Treatment of schizophrenia with anti-inflammatory and immunotropic drugs

Of course, often a patient with schizophrenia is not critical of his painful experiences and dissimulates them. He also does not understand and does not accept the need for drug treatment for his disease. Therefore, relatives or friends of the patient need to monitor the intake of antipsychotic drugs in order to obtain the maximum effect from the prescribed treatment.

Diagnosis and treatment

The diagnosis of schizophrenia can only be made by a psychiatrist. He does this based on a study of the anamnesis (the above-mentioned symptoms should be observed for six months) and studies in the hospital.

Therapy is prescribed individually, it depends on the clinical picture and at what stage the disease is.

Stages of treatment:

1. Stopping an attack.
2. Stabilization.
3. Preparing the patient for discharge and return to everyday activities.
4. Rehabilitation.
5. Prevention.

The first three points imply that the patient is in a hospital. This takes from 1 to 2 months, it all depends on the severity of the attack. Rehabilitation will take up to a year, and prevention will take from five years to a much longer period.

Of great importance for the success of treatment is the recognition of the fact of schizophrenia by the patient and his relatives.

Relatives living with a schizophrenic should take an active part in the fate of their relative, help him, and support him. They need to ensure that the patient complies with the psychiatrist’s instructions and control his behavior (which he himself is not always able to do).

A few words should be said about treatment methods, psychotherapy and what is recommended to be done at home. We will talk about the medication component separately, since it is the most important, necessary and extensive.

Psychotherapy for schizophrenia

The specialist’s task is to correct the patient’s behavior taking into account his psyche.

Most often, cognitive behavioral therapy is used, which restores the patient’s cognitive abilities: thinking, memory, attention, etc. Also used:

• hypnosis;
• psychoanalysis;
• art therapy;
• occupational therapy;
• music therapy.

Family members also receive the attention of the psychotherapist. He explains the features of schizophrenia, that it requires a special approach and attention on their part, benevolence. The doctor tells what relatives should do during periods of remission and exacerbation, about the inadmissibility of violence towards the patient, his isolation.

Housework

An important factor in treatment at home is good sleep. The brain of a person exhausted by illness urgently needs complete rest, deep, restful sleep. If you have problems falling asleep, it is advisable to take a sleeping pill, but only on the recommendation of your doctor.

Proper nutrition is extremely important for all diseases. While in an attack, the patient refuses food or eats only from time to time and becomes exhausted. As a result, the brain, and the entire body as a whole, does not receive enough necessary microelements, vitamins and other substances. It is necessary to eat well and properly to make up for the lack of all this, and to gain strength to fight the disease.

Physical activity softens the course of schizophrenia. Ordinary regular walks in the fresh air and any kind of sports are very useful.

Naturally, no alcohol or tobacco is allowed.

You should follow a daily routine, avoid stress, and be positive.

And, most importantly, you need understanding and support from the family, whose members, among other things, can prevent the dangerous and common tendency of schizophrenics - suicide.

The effectiveness of new generation neuroleptics

New generation neuroleptics, without side effects that impair the mental functioning of the brain, have weak antipsychotic activity. They act on certain dopamine receptors in the brain. Unlike typical antipsychotics, the use of which leads to complete disorientation of a person, atypical antipsychotics act only in the limbic system.

They have low anti-dopamine properties and high sedative qualities:

• eliminate obvious and hidden symptoms of psychosis;
• calm, reduce anxiety, gag reflex;
• prevent the progression of human mental disorders;
• do not affect the pituitary gland, extrapyramidal system, hypothalamus;
• retain cognitive function in full.

Forecast

Unfortunately, it is not yet possible to completely cure schizophrenia. Its chronic course requires treatment on an outpatient basis or at home, but acute attacks require hospitalization to relieve them. Rehabilitation can be carried out in a so-called day hospital, that is, the patient receives procedures in the hospital during the day and spends the night at home.

