Treatment of Schizophrenia Spectrum Disorders

Schizophrenia is a chronic mental disorder that causes the breakdown of emotional reactions and thought processes. It is impossible to cure it entirely, but it is possible to restore a person’s social activity and working capacity as a result of long-term therapy. The development of schizophrenia is based on the pathologization of the brain’s physiological processes, which provoke an imbalance in the psyche and its productive symptoms. The dopamine theory is considered one of the most reliable. According to it, schizophrenia is caused by ultra-high or ultra-low levels of the neurotransmitter dopamine, which is persistently retained for a long time (Kesby et al., 2018). If there is too much of it, then productive symptoms of the disorder appear as delirium, hallucinations, and disorganized thinking. If its amount is low, then negative symptoms prevail apathy, lack of will, depression. In addition to dopamine, there is an imbalance in other mediators: serotonin, acetylcholine, norepinephrine, and glutamate.

A link has been established between the failure of the liver, endocrine system, and schizophrenia. However, with the disorder, not only the chemical balance is disturbed, but also the structure of the brain tissue. Thanks to the methods of brain imaging (MRI, CT, spectroscopy), scientists were able to establish what happens to the brain of a person with schizophrenia. These people suffer from a deficiency of neural processes; therefore, the number of synapses that transmit nerve impulses decreases. As it turned out, the volume of brain tissue in such people is less than average; the amount of both white and gray matter decreases (Johns Hopkins Medicine, 2019). The lack of white matter plays a significant role in the occurrence of impaired attention, memory, thinking, apathy, and loss of the ability to set goals and go towards them. It has not yet been possible to establish the exact cause of brain substance deficiency. It is assumed that the inflammatory process in the brain may be the cause. It destroys neural connections, which causes disorganization of the brain, and with it, the psyche. Among the contributing factors that cause inflammatory reactions in the body, neuro infections are distinguished: meningitis, encephalitis, and other diseases. It was also noted that this kind’s destructive changes are visible during the study even before the onset of the disorder.

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Aminazine is one of the most widely used drugs used to treat schizophrenia. It is an antipsychotic agent from the group of phenothiazine derivatives. Aminazine has a pronounced antipsychotic, sedative, and antiemetic effect. It weakens or eliminates delusions and hallucinations, relieves psychomotor agitation, reduces affective reactions, and anxiety, and lowers motor activity. This drug is prescribed for chronic paranoid and hallucinatory-paranoid states, states of psychomotor agitation, alcoholic psychosis, and manic agitation (Mohammed et al., 2020). In addition, it can be used for other diseases accompanied by excitement and stress.

Aminazine has a significant number of side effects. These include blurred vision, arterial hypotension, tachycardia, dyspeptic symptoms, leukopenia, and agranulocytosis. In addition, chlorpromazine can cause menstrual irregularities, impotence, gynecomastia, and weight gain. It is necessary to use this drug with extreme caution in patients with pathological changes in the blood picture, impaired liver function, alcohol intoxication, and cardiovascular diseases. The risk group also includes patients with a predisposition to the development of Parkinson’s disease, gastric ulcer, duodenal ulcer, chronic respiratory diseases, and epileptic seizures. Aminazine should be used with caution in elderly patients, as it increases the risk of excessive sedative and hypotensive effects. However, despite a large number of side effects, the drug has proven its effectiveness over many years of practice.

Haloperidol is an equally well-known treatment for schizophrenia: it is a selective dopamine receptor blocker. It has powerful antipsychotics and mild sedative effects. The mechanism of the antipsychotic action of haloperidol is most likely associated with the blockade of dopamine receptors in the mesocortex and limbic system. It blocks dopaminergic activity in the nigrostriatal pathway related to abnormalities in the extrapyramidal system (Hanafi et al., 2017). Haloperidol has weak central α-adrenergic blocking, antihistamine, and anticholinergic effects, and disrupts the process of reuptake and deposition of norepinephrine. Haloperidol acts more actively on productive symptoms (delusions, hallucinations) than on negative ones. There is no evidence of its superiority in relieving negative symptoms. In addition, haloperidol itself can provoke negative secondary symptoms.

