Schizophrenia is a brain disease that interferes with normal brain functioning. It causes affected people to exhibit odd and often highly irrational or disorganized behavior. Because the brain is the organ in the body where thinking, feeling and understanding of the world takes place (where consciousness exists), a brain disease like schizophrenia alters thinking, feeling, understanding and consciousness itself in affected persons, changing their lives for the worse.
Schizophrenia symptoms include difficulty thinking coherently, interacting with others normally, carrying out responsibilities and expressing emotions appropriately. Even simple everyday tasks like personal hygiene can become unmanageable and neglected. The disease can thus impact every aspect of affected people's work, family, and social life.
Though not affected directly, family members also frequently become distressed and overwhelmed by the difficulties involved in providing care and in coming to terms with the transformation of their loved one into a patient with a serious chronic illness.
Treatment
Often a combination of drugs, psychotherapy, and community support
Because schizoaffective disorder often leads to long-term disability, comprehensive treatment (including drugs, psychotherapy, and community support) is often required.
For treatment of the manic type, antipsychotics combined with lithium, carbamazepine, or valproate may be more effective than antipsychotics alone.
For treatment of the depressive type, antipsychotics are commonly combined with antidepressants. Antidepressants should usually be introduced once positive psychotic symptoms are stabilized. SSRIs are preferred because of their safety profile. Second-generation antipsychotics may be more effective than conventional antipsychotics in alleviating depression associated with psychosis.
Patients with schizophrenia often do not respond to treatment or only partially improve and remain functionally impaired. While medication has been found to be effective for the treatment of positive symptoms of the disease, treatment of the negative symptoms of depression (including lack of energy, motivation, and emotional range) has historically not been very successful. In nearly 25 percent of those patients, the condition is so refractory to neuroleptic pharmacotherapy that they require custodial care.
Prevention of psychotic relapse in schizophrenic patients is a primary long-term clinical goal. The duration of psychotic episodes predicts the risk of relapse. Patients who have been psychotic for more than a year are rehospitalized for recurrence more often than those ill for less than a year. Neuroleptic drug therapy greatly shortens episodes of psychosis.
Antipsychotic drugs, also referred to as neuroleptics, are essential to the management of schizophrenia. With the exception of clozapine (Clozaril), all antipsychotic medications are equally effective overall. Older medications known as typical antipsychotics are known to generally have more severe side effects than newer atypical antipsychotics, specifically extrapyramidal symptoms like tremors, restlessness, and muscle spasms.
Atypical antipsychotic medications include risperidone (Risperdal), olanzapine (Zyprexa), ziprasidone (Geodon), quetiapine (Seroquel), and aripiprazole (Abilify). Typical antipsychotic mediations include haloperidol, chlorpromazine, thioridazine (Mellaril), trifluoperazine (Stelazine), and thiothixene (Navane).
Clozapine (Clozaril) has been shown to be more effective than any other treatment for schizophrenia, especially in refractory cases. It is effective for both positive and negative symptoms of the disease and has a low incidence of extrapyramidal side effects. However because of the risk of agranulocytosis, a disorder of suppressed white blood cells, it is rarely used as a first line agent.
As compliance with daily medication is an obstacle to care in schizophrenia, there are several long acting forms of antipsychotic medication that only have to be administered every week or every few weeks. Some of these long term medications include haloperidol deconate (Haldol Decanoate), fluphenazine deconate (Prolixin Decanoate), and Risperdal Consta.
Other drugs used include lithium and the benzodiazepines. Lithium alone is inferior to neuroleptic agents in inducing remission of psychosis
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