As for the prognosis, it generally depends on the response to treatment. If the tactics, methods of psychotherapy and medications are chosen correctly, then it is possible, albeit with difficulty, to achieve good results in which the patient will be able to live normally, have a family, work, etc. But he will have to take certain medications throughout his life and regularly visit a psychiatrist.

You can give examples from practice.

There have been cases where, thanks to successful treatment, a person who had one or two attacks at the beginning of the disease lived the rest of his life without relapses.

There are also people diagnosed with schizophrenia who live ordinary lives, performing quite complex tasks and engaging in mental activity.

Timely modern treatment allows the patient to return to his usual activities, since his intellect is not affected.

Long-term remission is possible in the following categories of patients:

• women;
• having a high level of socialization;
• sick people in old age;
• having a high level of intelligence;
• if the cause of the disease is severe psychological stress;
• having strong psychological support from others.

Many people have been restored to a state in which they can take care of themselves and perform simple operations.

Despite such positive data, it should be understood that a relapse can occur at any time, and both the patient and his relatives need to be prepared for this. It also happens that after an acute attack a person becomes disabled, unable to be independent, with a severe mental condition and requiring constant care.

Causes of mental illness

The exact cause of schizophrenia has not yet been identified. It is believed that this is a multifactorial disease that develops under the influence of a number of provoking and predisposing factors:

• Burdened heredity. If you have close relatives with schizophrenia, the risk of developing it in your offspring increases by about 20 times.
• Unfavorable social conditions such as poverty and family instability.
• Bad habits. Smoking, drug addiction, substance abuse and alcoholism do not so much cause the disease as accompany schizophrenia, complicating its course.
• Complicated pregnancy (prematurity, intrauterine hypoxia or infections).
• Emotional turmoil, especially in childhood. It has been proven that people who have experienced physical or sexual violence are more likely to develop schizophrenia.
• Anomalies in the development of central nervous system structures. Autopsies of dead patients showed that most of them had dilation of the cerebral ventricles, a decrease in the volume of the frontal lobe, and organic changes in the temporal gyri and hippocampus.

There are other theories of the development of schizophrenia that are not so popular and widespread.

Drug therapy

As already mentioned, the use of special drugs is the main method of treating schizophrenia. They are prescribed by a doctor and they are usually from the line of antipsychotics (neuroleptics). Usually this is one or, very rarely, two drugs, but three - under no circumstances.

The advent of antipsychotics in the mid-twentieth century literally revolutionized the treatment of schizophrenia. Before this, weaker and less effective bromides, plant extracts, opiates, antihistamines, and also a very radical lobotomy were used.

Antipsychotics block dopamine receptors, which cause the main symptoms of schizophrenia – hallucinations and delusions. In addition, they also have the following effects:

• hypnotic;
• sedative;
• antiemetic;
• anti-anxiety;
• relieve cognitive impairment and negative disorders.

Treatment with antipsychotics is a long process, since they have an effect in no less than a month, or even six. And such a long period is not reduced, even if the elimination of the attack was successful.

Taking such medications does not stop during the period of stabilization and prevention.

If a patient has 1 attack, supportive pharmacological treatment continues for two years, 2 attacks - five years, and 3 or more - throughout life.

The dosage can be reduced by a specialist at the preventive stage, but you cannot stop taking the medication without his recommendation - this can cause a relapse.

List of tablets and other forms of medication:

1. Chlorpromazine (Aminazine) is the “elder” among antipsychotics. Relieves manic and psychomotor agitation, paranoid state, hallucinations. Has a strong sedative effect. Available in the form of 0.25 and 0.5 g tablets, injection solution. Contraindicated for elderly people.
2. Haloperidol is an equally well-known drug, a selective blocker of dopamine receptors. The maximum permissible dose per day is 100 mg, the dosage is determined by the doctor. Available in 1.5 mg tablets, solution, drops.
3. Risperidone is a benzisoxazole derivative, the optimal dose is 0.5–6 mg. Affects serotonin and dopamine receptors. Suitable for relief of attacks and prevention.
4. Clozapine is a very powerful drug that also has sedative, antidepressant and anxiolytic effects. It is used only if the patient is immune to other antipsychotics, but not to relieve attacks, as it can lead to a decrease in the body's resistance to infections.
5. Quetiapine or Seroquel. Its effects are similar to Haloperidol, but it has fewer side effects. Daily dose 150–170 mg.
6. Amilsupride (Solian) – acts selectively on dopamine receptors, bypassing alpha-adrenaline, histamine and serotonin receptors. It also has a calming effect. Relieves symptoms of schizophrenia.
7. Thioridazine (Sonapax) is a classic antipsychotic, very mild compared to others, has few side effects, calms, relieves depression, suicidal thoughts, etc. Suitable for children from two years old.

