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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. Updated in 2009 

  • Efficacy Compared Between Second generation antipsychotic medication (SGA's)
  • Common Side Effects of First Generation Antipsychotic medication(FGA's) and SGA's
  • Extrapyramidal Symptoms and Their Treatment
  • Antipsychotics and Their Estimated Effects on Prolactin Level at Thereapeutic Doses
  • Antipsychotic Induced Weight Gain
  • Interventions for Weight Gain in Patients Treated with SGA's
  • 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 SGA's , with side effect profiles greatly improved over FGA's, have created the hope that individuals with schizophrenia will ultimately be able to recover and become reintegrated into society.

The SGA's include clozapine (which is approved only for treatment-resistant schizophrenia), olanzapine, quetiapine, risperidone, ziprasidone, and aripiprazole. The SGA's are often more effective than FGA's, 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 FGA's.

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, SGA's have are first-line choices for treating the symptoms of schizophrenia.

Percentage of Responders

SGA's have demonstrated advantages in maintenance-or-response and relapse prevention in clinical trials against placebo and FGA's. The SGA's vary in their propensities toward adverse events of treatment as well as efficacy. Total wellness in schizophrenia is achieved by using an SGA 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.  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 SGA's decreased following nutrition intervention. Diabetes type II is another event associated with antipsychotic treatment, but it is most probably associated with, familial history, poverty, poor nutrition, and other comorbidities. The connection between type II diabetes and schizophrenia seems likely.

Treating patients with SGA's 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 SGA's 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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