Subject(s)
Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Metabolic Syndrome/chemically induced , Metabolic Syndrome/epidemiology , Psychotic Disorders/drug therapy , Antipsychotic Agents/administration & dosage , Clozapine/administration & dosage , Comorbidity , Diabetes Mellitus/chemically induced , Diabetes Mellitus/epidemiology , Drug Monitoring , Humans , Obesity/chemically induced , Obesity/epidemiology , Psychotic Disorders/epidemiology , Risk FactorsABSTRACT
Pharmacological treatment remains the mainstay of the management of schizophrenia. Older, "typical" antipsychotics carry a significant burden of side effects, notably extrapyramidal and neurocognitive side effects. Newer, "atypical" agents carry a lower risk of extrapyramidal side effects. They appear to have added benefit for treating negative and cognitive symptoms of schizophrenia, and hence can enhance the quality of life of some patients. The choice of particular agents for individual patients requires a balancing of efficacy and side effects. Medication is only one element of what should be an individualised comprehensive treatment plan for people with schizophrenia.
Subject(s)
Antipsychotic Agents/therapeutic use , Pirenzepine/analogs & derivatives , Schizophrenia/drug therapy , Sulpiride/analogs & derivatives , Amisulpride , Antipsychotic Agents/adverse effects , Basal Ganglia Diseases/chemically induced , Basal Ganglia Diseases/prevention & control , Benzodiazepines , Clozapine/therapeutic use , Dibenzothiazepines/therapeutic use , Humans , Olanzapine , Pirenzepine/therapeutic use , Quetiapine Fumarate , Risperidone/therapeutic use , Sulpiride/therapeutic useABSTRACT
Patients who fail to respond adequately to pharmacological treatment present an ongoing therapeutic challenge. The term "incomplete recovery" (IR) is preferred to the current term "treatment resistance" to describe these patients. IR should be considered from a multidimensional perspective that includes a broad range of symptoms and functional disabilities that are relevant to schizophrenia. The approach to the incompletely recovered patient needs to be systematic, with consideration given to the factors that may hamper recovery. "Atypical" (second-generation) antipsychotic drugs target various domains of symptoms relevant to IR. Adjunctive treatment strategies (eg, mood stabilisers, antidepressants, combinations of antipsychotics) may be useful, but should be undertaken in specialist psychiatric settings. Although pharmacological treatment is a necessary first step in managing incompletely recovered patients, adjunctive psychosocial interventions are needed to optimise treatment success.
Subject(s)
Antipsychotic Agents/administration & dosage , Schizophrenia/therapy , Social Support , Antidepressive Agents/administration & dosage , Drug Therapy, Combination , Humans , Schizophrenia/pathology , Treatment FailureABSTRACT
Schizophrenia has been described as a "life-shortening disease", and physical comorbidity accounts for 60% of premature deaths not related to suicide. People with schizophrenia and other mental illnesses have a higher rate of preventable risk factors such as smoking, high alcohol consumption, poor diet, and lack of exercise. Recognition and management of morbidity in people with mental illness are made more difficult by barriers related to the patient, the illness, the attitudes of medical practitioners, and the structure of healthcare delivery services. Improved detection and treatment of medical illness in people with schizophrenia will have significant benefits for their psychosocial functioning and overall quality of life.