This is not the entire list of pharmacological agents for the treatment of schizophrenia.

The doctor selects the drug based on the patient’s health status, age, symptoms, and drug compatibility. Thus, for a certain category of patients, he considers the traditional strong haloperidol more suitable, and for others, the gentle risperidone.

If antipsychotics do not have the necessary effect (and this happens), then other drugs are prescribed, which, unfortunately, are more toxic. If this does not have any effect, then insulin coma, cytokines, and electroconvulsive therapy are used.

Side effects of antipsychotics

Drugs of this group, for all their excellent therapeutic qualities, unfortunately, have many negative side effects. That is, they are unsafe, and such manifestations depend on:

• type of antipsychotic (typical, atypical);
• doses;
• patient's age;
• the patient's condition;
• duration of therapy;
• compatibility with other drugs.

The biggest possibility is parkinsonism, that is, trembling and muscle spasms. Especially often, such a reaction can be caused by first-generation antipsychotics; this is less common for the second.

Other side effects include:

• drowsiness;
• disorders of the gastrointestinal tract;
• anxiety;
• depression;
• increased muscle tone;
• weight gain, change in appetite;
• fear.

Also possible:

• allergy;
• cholestatic jaundice;
• pneumonia;
• epileptic seizures;
• enlargement of the mammary glands;
• decrease in hemoglobin level.

Long-term treatment with antipsychotics risks menstrual irregularities for women, sexual dysfunction for men, and both:

• infertility;
• development of diabetes;
• stroke, ischemia, heart attack;
• osteoporosis;
• constipation;
• dizziness;
• blurred vision, etc.

Taking such drugs for more than 5 years reduces brain weight.

Too high doses of neuroleptics lead to a very dangerous neuroleptic syndrome, manifested by fever, muscle rigidity, and leukocytosis. The result can be terrible - death.

There are no antipsychotics that do not have side effects, even if they are the latest generation. But more effective medications have not yet been invented. Therefore, it is very important that the treatment is carried out by experienced psychiatrists who are able to select the correct medications and their correct dosage. And the patient should strictly follow the specialist’s instructions.

Ancillary drugs

Levodopa will help reduce the parkinsonian effect produced by antipsychotics.

To reduce anxiety and eliminate depression that accompany schizophrenia, tranquilizers - antidepressants are used:

• Phenazepam;
• Diazepam;
• Chlordiazepoxide;
• Sertraline;
• Fluoxetine.

To improve cerebral circulation, nootropics are prescribed: Pantogam and Piracetam.

Lithium salts and carbamazepine help stabilize the emotional state.

No folk remedies can help in the treatment of schizophrenia, but in some cases the doctor may allow tincture of lemon balm, motherwort, and valerian as a sedative.

Stopping a relapse

Treatment of exacerbations (exacerbations, relapses) of schizophrenia requires the use of those medications that have previously proven effective in a particular patient with schizophrenia. To do this, you need to know the features of previous therapy - drug history. However, in some cases, the effectiveness of an antipsychotic in the same patient may vary at different stages of the disease. This is due to differences in both the pharmacokinetics and, to a greater extent, the pharmacodynamics of the drug. The effectiveness of an antipsychotic depends on the functional state of the neurochemical systems of the brain and enzyme activity of the liver, which can change as the disease progresses.

