Medical Morbidity and Mortality
Medical Morbidity and Mortality Essential Concepts Physical health and wellness matter as much as mental health to patients with schizophrenia. Reducing premature deaths from cardiac disease is an important treatment…
Antipsychotics—Clinical Effectiveness
Antipsychotics—Clinical Effectiveness Essential Concepts A large clinical trial, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), compared risperidone, olanzapine, quetiapine, and ziprasidone with perphenazine. Only 26% of subjects who entered this…
Psychiatric Rehabilitation
Psychiatric Rehabilitation Essential Concepts Psychiatric rehabilitation and psychiatric treatment are separate, yet equally important, complementary components of schizophrenia care. Psychiatric rehabilitation focuses on function and role outcomes, not on symptoms….
Psychologic Treatments—The Family
Psychologic Treatments—The Family Essential Concepts Family members (often parents or siblings) can be the greatest resources your patient has. Help family members understand the illness, and let them help you…
Psychologic Treatments—The Patient
Psychologic Treatments—The Patient Essential Concepts Supportive therapy is the pragmatic, real physician trying to help patients in the here-and-now with encouragement and advice. The foundation of supportive therapy is a…
Polypharmacy
Polypharmacy Essential Concepts Polypharmacy is a fuzzy concept since, at the molecular level, antipsychotic monotherapy constitutes intrinsic polypharmacy. Appropriate reasons for combination treatments are as follows: added efficacy, supplemental symptom…
Drug Interactions
Drug Interactions Essential Concepts All antipsychotics are metabolized to varying degrees by the hepatic cytochrome P450 (CYP450) isoenzymes 3A4, 2D6, and 1A2. Some have additional non-P450 metabolism, which lowers the…
Ancillary Medications
Ancillary Medications Essential Concepts Avoid antidepressants during acute episodes of psychosis, but consider antidepressants in patients with remitted schizophrenia who develop full, syndromal depression. Valproate is useful adjunctively in acute…
Antipsychotics—Nonmotor Side Effects
Antipsychotics—Nonmotor Side Effects Essential Concepts Nonmotor side effects of antipsychotics, such as sedation or weight gain, can reduce quality of life and lead to nonadherence. Metabolic side effects (i.e., diabetes…
Antipsychotics—Motor Side Effects
Antipsychotics—Motor Side Effects Essential Concepts Motor side effects associated with antipsychotic treatment include acute extrapyramidal syndromes (acute dystonic reaction, akathisia, parkinsonism) and long-term complications [tardive dyskinesia (TD)]. The sine qua…
