1. Treatments for Schizophrenia
Chapter 15

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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

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