer antipsychotics may have an edge. For relieving hard-to-treat symptoms that don’t respond to other medications, clozapine may be beneficial. When one antipsychotic isn’t enough, doctors sometimes add another, but good evidence for the effectiveness of this approach is still missing and side effects should be monitored.

Side Effects of Antipsychotics

Although antipsychotics can be extremely helpful, they also can cause side effects. Common ones include drowsiness, dizziness, blurry vision, rapid heartbeat, and skin rashes. Women may have menstrual problems. Most of these side effects occur early or when the dose is increased, but often they go away quickly or can be managed well.

Other possible side effects include:

  • Enlarged breasts and sexual problems in both men and women may occur with most antipsychotics other than aripiprazole, clozapine and quetiapine.

  • Loss of infection-fighting white blood cells is a potentially serious side effect of clozapine. People taking this drug must get blood tests to check their white blood cell counts every week for the first six months, every two weeks for the second six months, and monthly thereafter if the results have remained normal.

  • Uncontrollable muscle movements (known as tardive dyskinesia) are more likely with older antipsychotics. In some cases, the problem is permanent.

  • Weight gain and changes in blood fat and blood sugar can increase the risk for diabetes and heart disease. These effects may occur more often with many of the newer antipsychotics, but not with all. Some older antipsychotics can also cause this problem. People taking antipsychotics should have their weight, blood sugar, and cholesterol checked regularly.

Other Types of Medications

When antipsychotics alone don’t provide enough relief, other psychiatric medications are sometimes added to a person’s treatment plan.

Antidepressants given in addition to antipsychotics may help people with schizophrenia who also have symptoms of depression or anxiety. In addition, some studies show that antidepressants, such as SSRIs and mirtazapine (Remeron), may help ease what are known as the negative symptoms of schizophrenia—speaking very little, showing a lack of emotion, taking no pleasure in daily life, and being unable to start and carry out activities, including social interactions. More research is needed, however.

Mood stabilizers help control unusual shifts in mood, energy and activity level. They include lithium, which is often used to treat bipolar disorder, and anticonvulsants, a group of medications that were originally developed to treat seizures. There’s some evidence that mood stabilizers may be helpful for certain people with schizophrenia. For example, valproic acid (Depakene) may reduce aggressive behavior, and lamotrigine (Lamictal) may lessen symptoms that are only partially relieved by other drugs. More research is needed to study the pros and cons of using mood stabilizers in addition to antipsychotics to treat schizophrenia.

Benzodiazepines are anti-anxiety or sleep medications. Because they have a quick sedating effect, these drugs are also used to calm very agitated or aggressive behavior in a crisis. However, there’s a lack of good evidence to show whether combining benzodiazepines with antipsychotics is safe and effective.

When it comes to taking medicine, sometimes more is better—and sometimes it’s not. To reduce the risk for harmful drug interactions, make sure your doctor knows about everything you’re taking, including prescription medications, over-the-counter products, vitamins, and herbal supplements.

Key Takeaways

  • The primary medications used to treat schizophrenia are antipsychotics, taken by either pill or injection. These medicines often make a huge difference in a person’s ability to function in daily life.

  • Older and newer antipsychotics both work well against hallucinations and delusions. For problems with showing emotion and relating to others, newer antipsychotics may have an edge.

  • Psychosocial treatments can help manage any symptoms that remain.

  • When still more help is needed, antidepressants, mood stabilizers, and anti-anxiety drugs may be beneficial.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 20, 2016

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Medical References

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  2. Benzodiazepines for Psychosis-Induced Aggression or Agitation (Review). D. Gillies et al. Cochrane Database of Systematic Reviews, 2013, iss. 9, art. CD003079.
  3. Effects of Polypharmacy on Outcome in Patients with Schizophrenia in Routine Psychiatric Treatment. G. Langle et al. Acta Psychiatrica Scandinavica, 2012, vol. 125, pp. 372-381.
  4. Hecht EM, Landy DC. Alpha-2 receptor antagonist add-on therapy in the treatment of schizophrenia; a meta-analysis. Schizophr Res 2012; 134:202.Singh SP, Singh V, Kar N, Chan K. Efficacy of antidepressants in treating the negative symptoms of chronic schizophrenia: meta-analysis. Br J Psychiatry 2010; 197:174.
  5. Treatment-Resistant Schizophrenia: Evidence-Based Strategies. S. Englisch and Mathias Zink. Mens Sana Monographs, 2012, vol. 10, pp. 20-32.

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