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Video transcript

so managing schizophrenia is a tricky business typically the main problem that we want to try to manage our psychotic symptoms like hallucinations and delusions using medications that are called antipsychotics now antipsychotics can be broken up into older drugs sometimes called first generation antipsychotics or we can shorten that to fga and these guys are also called typical and then the newer drugs are called second-generation antipsychotics or SGA's and these ones can also be called atypical now most of these work by blocking a specific type of receptor called dopamine receptor d2 we're not exactly sure why blocking these receptors has been shown to help with psychotic symptoms we just know that they're helpful for most of the people that take them now SJS are actually usually preferred over FGA s because they usually have less side effects that induce movement disorders like Parkinson's ISM these movement types side effects are also called extrapyramidal side effects and the main difference between FGA s and s JS is thought to be that SGA's have this tendency to block serotonin receptor v h t2 with a higher potency than FG a's and block dopamine receptors less than FG a's and 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 persons 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 the 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 and 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 antipsychotic medications they'll often be quote unquote trialed to find the right antipsychotic for each person so let's say that we give our patient one of our FGA s this seems to help with their psychotic symptoms meaning things like delusions and hallucinations tend to be down but they're experiencing spasms in movements as a side-effect knowing this we might switch to SGA's 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 they're essentially recovered from the acute phase and enter the stable slash maintenance phase and our goal in this phase is to prevent 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 weight as in weight gain anticholinergic things like dry mouth blurred vision constipation sexual dysfunction metabolic or glucose tolerance and endocrine like hyperprolactinemia which is high levels of prolactin 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 antidepressants where manic depressive episodes can be treated with mood stabilizers so with all this known what's usually the prognosis for patients well unfortunately relapse are relatively common even those that are on antipsychotic medications see relapse is about 20% of the time those not being treated with antipsychotics 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 like if you're 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 factors that seem to be associated with a worse prognosis and simply being male is one of them but we're not quite sure why an earlier 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 effect 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 and this is a huge huge issue and about 50% of patients within the first 1 to 2 years will be non-compliant in some way which tends to make the prognosis even worse