Some authors warn against the routine transfer of all patients to atypical antipsychotics, emphasizing the importance of the patient’s drug anmanesis: which drug, in what dosage and through which route of administration was most effective, caused the least side effects in the process of stopping previous exacerbations of the disease.

Recommendations for stopping relapses usually include a dose range of 300 to 1000 mg chlorpromazine equivalent per day for at least 6 weeks (Falkai P. et al., 2005).

Good news

A new antipsychotic for the maintenance treatment of schizophrenia from the Janssen company, part of the Johnson & Johnson pharmaceutical division, Trevicta, has been registered in Russia. It has a long-lasting effect and can be used only 4 times a year, that is, every three months, which is much better than monthly injections of long-standing antipsychotics.

Trevicta is now an antipsychotic with the longest dosing interval registered in our country. It maintains its optimal concentration of paliperidone in the patient’s blood for a long time, which is why it requires such rare use.

Prescribe three months of Trevicta to patients with a stable condition after treatment with other drugs. It helps reduce the risk of relapse due to its prolonged action, has a low risk of side effects, and does not create withdrawal syndrome if treatment is abruptly stopped. This makes it possible for a patient with schizophrenia to socialize and maintain his constant normal state.

Types of atypical antipsychotics

Neuroleptics are drugs for the treatment of various psychiatric pathologies and nervous system disorders that help:

• normalize human social behavior;
• stop coughing, nausea, vomiting;
• reduce body temperature;
• eliminate increased anxiety, insomnia;
• reduce vegetative reactions.

Previously used drugs to relieve the symptoms of schizophrenia and bipolar disorder completely blocked the metabolism of dopamine, causing a decrease in a person’s mental and physical activity. Atypical neuroleptics of the new generation, in contrast to their predecessors, have a milder effect and rarely provoke the appearance of adverse reactions in the body.

The classification of atypical antipsychotics is based on:

1. The duration of the effect produced. In modern pharmacology, antipsychotics with rapid and prolonged action are produced.
2. The severity of the clinical picture of treatment.
3. The mechanism of action of the drug on dopamine nerve endings (the doctor can choose the appropriate therapy for the patient).
4. Chemical composition of the drug. The synthetic formula of the drug is selected strictly individually, in order to reduce the possible unpleasant consequences of the treatment.

Antipsychotics without side effects that can be bought without a prescription

New generation neuroleptics without side effects on the nervous and endocrine systems are widely used to eliminate neurological and psychotic disorders. The medicinal properties of the drugs are aimed at blocking dopamine receptors D1, D2, reducing increased excitability and anxiety.

This list of antipsychotics has a sedative effect and is used for depression and stress, and sleep problems:

1. "Olanzapine" - reduces the action of neurons, pacifies the activity of the nerve pathways that control motor functions. Removes anxiety and negative manifestations of stress. Prescribed for depression, mental pathologies, and increased fear. Pregnant and lactating women, children under 18 years of age, and persons suffering from blood, liver, and kidney diseases should not take the drug.
2. "Amisulpride" is an antipsychotic with a calming and antidepressant effect. Indicated for schizophrenia, mental pathologies accompanied by delusions, hallucinations, impaired thinking, and withdrawal.
3. "Aprizol" - used to treat psychosis. Acts on dopamine and sedative receptors. Relaxes the nervous system. The maximum drug effect occurs 4-5 days after the start of therapy. Recommended for depressive disorders. May be dangerous for patients suffering from pathologies of the cardiovascular system.
4. "Serdolect" – generic “Aprizola”. Similar in composition and therapeutic effects.

5. "Respiridone" is a psychotropic drug that has a hypothermic, antiemetic, and sedative effect. It overcomes mental disorders well, accompanied by delusions, hallucinations, neurological problems, the effects of stress, and depression. Prescribed for cyanide dementia of the Alzheimer's type, senile dementia, and uncontrolled aggression in adolescents.
6. Clozapine is an antipsychotic that eliminates anxiety and destructive behavior. It affects the symptoms of negativism, schizophrenia, manic-depressive psychosis, psychomotor agitation of the emotional-behavioral type, bipolar disorder.