精神分裂症治疗

Main therapy: antipsychotics

Pharmacotherapy is a key method in the treatment of schizophrenia, with emphasis placed on antipsychotics. The choice of a specific drug depends on the predominant symptoms:

• Psychomotor agitation and confusion: chlorpromazine, clozapine, chlorprothixene, zuclopenthixol, olanzapine are used.
• Delusions and catatonic disorders: haloperidol, risperidone, trifluoperazine, perphenazine, fluphenazine, olanzapine are indicated.
• Negative symptoms (autism, passivity): atypical antipsychotics are used, such as clozapine, aripiprazole, risperidone, olanzapine, flupentixol, sulpiride, amisulpride, and ziprasidone. Their continuous intake helps the patient maintain social skills.
• For long-term maintenance: long-acting injectable preparations (depot forms) are convenient — fluphenazine decanoate, haloperidol decanoate, zuclopenthixol decanoate.

Principles of therapy and management of side effects

The gold standard is considered to be monotherapy — the prescription of only one antipsychotic. However, if the patient tolerates the medication poorly, the doctor may combine two drugs to lower doses, reduce side effects, or make the treatment more affordable.

Typical antipsychotics can cause neurological disorders, which are treated with anticholinergic drugs (e.g., trihexyphenidyl, biperiden, diphenhydramine).

Additionally, the following may be prescribed to correct the condition:

• Antidepressants — if a decrease in mood is observed.
• Tranquilizers — for marked anxiety and insomnia.
• Psychostimulants and nootropics — for decreased activity and energy potential (with great caution).

Important: Tricyclic antidepressants and psychostimulants can provoke an exacerbation of psychosis, so they are strictly prescribed together with potent antipsychotics.

Challenge of long-term treatment (compliance)

The elimination of acute symptoms does not mean complete recovery, so the doctor's most important task is to convince the patient and their family of the need for long-term medication intake.

Long-term therapy has its contradictions. Typical antipsychotics increase the risk of tardive dyskinesia, but discontinuing the drugs threatens a new psychotic episode. The solution is the transition to modern atypical antipsychotics (clozapine, quetiapine, aripiprazole, etc.), which less frequently cause neurological side effects with prolonged use.

For successful cooperation (compliance), the doctor should consider aspects that concern the patient: sleep quality, mood, appearance, and even sexual life.

Shock methods and rehabilitation

Shock methods, such as electroconvulsive therapy (ECT) and insulin coma therapy, are now rarely used because psychopharmacotherapy is more effective. ECT may be indicated for acute attacks with pronounced affect and in the early stages of the disease, as well as for severe febrile schizophrenia (along with plasmapheresis and hemosorption).

Rehabilitation is a long-term process. Even after the disappearance of delusions and hallucinations, lethargy and sluggishness may persist. Patients often experience post-schizophrenic depression and severe distress due to the realization of their behavior during psychosis.

For successful rehabilitation, it is important to:

• Gradually return the patient to normal activity.
• Not create hothouse conditions at home and not shield them from everyday stresses.
• Encourage feasible help around the house.
• In case of persistent defect, involve the patient in various activities in specialized institutions.

简述：主题相关问答

课堂与考试常见问题

该主题的其他拓展内容

• Differential diagnosis of schizophrenia with manic-depressive psychosis and hysteria
• First-rank symptoms according to K. Schneider
• Features of post-schizophrenic depression
• Management of patients with persistent defect in specialized institutions
• Expertise of legal incapacity and disability in schizophrenia

Other topics in "Chapter 22. Schizophrenia and Related Disorders"

本资料由 WhiteCoat Pro 讲师根据医学院校教学大纲编写。仅供教育参考。