Antipsychotic medicines can help to treat many of the symptoms of schizophrenia. Counselling, social and family support and rehabilitation are also vital to successful therapy.
Medicines used to treat schizophrenia include: Typical antipsychotics Traditional, or typical, antipsychotics (eg chlorpromazine, fluphenazine, haloperidol, loxapine, mesoridazine, perphenazine, thioridazine, thiothixene and trifluoperazine), sometimes known as neuroleptics, work by blocking certain receptors in the brain and by reducing the release of certain chemicals. This helps relieve the symptoms of schizophrenia. Some of these medicines are available in long-acting injectable forms that may be useful in patients who dislike taking oral medicines. Common side-effects of these medicines include:
- Brief involuntary muscle spasm and twitching (acute dystonia)
- Severe restlessness that leads to agitation and anxiety (akathisia)
- Mask-like expression
- Muscle tremor
- Shuffling, unstable gait (walk)
- Dry mouth
- Urinary retention
While traditional antipsychotics are effective in reducing the positive symptoms of schizophrenia, they are less effective in controlling the negative symptoms. Each year, around 5% of people taking traditional antipsychotics develop a condition called tardive dyskinesia, which causes repetitive, involuntary movements of the facial muscles or tongue. Rapid movements of the arms, legs, and trunk may also occur. Although there is no cure for tardive dyskinesia, with careful management some of the symptoms may improve and/or disappear.
Atypical antipsychotics work by helping correct imbalances of certain neurotransmitters (chemicals involved in communication between nerve cells) in the brain. Several atypical antipsychotics have recently been developed:
Atypical antipsychotics reduce positive symptoms and also show beneficial effects on the treatment of negative symptoms and cognitive symptoms. They also cause fewer side-effects than traditional antipsychotics, in particular less tardive dyskinesia. As a patient’s wellbeing has a major impact on their willingness to follow a treatment plan, the lower incidence of side-effects associated with atypical antipsychotic use should help patients to continue with their treatment.
Other medicines may also be prescribed based on symptoms. For example, benzodiazepines may be prescribed for the treatment of anxiety, which is common among people with schizophrenia.
Other therapies commonly used in the treatment of schizophrenia include:
- Hospitalisation: a person who has been newly diagnosed with schizophrenia may be hospitalised briefly, so that they can be closely monitored while they begin taking their medicine and to ensure that they can look after themselves adequately. A person who is experiencing a severe episode may be hospitalised to prevent them harming themselves or others until they regain control of their symptoms.
- Outpatient services such as supervised housing, where doctors or nurses oversee daily routine and medication, may be suitable for some patients. This gives a person with schizophrenia some independence, while ensuring that they continue to receive support. Outpatient services may help to encourage recovery, reduce the need for hospitalisation and act as a ‘stepping stone’ towards returning to normal life. When a person with schizophrenia is discharged from hospital, they may enter a day care programme. This may include counselling sessions, skills training, family education, physical activities and occupational therapy.
- Day care programmes provide the patient with a daily routine and also allow their doctor a chance to monitor their progress. Social skills training given on an outpatient basis provides people with schizophrenia with the skills they need to be able to return to work, school, family or to be able to look after themselves. Providing support and education about schizophrenia is useful in helping families of people with schizophrenia to cope with their relative’s illness and may also reduce relapses.