- Although multiple neurotransmitter dysfunctions are involved in schizophrenia, the etiology is more likely mediated by multiple subcellular processes that are influenced by different genetic polymorphisms.
- The clinical presentation of schizophrenia is characterized by positive symptoms, negative symptoms, and impairment in cognitive functioning.
- Comprehensive care for individuals with schizophrenia must occur in the context of a multidisciplinary mental healthcare environment that offers comprehensive psychosocial services in addition to psychotropic medication management.
- A thorough patient evaluation (e.g., history, mental status examination, physical examination, psychiatric diagnostic interview, and laboratory analysis) should occur to establish a diagnosis of schizophrenia and to identify potential co-occurring disorders, including substance abuse and general medical disorders.
- Given that it is challenging to differentiate among antipsychotics based on efficacy, side effect profiles become important in choosing an antipsychotic for an individual patient.
- Pharmacotherapy guidelines should emphasize monotherapies with antipsychotics of optimal efficacy-to-side effect ratios and progress to medications with greater side effect risks, and combination regimens should only be used in the most treatment-resistant patients.
- Adequate time on a given medication at a therapeutic dose is the most important variable in predicting medication response.
- Long-term maintenance antipsychotic treatment is necessary for the vast majority of patients with schizophrenia in order to prevent relapse.
- Thorough patient and family psychoeducation should be implemented, and methods such as motivational interviewing that focus on patient-driven outcomes that allow patients to achieve life goals should be employed.
- Pharmacotherapy decisions should be guided by systematic monitoring of patient symptoms, preferably with the use of brief symptom rating scales and systematic assessment of potential adverse effects.
On completion of the chapter, the reader will be able to:
Describe the most common theories regarding the etiology of schizophrenia.
Outline the neurotransmitters thought to be involved in schizophrenia.
List the three categories of symptoms seen in schizophrenia and give examples of each.
List the types of nonpharmacologic therapies that should be offered to individuals with schizophrenia.
Discuss the major areas included in the initial evaluation of a patient suspected of having schizophrenia.
Discuss the considerations for choosing initial drug therapy for a patient with schizophrenia.
Recommend methods to improve treatment adherence in a patient with schizophrenia.
Discuss treatment approaches for individuals with treatment-resistant schizophrenia.
Discuss the potential advantages and disadvantages of antipsychotic polypharmacy.
Discuss the two major hypotheses regarding second-generation antipsychotic mechanism of action, and give an example of a drug with each mechanistic approach.
Compare the side effect profiles of antipsychotics, and apply this information to the selection of an appropriate antipsychotic regimen for an individual patient.
Recommend a treatment plan for a patient with Parkinson’s symptoms secondary to a first-generation antipsychotic, secondary to a second-generation antipsychotic.
Recommend treatment interventions for a patient with antipsychotic-induced glucose intolerance.
Evaluate a patient profile of a patient with schizophrenia and co-occurring general medical disorders for potential drug interactions.
Outline a pharmacotherapeutic treatment plan for a patient with schizophrenia in acute exacerbation, including appropriate monitoring and followup.