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Professional Issues >> Total Wellness
Achieving Total Wellness in Patients With Schizophrenia
Marianne Emanuel, R.N.
The following is reprinted with permission from the Journal of clinical Psychiatry, JCP Visuals, Vol. 2 No. 1, November 2000. Links ot subsections of the main article include:
- Efficacy Compared Between Two Atypical Antipsychotic Agents
- Common Side Effects of Typical and Atypical Antipsychotics
- Extrapyramidal Symptoms and Their Treatment
- QTc Interval Prolongation and Atypical Antipsychotics
- Antipsychotics and Their Estimated Effects on Prolactin Level at Thereapeutic Doses
- Antipsychotic Induced Weight Gain
- Interventions for Weight Gain in Patients Treated with Novel Antipsychotics
- Diabetes in Schizophrenia and Bipolar Disorder
- References
Schizophrenia has perhaps been the most daunting illness confronting psychiatrists. Without proper treatment, a frightening degree of disability is associated with this disease. Until recently, the treatment options for schizophrenia - the typical neuroleptics - involved a host of troubling CNS and other side effects, including tardive dyskinesia and extrapyramidal symptoms (EPS). But the newer atypical antipsychotics, with side effect profiles greatly improved over their typical antecedents, have created the hope that individuals with schizophrenia will ultimately be able to recover and become reintegrated into society.
The atypical antipsychotics include clozapine (which is approved only for treatment-resistant schizophrenia), olanzapine, quetiapine, risperidone, and ziprasidone (which is not yet approved for use in the United States). The atypical agents are more effective than the typical agents, especially for negative symptoms of schizophrenia, including depressive symptoms and cognitive dysfunction. This greater efficacy, combined with an improved side effect profile, leads to better patient compliance and fewer relapses than with the typical neuroleptics.
Since adverse effects are more manageable with these newer agents, there is promise for enhancing compliance, improving overall outcome, and ending the terrible downward spiral that for so long was associated with schizophrenia and other psychotic disorders. For these reasons, the atypical antipsychotics have become the first-line choices for treating the symptoms of schizophrenia.
Percentage of Responders
Atypical antipsychotics have demonstrated advantages in maintenance-or-response and relapse prevention in clinical trials against placebo and typical antipsychotics. The atypical antipsychotics vary in their propensities toward adverse events of treatment as well as efficacy. Total wellness in schizophrenia is achieved by using an atypical antipsychotics with a manageable adverse event profile.
Extrapyramidal symptoms are adverse effects that can only be managed with medications that have many unwanted effects themselves. Hyperprolactinemia is another side effect of some antipsychotics that can be treated, if at all, only with other medications, which can result in more adverse events. A prolonged QTc interval is a side effect of some antipsychotics that needs to be monitored. One potential side effect of antipsychotic treatment, weight gain, appears to be more a function of diet and exercise than of particular antipsychotic medication. In one study, the percentage on patients who experienced weight gain while taking various atypical antipsychotics decreased following nutrition intervention. Diabetes mellitus type II is another event associated with antipsychotic treatment, but it is most probably associated with poor diets, familial history, and other comorbidities. The connection between type II diabetes and schizophrenia requires further study.
Treating patients with the atypical antipsychotic medications with the best acute efficacy, strongest relapse prevention, and more manageable side effect profile is an important first step toward reintegration. For patients with schizophrenia and related disorders, and for their network of family and friends, the time has come to look beyond symptom relief and toward a real sense of recovery. The partnering of the new antipsychotic medications with state-of-the-art rehabilitation strategies has allowed the implementation of outcome measures, such as back-to-work programs, and has improved the quality of life for people with schizophrenia.
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