The drugs currently on the market are safe and effective for the patient. Their effectiveness, which has been widely demonstrated over the last 50 years, is based around two points: firstly, remission of the psychotic symptoms during the acute stage; and secondly, prevention of further relapses.

Therefore, an important part of the work that must be carried out along with the family and healthcare team consists of ensuring correct therapeutic adherence, as well as persuading the patient of the need to follow their treatment, even if the symptoms may have remitted.

The range of medicines used to treat schizophrenia includes different families of drugs:

Pills with blue and white stripes

Antipsychotics. Antipsychotic drugs are indicated for patients with schizophrenia and must always form the basis of any treatment plan.

Blue, white and green pills

Medicines to correct the side effects of antipsychotics.

round pills, vasodilators

Antidepressants. Patients with schizophrenia can become depressed. Before treating depression it must be diagnosed correctly, since many of the depressive symptoms could actually be negative symptoms (e.g., apathy or a lack of interest in social relationships) or periods of demoralisation due to the patient’s life situation. Having made the diagnosis, it is essential to treat the depression because such patients present a high risk of committing suicide.

The same medicines that are effective in patients with depression are also useful in patients with schizophrenia who are suffering depression. In the last decade, the new generation of antidepressants (selective serotonin re-uptake inhibitors or SSRIs) have become the first choice drug for treating depression, basically because of their low side effects profile. Classic tricyclic antidepressants can sometimes be of use, such as imipramine or clomipramine, or dual-action antidepressants, such as venlafaxine, desvenlafaxine or duloxetine.

Green and white pills

Anxiolytics (diazepam, lorazepam and others). These medicines, also known as antianxiety agents, are designed to reduce anxiety. They have the advantage of a rapid onset of action, which means the patient’s anxiety diminishes a few minutes after they are administered. A typical example of their use would be during a psychotic flare-up in which treatment with an antipsychotic is started. As mentioned earlier, antipsychotics require a somewhat extended period before they start acting and so they can be co-administered with an anxiolytic in order to reduce the patient’s immediate discomfort.

anti-inflammatory green and blue pills

Mood stabilisers (lithium, carbamazepine, valproic acid and others). These medicines exercise control over impulsive behaviours and are consequently indicated for patients with a frequent lack of behavioural control or a history of substance abuse.

The most common side effects, which can be corrected with medication, are:

Sweating, trembling and pallor

Tremors, involuntary movements of the tongue, lips and face, rapid breathing, muscle contractions (extrapyramidal symptoms), amongst others.

Dizziness and bad general condition

Dizziness caused by blood pressure drops.

dysphagia, difficulty to swallow

Increased salivation.

woman hormonal cycle

Increased prolactin hormone levels (which can cause amenorrhoea, i.e., absence of menstruation).

nipple secretions

Secretion of milk from the breasts (galactorrhoea).

Sleep disorder

Excessive sleepiness.

Weighing scale

Weight gain.

Sexuality, sex, masculine, feminine

Alterations in sexual function.

Testing the sugar through a glutometer

Tendency to develop diabetes.

A lack of treatment adherence and partial or total abandonment of medication (therapeutic non-compliance) is a significant problem in patients with chronic psychiatric illnesses, e.g., schizophrenia, as it occurs very frequently and can have serious consequences.

Therapeutic non-compliance may be due to different causes: the psychosis itself, a lack of awareness of the disease, the side effects of the medicines or a lack of information about the need to follow treatment.

It is estimated that almost 40% of patients with schizophrenia abandon their treatment during the first year and 75% during the second year. This is a very important point because up to 80% of patients experience a relapse of the condition in the first 5 years. In fact, patients who abandon their medication increase the risk of a relapse by a factor of five.

Relapses tend to be more severe and require more time to overcome. Researchers have also noted that abandonment of medication is accompanied by relapses associated with a greater risk of suicide and aggressive behaviour. Furthermore, there is a growing consensus among doctors and ever-increasing biological evidence to suggest that successive relapses worsen the prognosis for the disease.

This therapeutic non-compliance has resulted in the development of long-acting injectable antipsychotics which guarantee antipsychotic coverage over the course of several weeks, thus preventing treatment interruptions and, consequently, possible relapses.

During situations in which the patient needs to be hospitalised or admitted to the emergencies unit (due to a flare-up of symptoms), antipsychotic medicines sometimes have to be administered via an intramuscular injection, which has an immediate, yet short-lived, effect (short-acting injectables). Both conventional and second-generation injectable antipsychotics are available to cover this need. There is also an inhaled drug, loxapine, currently available to treat mild to moderate agitation.

There are two types of psychological intervention: individual (one therapist with one patient) and group therapy (one therapist with several patients). They can also be classified according to the techniques or proposed objectives. Psychosocial treatments can be carried out by a range of healthcare professionals (psychiatrists, psychologists, nursing staff and social workers). Included among the psychosocial treatment methods are:

  • Psychoeducation
  • family therapy
  • social skills training
  • vocational rehabilitation
  • cognitive behavioural therapies
  • cognitive rehabilitation

It is important to stress that these current psychosocial techniques are a complement to and not a replacement for drug-based therapies. In other words, they form part of the integral therapeutic approach to schizophrenia and must be combined with drug-based therapy that forms the central axis of the overall treatment. Furthermore, it is critical to point out that their indication should be tailored to each case and the specific stage of the disease at that time.

The appropriate management of patients with schizophrenia must involve holistic therapy with an optimised medicine regime, psychological interventions and psychosocial rehabilitation following an individualised plan.

Substantiated information by:

Miquel Bernardo
Miquel Bioque

Published: 20 February 2018
Updated: 20 February 2018

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