Schizophrenia (8)

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The effectiveness of schizophrenia treatment is often assessed using standardized methods, one of the most common being the positive and negative syndrome scale (PANSS). Management of symptoms and improving function is thought to be more achievable than a cure. Treatment was revolutionized in the mid 1950s with the development and introduction of chlorpromazine.[87] A recovery model is increasingly adopted, emphasizing hope, empowerment and social inclusion.[88]

Hospitalization may occur with severe episodes of schizophrenia. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Long-term inpatient stays are now less common due to deinstitutionalization, although can still occur.[5] Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or Assertive Community Treatment team, supported employment[89] and patient-led support groups.
In many non-Western societies, schizophrenia may only be treated with more informal, community-led methods. The outcome for people diagnosed with schizophrenia in non-Western countries may actually be better than for people in the West.[90] The reasons for this effect are not clear, although cross-cultural studies are being conducted.

Medication: The mainstay of psychiatric treatment for schizophrenia is an antipsychotic medication.[91] These can reduce the "positive" symptoms of psychosis. Most antipsychotics take around 7–14 days to have their main effect. Risperidone (trade name Risperdal) is a common atypical antipsychotic medication. Though expensive, the newer atypical antipsychotic drugs are usually preferred for initial treatment over the older typical antipsychotics; they are often better tolerated and associated with lower rates of tardive dyskinesia, although they are more likely to induce weight gain and obesity-related diseases.[92] Prolactin elevations have been reported in women with schizophrenia taking atypical antipsychotics.[93]It remains unclear whether the newer antipsychotics reduce the chances of developing neuroleptic malignant syndrome, a rare but serious and potentially fatal neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs.[94]

The two classes of antipsychotics are generally thought equally effective for the treatment of the positive symptoms. Some researchers have suggested that the atypicals offer additional benefit for the negative symptoms and cognitive deficits associated with schizophrenia, although the clinical significance of these effects has yet to be established. Recent reviews have refuted the claim that atypical antipsychotics have fewer extrapyramidal side effects than typical antipsychotics, especially when the latter are used in low doses or when low potency antipsychotics are chosen.[95]

Response of symptoms to medication is variable; "Treatment-resistant schizophrenia" is a term used for the failure of symptoms to respond satisfactorily to at least two different antipsychotics.[96] Patients in this category may be prescribed clozapine,[97] a medication of superior effectiveness but several potentially lethal side effects including agranulocytosis and myocarditis.[98] Clozapine may have the additional benefit of reducing propensity for substance abuse in schizophrenic patients. [99] For other patients who are ... ...To be continued