TREATMENT & PROGNOSIS IN SCHIZOPHRENIA

TREATMENT:
Typical antipsychotics (first generation antipsychotics) Phenothkanes - Chlorpromazine, Thioridazine, Trifluperazine,
Fluphenazine.Thioxanthenes - Thiothixene, Flupenthixol
.Butyrophenones - Haloperidol, Trifluperidol, Penfluridol.
Other heterocyclics - Pimozide, Loxapine, Sulpiride
Atypical antipsychotics(second generation antipsychotics) Amisulpiride, clozapine, olanzapine, quetiapine, risperidone, sertindole, sulpiride,Aripiprazole
  • Clozaopine is inndicated in:
  1. Patients with schizophrenia who have failed to respond adequately to typical neuroleptic drugs (treatment-resistant schizophrenia)
  2. Patients who are intolerant of typical neuroleptic drugs because of EPS or tardive dyskinesia
  3. Refractory schizophrenia
  4. Negative symptoms schizophrenia
  5. Patients who are at high risk for suicide
  6. Problems with agranulocytosis prevent clozapine from being used as a “first line" neuroleptic. 
  7. Side effects:purposeless involuntary facial and limb movements, constant chewing and puffing of cheeks 
  • ECT
  1. Given every two to five days for a total of 6 to 12 sessions. 
  2. After the sessions are complete, a course of medication can help maintain remission of symptoms.
  • PSYCHOLOGICAL THERAPIES:
  • PSYCHO SOCIAL THERAPIES:
  • GROUP THERAPY
  • FAMILY THERAPY
MOA OF DRUGS:
  • All antipsychotic agents except rauwolfia alkaloids block dopamine receptors in the brain.
  • Locus coeruleus is the site of most noradrenergic neurons in the brain.
  • The dopaminergic neurons in the brain are primarily found in three areas ;the basal ganglia (nigrostriatal tract), the midbrain (mesolimbic tract), and the hypothalamus. 
COMPLICATIONS:
  • Withdrawal dyskinesia:
  1. Emerge when the dosage is reduced
  2. Subtle involuntary movements of hands, feet, lips, and tongue
  • Tardive dyskinesia:
  1. Restlessness, fidgety, irritability and cannot sit still at one place 
  2. Treated with betablocker
PROGNOSIS:
  • Good Prognostic Factors 
  1. Late Onset 
  2. Catatonic features 
  3. Pyknic Built 
  4. No Family history 
  5. Acute onset 
  6. Emotions are preserved 
  7. Type I 
  • Poor Prognostic Factors
  1. Younger age of onset 
  2. Disorganized type
  3. Asthenic built
  4. Family history present
  5. Chronic type
  6. Blunting of affect or atypical Feature Present 
  7. Type II
Exam Question
  • Good prognosis in schizophrenia is indicated by Late Onset ,Catatonic features ,Pyknic Built ,No Family history, Acute onset ,Emotions are preserved ,Type I 
  • Subtle involuntary movements of hands, feet, lips, and tongue on decreasing the dose of haloperidol is increase initially as the medication is decreased
  • Resistant,negative symptoms & Refractory Schizophrenia is an indication for the use of Clozapine
  • Drugs used in the treatment of schizophrenia have in common their ability to Block dopamine receptors in the brain
  • In Schizophrenia treated with CPZ (chlorpromazine) if develops auditory hallucination again should be given Clozapine
  • After the initiation of haloperidol if the patient shows be restlessness, fidgety, irritability and cannot sit still at one place should be treated with betablocker Schizophrenia patient treated with Clozapine medication may develope purposeless involuntary facial and limb movements, constant chewing and puffing of cheeks 
  • Bad prognostic indicator of Schizophrenia are Family history ,Poor Prognostic Factors,Younger age of onset ,Disorganized type,Asthenic built,Chronic type,Blunting of affect or atypical Feature Present ,Type II
  • Common Drugs used in schizophrenia include Chlorpromazine,Haloperidol,Olanzapine
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