| Although there is presently no permanent cure for schizophrenia, the symptoms of the illness can be effectively controlled in many patients by the use of antipsychotic (neuroleptic) drugs. Most individuals can obtain improvement in their symptoms with the use of modern drugs and modern approaches to management. Successful drug treatment of schizophrenia is dependent on: - careful assessment of the individual,
- careful selection of the antipsychotic drug and dosage, and
- provision of appropriate information and support for the patients and their family.
Conventional neuroleptic drugs The conventional neuroleptic drugs were the foundation of pharmacological treatment in schizophrenia, beginning in 1952, when chlorpromazine was introduced, until the early 1990s. These drugs have been found to be effective in treating the positive symptoms of schizophrenia, enabling patients to remain out of hospital and to function in the community. Although all typical antipsychotic agents are effective in acute and maintenance treatment of schizophrenia, they have several therapeutic limitations. They have a limited range of efficacy, being mainly effective against positive symptoms (such as hallucinations, delusions, or mood swings), and relatively ineffective against negative (affecting skills and abilities the patient used to have) and affective symptoms and neurocognitive deficits (related to concentration, the ability to plan and to solve problems, to memory, etc.). In addition, 30 to 60% of patients have no response or only a partial response to conventional agents. Finally, conventional antipsychotic agents may not effectively alter the course of the illness sufficiently to minimise the occurrence of other health problems over the course of the patient's lifetime. Consequently, conventional antipsychotics are no longer regarded as a first-line option for most patients with schizophrenia. Side effects of treatment with conventional agents Conventional neuroleptic drugs are also associated with a high incidence of side effects. This both limits the drugs' effectiveness and reduces their acceptability to patients.
Some patients may need to take additional medication as treatment for the side effects. However, many patients discontinue their medication because they find the side effects unacceptable.
Patients who do discontinue their antipsychotic medication are highly likely to see their psychotic symptoms relapse. The major side effects associated with conventional antipsychotic drugs relate to the occurrence of extrapyramidal symptoms (EPS, including the parkinsonian symptoms of tremor and rigidity), tardive dyskinesia (abnormal movements, particularly of the mouth and facial muscles, which are severely incapacitating and which can become irreversible) and akathisia (motor restlessness, which is extremely distressing and often the reason for non-adhesion to treatment rules and withdrawal of treatment). Because of their mechanism of action on the brain, more than 50% of patients receiving conventional antipsychotic agents experience side effects. Atypical/novel antipsychotic drugs The introduction of the first atypical antipsychotic drug, clozapine, in 1990 was a landmark event, not only because it was found to be effective in patients who were not responding to treatment with conventional neuroleptics, and also in reducing negative symptoms, but also because it was associated with a reduced risk of parkinsonia symptoms. The list of novel antipsychotic drugs also includes risperidone, olanzapine, quetiapine, and ziprasidone. As a group, the newer agents have for the first time provided improvements in negative symptoms, affecting (and reducing) skills and abilities the patient used to have (such as socialization, energy, or interest in other peoples). They are therefore proving to be at least as efficacious and more tolerable than the conventional drugs, and hold the expectation of a more favourable clinical course for patients with schizophrenia. Side effects of treatment with novel agents While the atypical neuroleptics are generally better tolerated than the conventional drugs, the adverse-effect profiles of the atypical agents vary, and these differences may affect patient adhesion to treatment schedule. Thus, side effects such as dry mouth, blurred vision, constipation, and confusion can be observed. Atypical neuroleptics are also associated with sedation, drowsiness, appetite stimulation and weight gain, together with blood pressure and cardiac rhythm alterations, and dizziness. Among the possible neurological side effects associated with neuroleptic drugs are neuroleptic malignant syndrome (NMS), seizures, and adverse effects on cognition, including sedation. The risk of seizures is low in patients receiving atypical antipsychotic medications. New treatment - atypicals in long-acting injectable form Until now, only older, conventional antipsychotics - which are not considered by most experts to be as broadly effective as atypicals or novel antipsychotic drugs and are more likely to cause serious movement disorders - have been available in long-acting forms.
However, recent developments mean that long-acting atypical antipsychotic medication, using long-acting injections, has become available. This new type of treatment has been developed using a new technology which encapsulates the medication in microspheres. These are made of a biodegradable polymer and are suspended in a water-based solution. This is injected into the muscle. After injection, the microspheres gradually degrade at a set rate to provide consistent levels of the drug in the bloodstream. The polymer from which the microspheres are made breaks down into two naturally occurring compounds that are then eliminated by the body. The new medication will be an option for all patients requiring long-term treatment. Requiring administration just once every fortnight, this type of treatment relieves the burden of daily medication, whilst offering long-term efficacy with a low risk of relapse. Psychosocial Treatment Relieving the psychotic symptoms of schizophrenia requires antipsychotic medication . However, these medications are not always as beneficial for behavioural symptoms. Even when patients with schizophrenia are relatively free of psychotic symptoms, they experience ongoing difficulties with communication, motivation, looking after themselves, and establishing and maintaining relationships with others. Because patients with schizophrenia tend to become ill during the educational and career-defining phase of life - e.g. between ages 18 to 35 - they are less likely to complete their education or the required training for skilled work. As a result, many of them not only experience thinking disorders and emotional difficulties, but also lack social and work skills, as well as job experience. Psychosocial treatment programmes target these social, psychological and occupational problems. While psychosocial treatments only have limited benefits for acute psychotic patients , they may be useful for patients with less severe symptoms or for patients whose psychotic symptoms are under control. A variety of psychosocial therapy programmes are available. Most focus on improving social functioning, whether in hospital or in the community, at home or at work. Rehabilitation Rehabilitation includes a wide array of non-medical interventions for those with schizophrenia. Rehabilitation programmes emphasise social and vocational training to help patients and former patients overcome difficulties in these areas. Programmes may include vocational counselling, job skills, problem solving, money management skills, the use of public transport and social skills. These approaches are important for the success of the community-centred treatment of schizophrenia patients. They arm discharged patients with the necessary skills and support to lead productive lives in the community, outside the sheltered environment of a mental hospital. Individual psychotherapy Individual psychotherapy involves regularly scheduled talks between the patient and a psychiatrist, psychologist, psychiatric social worker, or nurse. The sessions may focus on current or past problems, experiences, thoughts, feelings, or relationships. By sharing experiences with a trained sympathetic person, people with schizophrenia may gradually gain a better insight in themselves and their problems. They can also learn to sort out the real from the unreal and distorted. Studies suggest that supportive, reality-oriented, individual psychotherapy and cognitive-behavioural approaches, that teach coping and problem-solving skills, can be beneficial for outpatients with schizophrenia. However, psychotherapy is not a substitute for antipsychotic medication. It is most helpful once drug treatment has relieved a patient's psychotic symptoms. Your doctor will be able to advise you on the most suitable treatment programme. Family intervention Very often, patients with schizophrenia are discharged from hospital into the care of their family. It is vital important that relatives learn all they can about schizophrenia and understand the difficulties and problems associated with the illness. It is also helpful for relatives and friends to learn ways to minimise the patient's chance of relapse . This can be achieved, for example, by using different treatment commitment strategies. Families also need to be aware of the available outpatient and family support services available in the period after hospitalisation. Psycho-education includes teaching various coping strategies and problem-solving skills, may help families and friends deal more effectively with their beloved one and may contribute to an improved outcome for the patient. Read more about Schizophrenia Medication | 
