schizophrenia
SCHIZOPHRENIA
Schizophrenia is a devastating mental illness characterized by symptoms eg hallucinations, disorganized thinking, loss of goal-directed behaviors and deterioration in social role functioning.
Positive or psychotic symptoms are delusions, hallucinations, and distorted perceptions.
Negative symptoms include flat or blunted emotions, lack of motivation or energy, lack of pleasure or interest in things, and limited speech.
Disorganized symptoms are confused thinking, disorganized speech and behavior.
Cognitive symptoms include impairment in attention verbal fluency memory, and executive functioning.

Supportive Therapy

Adjunctive Pharmacological Therapy and Pharmacological Therapy for Adverse Reactions to Antipsychotics

Adjunctive Medications1

  • It may be necessary to use additional medications along with antipsychotics
    • Adjuncts (eg anticholinergic agents) may be used to treat side effects caused by antipsychotics
    • Other adjuncts may be used to treat refractory psychotic symptoms, comorbidities or nonpsychotic symptoms eg agitation, anxiety and depression

Anticholinergic Agents

  • Effect: Effectively treat extrapyramidal symptoms due to antipsychotics
    • May be added to atypical antipsychotics to treat akathisia, extrapyramidal symptoms or excessive salivation due to Clozapine

Antidepressants

  • Depressive symptoms are usually treated after acute psychosis has been treated with antipsychotics
    • Use antidepressants with caution in the acute phase of illness since they may exacerbate psychotic symptoms 
  • Effect: Effectively treat residual (post-psychotic) depressive symptoms

Benzodiazepines

  • Effects tend to be most useful in the acute management phase
  • Effect: Treat agitation, insomnia, anxiety, akathisia and other concomitants of schizophrenia

Beta-Blockers

  • Effect: Treat akathisia due to conventional antipsychotics

Bupropion

  • It has been shown to be effective in people with schizophrenia who also smoke tobacco, particularly when combined with nicotine replacement therapy
  • Should be offered to schizophrenia patients who want to reduce or quit smoking
  • May lower epileptic threshold

Mood Stabilizers

  • Lithium
    • Used to stabilize mood and reduce excitement in patients treated with antipsychotics
    • Effect: Has been shown to augment the antipsychotic response when added to conventional antipsychotic medications
  • Valproate and Carbamazepine
    • Effects: Stabilize mood and help reduce persistent agitation in schizophrenia

Varenicline

  • May be offered to schizophrenia or psychotic patients who want to reduce or quit smoking
  • Carries the risk of developing mood swings during treatment

Vesicular Monoamine Transporter2 (VMAT2)

  • Eg Deutetrabenazine, Tetrabenazine, Valbenazine
  • May be given to patients with disabling tardive dyskinesia secondary to effects of antipsychotic medications
  • Acts effectively in lessening the motor aspect of tardive dyskinesia 
1There are many medications that can be used as adjuncts to antipsychotics. Specific prescribing information may be found in the latest MIMS.
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