Chronic schizophrenia

Chronic schizophrenia

 

 

1️⃣ Antipsychotic drugs:

 

– use atypical antipsychotic for negative symptoms -> Olanzapine, Risperdone (in negative symptoms the dopamine level is low while serotonin level is high )

 

 

– see the response after 6weeks

 

– intervene earlier in schizophrenia – before symptoms become established -> better outcome

 

– after single episode of schizophrenia -> continued for 12–24 months -> If the person remains well-> stop medications

 

– Patients who have had multiple episodes or persistent symptoms -> remain on medication for many years

 

– given in depot form (if there are concerns around poor adherence)

 

– Avoid routine co-administration of anticholinergic agents, or of combinations of antipsychotics.

 

 

*:- resistance schizophrenia

*definition: it is a failure to respond to two drugs over 6-week treatment trials of antipsychotic medication (at least one of which is an atypical antipsychotic).

*Rx : clozapine

 

✔️Clozapine

– has an important role in patients who are :

*poorly responsive to antipsychotic

*develop treatment resistant

*intolerant of other antipsychotics (Change Rx to clozapine when patient develop tradive dyskinesia)

– It also decreases the risk of suicide and can reduce aggression.

 

 

 

2️⃣ other Treatment

– Benzodiazepines are useful for short-term sedation.

– Antidepressants should be used in the normal fashion for depression occurring in schizophrenia.

– Electroconvulsive therapy (ECT) is not effective, except for catatonic stupor.

 

 

 

3️⃣ Psychological treatments:

 

A — family approach

– education about the illness and changing the behaviour of the family

– high expressed emotion (EE) families could be taught to lower EE

– decrease relapse rate

– prevent exacerbates the apathy and withdrawal of chronic schizophrenia.

 

B — CBT approach

– treatment of residual symptoms

– some efficacy against auditory hallucinations and delusions

– it effects is small, benefit for short term & patient not able or willing to engage in treatment.

 

 

 

4️⃣ Social interventions

– The nature of chronic schizophrenia means that many patients have problems with daily living.

 

– need multidisciplinary team

– support employment

 

 

 

* Patients with schizophrenia have high risks of type 2 diabetes and cardiovascular disease, contributing to their excess mortality. Some of this is attributable to side effects of antipsychotic medication. The other reasons are unclear, but probably include genetic predisposition, poor diet and lack of exercise.

Regular medical review and investigations (e.g. for diabetes, lipids, blood pressure) should be an integral part of management.

 

*DDx
A) acute schizophrenia
See the picture

B) chronic schizophrenia
– distinguish negative symptoms from depression
– distinguish negative symptoms from sedative
– distinguish negative symptoms from parkinsonian effects of antipsychotics.

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