Schizophrenia
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Introduction
It is the most malignant of all psychiatric disorders and may lead to considerable changes in the personal and social functioning of the individuals. The onset of schizophrenia is usually in the adolescence and may be insidious. It also occurs late in life and rarely in children.
Classification
As per the symptom profile, schizophrenia is classified into two, viz:
- Positive: Hallucinations, delusions, etc. and
- Negative: Alogia, apathy, affective flattening, anhedonia and a sociality.
Clinical Features
- Hallucinations
- Delusions and apathy
- Reference (The patient may misinterpret happenings in the environment and attribute meanings to innocuous events as plans to harm him)
- Catatonic stupor (The withdrawal may be of extreme degree and the patient may maintain bizarre uncomfortable postures for prolonged periods)
- It is too difficult to establish rapport with the patient.
- Thought disorders and language disorder may be present.
Treatment
- Phenothiazines are the drugs of choice. The dosage depends upon the severity of the condition and the body weight of the patient.
- Antipsychotic drugs are divided into two groups, viz. typical or classical and atypical.
- Typical antipsychotics or conventional antipsychotics include Chlorpromazine, Trifluoperazine, Thioridazole, Haloperidol, Pimozide, etc. Their common side effects are extrapyramidal side effects.
- Atypical antipsychotics or novel antipsychotics have lesser propensity to produce extrapyramidal symptoms and hyperprolactinemia. They include Clozapine, Risperidone, Olanzapine, Quetiapine, Ziprasidone, etc. Atypical antipsychotics are effective in both positive and negative symptoms, whereas conventional ones are effective only on positive symptoms. Clozapine is reported to produce agranulocytosis. Olanzapine can produce obesity and diabetes.
Depending upon the clinical response, the dosage schedule has to be flexible. Once the target symptoms improve, dose can be reduced to a maintenance level. Regular periodic follow-up is mandatory to watch the progress and screen for long-term side effects of the drug. Long acting phenothiazines are also used parenterally when drug compliance is very poor.
- ECT: In selected cases, electroconvulsive therapy (ECT) is useful. Also, social therapy to improve interpersonal understanding and adjustment and for occupational rehabilitation.
- Ariprazole is the latest introduced antipsychotic which is found to be effective and with favorable side effect profile.