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Schizophrenia Treatment - Antipsychotic Medications

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA Updated: Mar 21st 2017

Antipsychotics are divided into two categories. The first-generation are known as "typical" drugs. The second-generation are known as "atypical" drugs. Typical antipsychotics were the first family of drugs discovered to treat psychotic symptoms. Some examples of "typical" antipsychotic medications are: chlorpromazine, fluphenazine, haloperidol, molindone, thiothixene, thoridazine, trifluoperazine, and loxapine.

pile of pills Atypical antipsychotic drugs were developed later and named to distinguish them from the earlier drugs. Some examples of "atypical" antipsychotic medications include: clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole.

The distinction in these category names also reflects differences in how they were thought to work. Typical medications were originally thought to work primarily by affecting dopamine in the brain. Atypical drugs were thought to work through other brain chemical systems. Recent research, however, suggests that all these drugs mainly affect dopamine systems.

Atypical medications can offer some advantages over typical medications. They seem to:

  • produce greater negative symptom relief
  • affect thinking and comprehension less
  • offer better relapse prevention and ability to function in daily life
  • have fewer extrapyramidal symptoms (EPS) and cause less tardive dyskinesia (TD) (see discussions below)

These are significant advantages and suggest that where tolerated and appropriate, atypical medication therapy may result in a better quality of life for those living with schizophrenia. Antipsychotic medications of all varieties come in tablet/pill and liquid forms. They are usually taken once a day. Some are also available in long-lasting forms that can be injected once or twice a month. Injectable types may be necessary in situations where people will not voluntarily take their medications and must be forced to do so for relief of psychotic symptoms. Medications are generally only forced when necessary for safety reasons.

Doctors will also give additional medications for to address other symptoms besides the hallucinations/delusions. For example, antidepressants and mood stabilizers may be used where mood symptoms are a problem and anti-anxiety medications may be given on an as needed basis for when anxiety is an issue.

Antipsychotic Medication Side Effects

Side effects of antipsychotic medications can be serious. One form of side effect is extrapyramidal symptoms (EPS). This can leave patients with body stiffness, tremor, slowed movement, loss of capability for facial expression, and restlessness. These symptoms result from the blockage of dopamine receptors in the brain. They are very similar to Parkinson's disease, which also results from a dopamine deficiency. In general, typical medications produce more EPS than do atypicals. This is a primary reason why atypicals have become more popular in the treatment of schizophrenia.

Another potential side effect of typical antipsychotic use is Tardive Dyskinesia (TD), This is a condition characterized by involuntary body movements, most often happening with the mouth and facial twitching. Symptoms may range from mild to severe, and can be permanent once they have started. More commonly, they can be partly or completely reversed though.

Atypical medications also have their side effects as well. These drugs cause weight gain, high blood sugar (hyperglycemia) and high cholesterol(dyslipidemia). Other side effects may include a decrease in sexual performance abilities and/or interest, menstrual problems, and sensitivity to sunburn or skin rashes.

Patients or family members should let doctors know when side effects happen. Doctors can sometimes prescribe different medications, change dosages or schedules, or give additional medications to control and minimize side effects.


Reader Comments
Discuss this issue below or in our forums.

Minimum Drugs Maximum Results! - Dr. Abdul Salam Khan - Oct 15th 2006
First of all attempts should be undertaken to improve socialization, self support, Positive community Participation and drugs should be left at last resort, even if, the patient is in serious condition so minimum of minimum drugs should be given, because, drug side effects are more dangerous as compared then that of actual disorder, therefore, mind should be tuned up that low drugs and maximum psychotherapeutic observable facts.

Editor's Note: It is undoubtably right as a good philosophy of care that invasive treatments should be reserved for situations where other less invasive treatments will work. The thing is, in a situation like Schizophrenia, I (Dr. Dombeck) am not aware of reasonable non-medical treatments that are going to work adequately to reduce symptoms to managable levels and thus replace medicine treatments. I say this as a Psychologist - a specialist in non-medical treatments who is not a medical doctor and who is not licensed to prescribe medicine. There are good psychotherapy and psychosocial treatments for Schizophrenia, and they should be used to their fullest potential. However, these treatments are ultimately adjunctive; best used along side of antipsychotic therapy, and not as a replacement for it.

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