Schizophrenia treatment

- [Voiceover] So, managing Schizophrenia is a tricky business. Typically, the main problem that we want to try to manage are psychotic symptoms, like hallucinations and delusions using medications that are called anti-psychotics. Now, anti-psychotics can be broken up into older drugs, sometimes called first generation anti-psychotics, or we can shorten that to FGA. And these guys are also called typical and then the newer drugs are called second generation anti-psychotics, or SGAs, and these ones can also be called atypical. Now, most of these work by blocking a specific type of receptor called dopamine receptor D2. Were not exactly sure why blocking these receptors has been shown to help with psychotic symptoms, we just known that they're helpful for most of the people that take them. Now, SGAs are actually usually preferred over FGAs because they usually have less side effects that induce movement disorders, like, Parkinsonism. These movement type side effects are also called extrapyramidal side effects. And the main difference between FGAs and SGAs is thought to be that SGAs have this tendency to block serotonin receptor 5HT2 with a higher potency than FGAs and block dopamine receptors less than FGAs. This has been shown to lead to less extrapyramidal side effects. That's not to say that there are no side effects at all, though. The SGA side effects will depend on their type. Okay. So, depending on what stage the person's in, we'll try to focus on different treatments. So, let's say that someone has their first episode of psychosis, and we want to treat it . We would say that they're in the acute phase and the acute phase is the very early stages where the person is having their first episodes of psychosis, or this also includes when they're relapsing after not having episodes of psychosis for a while. And our goal here is to reduce the severity of psychotic thoughts and behaviors. In patients that are having their first episodes often respond better than those that are relapsing, and so they might be able to take lower doses of their medication. But because everybody responds so differently to anti-psychotic medications, they'll often be "trialed" to find the right anti-psychotic for each person. So, let's say that we give our patient one of our FGAs, this seems to help with their psychotic symptoms, meaning things like delusions and hallucinations, tend to be down, but they're experiencing spasms and movements as a side effect. Knowing this, we might switch to SGAs that tend to produce less movement related side effects. And after these trials of different medications, we eventually find the ones that are right for this patient and their symptoms are reasonably controlled. At this point, there are essentially recovered from the acute phase and enter the stable/maintenance phase. And our goal in this phase is to prevent a relapse. So, we're minimizing symptoms and we're trying to improve any areas of life that have been impaired, like relationships or work capabilities. At this point, therapy might be added into the treatment plan to help. And we might focus on things like stress reduction, as well as creating support networks of family and friends. And finally, emphasizing the importance of minimizing the use of drugs and alcohol. Now, in this phase of treatment, even though psychotic symptoms might be under control, managing side effects of the medications, themselves, is a really important part of managing Schizophrenia and improving quality of life. Now, one helpful mnemonic that might help us look for side effects is SHE WAS ME, which stands for the following: Sedation, which is a state of being calm or sleeping, hypotension, which is low blood pressure, extrapyramidal, movement related, wieght, as in weight gain, anticholinergic, things like dry mouth, blurred vision, constipation, sexual dysfuntion, metabolic, or glucose tolerance, and endocrine, like hyperprolactinemia, which is high levels of prolactine in the blood. And a lot of times, Schizophrenia also comes with other symptoms, besides psychosis, right? Like Depression and Manic Depression. And Depression will usually be treated with Anti-Depressants, where Manic-Depressive episodes can be treated with mood stablizers. So, with all this known, what's usually the prognosis for patients? Well, unfortunately, relapse are relatively common. Even those that are on anti-psychotic medications, see relapses about 20% of the time. Those not being treated with anti-psychotics, though, are significantly higher and have about a 75% chance of relapse. Additionally, after each relapse, the stable baseline of functioning usually gets worse. So, if you are currently stable and being treated, but still have some side effects and symptoms, after an episode of psychosis in relapse, you might come back to a baseline that's worse than before. And there are a couple of factors that seems to be associated with a worse prognosis, and simply being male is one of them, but we're not quite sure why. An early onset seems to also be associated with worse prognosis. And, finally, a strong family history of Schizophrenia, meaning the more family members that have Schizophrenia, the worse the outlook on your prognosis is. With that said, though, positive symptoms, like delusions, hallucinations, and disorganized thinking and behavior typically improve over time and with treatment. Unfortunately, though, negative symptoms that tend to be socially debilitating, like apathy or flat affect, tend to get worse over time. And it's also unclear at this point why this is the case. And, finally, another difficulty with treating Schizophrenia is non-compliance with medications and treatments. This is a huge, huge issue. In about 50% of patients within the first one to two years will be non-compliant in some way, which tends to make the prognosis even worse.