Among the side effects of haloperidol are extrapyramidal disorders. The risk of their development is especially high in people over 45 years old; therefore, these people should use the drug with caution. Other consequences of using the medication: anxiety, fear, insomnia, epileptic seizures, laryngospasm, nausea, and changes in body weight. Thus, this remedy is quite common and useful for patients with excessive activity and the presence of hallucinations.

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Another drug for the treatment of schizophrenia is clozapine: it is a powerful medication that also has sedative, antidepressant, and anxiolytic effects. It is used only when the patient is not susceptible to other antipsychotics, but not to stop seizures, as it can lead to a decrease in the body’s resistance to infections. Clozapine has a pronounced antipsychotic and sedative effect. It practically does not cause extrapyramidal disturbances; therefore, it belongs to the so-called “atypical” antipsychotics group. The drug is characterized by stages: hypnotic and sedative effects appear first, then anxiety and excitement are stopped, and after that, psychosis and symptoms of negativism are removed (Samanaite et al., 2018). The drug can cause drowsiness, headache, tachycardia, sleep disturbances, and nausea. It is essential to avoid alcohol consumption and monitor blood counts while using clozapine. In addition, patients should refrain from potentially hazardous activities that require concentration and quick reactions. Periodically, this drug is used for dementia, but its use after 60 years is associated with the risk of developing vascular diseases.

Of the three drugs, clozapine has the most acceptable side effects. Despite the strong effect of the medication, it does not cause significant harm to patients’ health. It also allows doctors to align the general psycho-emotional background of patients. This helps avoid aggressive behavior and suicidal intentions, which makes it possible to work more productively with patients with schizophrenia. In addition, the phased action of the drug allows doctors to bring the patient’s condition back to normal gradually, without abrupt changes. Thus, this drug can be called one of the best in the complex treatment of schizophrenic spectrum disorders.

Treatment for schizophrenia should include not only drug therapy but also psychotherapy and social rehabilitation measures. After the reduction or disappearance of positive symptoms, the patient with schizophrenia needs psychotherapy using cognitive-behavioral methods. Family therapy is used to create a supportive family atmosphere. Therapists should conduct training sessions for relatives of patients with schizophrenia, providing psychological support to patients’ relatives. Prognostically favorable schizophrenia factors include female sex, late age at onset, acute onset of the first psychotic episode, and mild negative symptoms. Favorable personal relationships, and good professional and social adaptation before the beginning of schizophrenia also play a critical role. The combination of these factors and the right treatment will help to stop the symptoms of schizophrenia effectively.

References

Hanafi, I., Arafat, S., Al Zayed, L., Sukkar, M., Albeirakdar, A., Krayem, D., & Essali, A. (2017). Haloperidol (route of administration) for people with schizophrenia. The Cochrane Database of Systematic Reviews, 2017(10). Web.

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Johns Hopkins Medicine. (2019). Physical evidence in the brain for types of schizophrenia: Findings suggest a form of schizophrenia has more in common with neurodegenerative diseases than previously thought. ScienceDaily.

Kesby, J., et al. (2018). Dopamine, psychosis and schizophrenia: the widening gap between basic and clinical neuroscience. Translational Psychiatry, 8, 30.

Mohammed, M. A., Ahmed, M.T., Anwer, B.E., Aboshanab, K.M., Aboulwafa, M.M. (2020). Propranolol, chlorpromazine and diclofenac restore susceptibility of extensively drug-resistant (XDR)Acinetobacter baumannii to fluoroquinolones. PLoS ONE, 15(8).

Samanaite, R., Gillespie, A., Sendt, K. V., McQueen, G., MacCabe, J. H., & Egerton, A. (2018). Biological predictors of clozapine response: A systematic review. Frontiers in Psychiatry, 9, 327.

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