Because the causes of schizophrenia are still unknown, treatments focus on eliminating the symptoms of the disease. Treatments include antipsychotic medications and various psychosocial treatments.
If not treated, people with schizophrenia may have difficulty holding a job or caring for themselves, so they rely on others for help. Treatment can help relieve many symptoms of schizophrenia but most people who have the disorder will still have to cope with certain symptoms throughout their lives. However, many people with schizophrenia can lead rewarding and meaningful lives in their communities.
In the 1990's, new antipsychotic medications were developed. These new medications are called second generation, or "atypical" antipsychotics. One of these medications, clozapine (Clozaril) is an effective medication that treats psychotic symptoms, hallucinations, and breaks with reality. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. People who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. But clozapine is potentially helpful for people who do not respond to other antipsychotic medications.19
Other atypical antipsychotics were also developed. None cause agranulocytosis. Examples include:
• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Aripiprazole (Abilify)
• Paliperidone (Invega).
When a doctor says it is okay to stop taking a medication, it should be gradually tapered off, never stopped suddenly.
What are the side effects? Some people have side effects when they start taking these medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:
• Dizziness when changing positions
• Blurred vision
• Rapid heartbeat
• Sensitivity to the sun
• Skin rashes
• Menstrual problems for women.
Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol.20 A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.
Typical antipsychotic medications can cause side effects related to physical movement, such as:
Tardive dyskinesia (TD) which causes muscle movements a person can't control (often around the mouth), happens to fewer people who take the atypical antipsychotics compared with first generation or typical antipsychotics. People who think that they might have TD should check with their practitioner before stopping their medication.
How are antipsychotics taken and how do people respond to them? Antipsychotics are usually in pill or liquid form. Some anti-psychotics are shots that are given once or twice a month.
Symptoms of schizophrenia, such as feeling agitated and having hallucinations, usually go away within days. Symptoms like delusions usually go away within a few weeks. After about six weeks, many people will see a lot of improvement.
However, people respond in different ways to antipsychotic medications, and no one can tell beforehand how a person will respond. Sometimes a person needs to try several medications before finding the right one. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose.
Some people may have a relapse-their symptoms come back or get worse. Usually, relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel they don't need it anymore. But no one should stop taking an antipsychotic medication without talking to his or her practitioner. When a practitioner says it is okay to stop taking a medication, it should be gradually tapered off, never stopped suddenly.
How do antipsychotics interact with other medications? Antipsychotics can produce unpleasant or dangerous side effects when taken with certain medications. For this reason, all practitioners treating a patient need to be aware of all the medications that person is taking. Practitioners need to know about prescription and over-the-counter medicine, vitamins, minerals, and herbal supplements. People also need to diskuss any alcohol or other drug use with their practitioner.
To find out more about how antipsychotics work, the US National Institute of Mental Health (NIMH) funded a study called CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness). This study compared the effectiveness and side effects of five antipsychotics used to treat people with schizophrenia. In general, the study found that the older typical antipsychotic perphenazine (Trilafon) worked as well as the newer, atypical medications. But because people respond differently to different medications, it is important that treatments be designed carefully for each person.