Treatments for Schizophrenia Chapter 15

Traditional Care Little tx for schizophrenia Life in an institution > house, care & restrain 1850s-1950s: rise of state hospital system in US > depended on $$$ > isolated – quiet for pts & cheap > lowest form of medicine > # grew from low thousands to hundreds of thousands Pts were permanent – unfit to leave Medical approaches > lobotomy

Therapies in Hospitals Milieu Therapy – create a community of residents; give them projects, etc Token economies – pay pts for doing things – very behavioristic Token econ – very good results

Medications Antipsychotics - French - 1950s – first used as antihistamines – phenothiazines used for that – relax people Conventional antipsychotics or neuroleptics 1954: chlorpromazine > brand Thorazine > that, others, haloperidol (Haldol) Mellaril, Stelazine Called neuroleptics b/c of side-effects

Rating Meds Strong sx reduction (mainly key features) 65% pt improved Meds can work alone Pts can relapse w or w/o meds, but more will if they stop their meds Side-effects – work on DA circuit Parkinsonian sx - ~ to PD – tremors, rigidity, mask

side-Effects Neuroleptic malignant syndrome – 1% pts – elderly more likely – paralyzed, breathing & heart issues, coma > may die Meds discontinued – tx condition Tardive dyskinesia – long-term use – pill-rolling, grimaces, chewing, movement problems, memory loss – may be mild to severe - permanent Conditions impact substantia nigra

Newer Medications Second-generation antipsychotics – called atypical – work differently clozapine (Clozaril), risperdone (Risperdal), aripiprazole (Abilify). others Help both key features & negative ones !! Fewer dramatic side-effects > but some Most pts on one of these Other uses – bipolar, MDD Some need older meds - $, availability, etc

Side-Effects Clozapine > agranulocytosis – death of WBC – compromises immunity Dizziness, fatigue, weight gain, DM

Talk Therapy Psychodynamic – forget Cognitive-Behavioral Therapy – stress behavioral > educate pts about sx > pts can learn triggers & how to cope > encourage pts to challenge own hallucinations & delusions > encourage better interpretation of sx > coping, mindfulness, acceptance

Community Approaches 1960s – deinstitutionalization Brief hospital stays – transitional care – aftercare Use clinics, day treatment centers Group homes/halfway houses Occupational training