Understanding Schizophrenia and Its Treatments

Schizophrenia

• Schizophrenia involves genetic factors, and the precise genes and gene-environment interactions are yet to be clarified
• Schizophrenia shares many heritable factors with Bipolar I disorder, suggesting there may be an underlying genetic basis for both disorders that runs on a continuum
• The phenotypic complexity of Schizophrenia, together with the multifarious nature of the ‘group’ of ‘schizophrenic psychoses’ limits our ability to form a simple and logical biologically based hypothesis of the disease group

Treating Schizophrenia

• There are agents that can be used to treat the symptoms of Schizophrenia, but they do not really differ much from one another in general effectiveness
• The mechanisms underlying Schizophrenia and it's progression need to be understood, in order to move beyond symptom management
• Although they were widely used, chlorpromazine/Thorazine and other neuroleptics were used before their mechanisms of action were isolated

Side Effects of Neuroleptics

• Neuroleptics can cause extrapyramidal side effects (EPSs) that occur early in the course of therapy
• Early-onset side effects include akathisia and parkinsonism
• Late-onset side effects include tardive dyskinesia and neuroleptic malignant syndrome (NMS)

Akathisia

• Akathisia is a feeling of restlessness and an inability to sit still
• Akathisia may cause the client to pace, fidget, or even rock back and forth in the chair
• Akathisia can be treated with benzodiazepines, anti-Parkinsonian agents, and beta-blockers

Parkinsonism

• Parkinsonism is a side effect characterized by muscular rigidity, slowed movement, tremors, and bradykinesia
• Parkinsonism is treated with anticholinergic agents, such as benztropine
• Once the neuroleptic is discontinued, the symptoms of Parkinsonism often vanish within weeks to months

Tardive Dyskinesia

• Tardive dyskinesia is a late-appearing abnormal movement of the mouth, lips, and tongue
• It may be accompanied by involuntary twitching and jerking of muscles (choreic movement)
• Tardive dyskinesia is a serious side effect that can be irreversible
• Tardive dyskinesia affects on average 15 to 20% of clients on neuroleptics
• The incidence of tardive dyskinesia is higher in older adults
• People with schizophrenia have a 31 times higher chance of developing tardive dyskinesia than those in the general population

Neuroleptic Malignant Syndrome (NMS)

• NMS is a life-threatening condition that can occur with the use of neuroleptics
• NMS is characterized by fever, muscle rigidity, altered mental status, and autonomic instability
• NMS is a rare condition and fatalities are rare due to the decrease in neuroleptic use and early detection
• If the medication is discontinued in time, most cases resolve within a month
• NMS is uncommon, and most patients recover without long term effects

Agents to Treat Extrapyramidal Side Effects

• Anti-Parkinsonian agents are used to treat early-onset extrapyramidal symptoms
• These side effects result from neuroleptic-induced blockade of dopamine receptors in the nigrostriatal pathway
• Experimental studies have been conducted to examine calcium channel blockers as potential treatments for EPSs