AP English 12
14 March 2008
Medication and Treatment of Schizophrenia
Schizophrenia is a disabling brain disease found all over the world and in all people. No one is immune to its disabling effects; it affects women as much as men and it affects Europeans as much as Asians, Africans, or any other nationality. In America alone, it's estimated that 2.2 million people have been diagnosed with the disorder. It affects 1 in 100 people worldwide and usually strikes younger people in the prime of life ("Schizophrenia"). Often the disorder is not only disabling because of its nature as an illness, but also because of the nature of medications and their undesirable side-effects, as well as the years that could be spent in different types of therapy. To truly understand the treatment of schizophrenia, one must look at the illness itself, the different medications and treatments, and the progression and evolution of a disease once thought to be caused by toxins or demons in the body.
Schizophrenia is brain disease, literally translated "split mind." Originally, the disorder was termed "dementia praecox," or early dementia, by physician Emile Kraepelin in 1887; but in 1911 a Swiss psychiatrist, Eugen Bleuler, used "schizophrenia" instead because Kraepelin's name was misleading as the illness could occur at any age and was not dementia since it did not always cause mental deterioration (History). Schizophrenia is often confused with multiple personalities, but is actually a split from reality characterized by delusional and disorganized thinking, inappropriate emotions or actions, and dream-like or disturbed perceptions. "If depression is the common cold of psychological disorders, then schizophrenia is the cancer." It is a serious and often a very troubling and frightening disorder for those afflicted with it and those who know someone afflicted with it (Myers 647-648). Schizophrenia has been called a "psychiatric mystery. Though research has been ongoing for over forty years, doctors and scientists still do not know the cause and there is no cure (FDA).
Although there is no cure for
the disorder, the treatment of the mentally ill dates back to
historically to Ancient Egypt, two millennia before Christ
(History). Treatment of schizophrenia and the mentally ill has
progressed from the ancients, such as the Egyptians, to shaman
and medicine men in the 1600s. Misunderstood individuals, who may
have suffered from the disorder were hung in the 1692 Salem Witch
Trials. More modern treatments beginning in the twentieth century
included insulin shock and induced temporary coma in the 1930s
Frontal lobotomy procedures were done between 1936 and the 1950s.
Electrotherapy was developed and used in the 1940s. Other more
modern and humane treatments of the mentally ill began
mid-century when the first antipsychotic drugs were introduced
("Evolution"). Other treatments included, but were not limited
to, exorcising evil spirits thought to cause the illness through
simple methods, such as certain types of music, to the dangerous
methods, such as drilling holes into the skull, injections of
colloidal gold or deactivated horse serum, removing teeth, and
even dropping patients down wells in vain to try and remove the
"demons" or "toxin" (History). More accepted modern treatments of
the disorder are antipsychotic medications and
Successes in treatment progressed as did the discovery of medications. The first conventional antipsychotic was Chlorpromazine "Thorazine" in 1952, and now falls into the category of typical antipsychotics ("Evolution"). Typical antipsychotics, or neuroleptics, such as Chlorpromazine and Haloperidol "Haldol," are older antipsychotics. More modern antipsychotics, introduced first in 1989, are referred to as atypical antipsychotics. Since the discovery of antipsychotics in 1952 and the slight weakening of the social stigma against the mentally ill, the progression of medicine has improved to intramuscular injections that can last much longer than the orally taken medications ("Schizophrenia").
Clozapine "Clozaril" was the first atypical antipsychotic drug, introduced in 1989 for treatment resistant patients ("Evolution"). In contrast with drugs like Haldol, atypical antipsychotic drugs, like Clozaril, bind to dopamine receptors and differ from the typical antipsychotics. Clozaril is also different from all other antipsychotic drugs because of its significant risk of potentially life-threatening side-effects. Clozaril is indicated for use in only those patients who do not respond adequately to standard antipsychotics, such as Haldol, due to lack of effectiveness of the drug or intolerable adverse side effects due to the drug ("Clozapine"). The drug was first synthesized in 1960, but the FDA did not approve the drug until 1989. Clozaril was hard to pass due to two major side effects: agranulocytosis and seizures. Typically seizures can be controlled by lowering the dosage or using anticonvulsants, but though agranulocytosis can be a result of other antipsychotics, it is the most common and most deadly feature of Clozaril. 1 or 2 of 100 patients suffer from agranulocytosis, which is a serious blood disorder in which the patient's white blood cell count reduces and leaves the patient vulnerable to infection (FDA). The medication can only be issued by a distribution service that ensures WBC (white blood cell) testing prior to the delivery of the next week's supply of the medication, and if the tests show significant decreases in blood cell count, the patient is to be immediately taken off the medication and cannot go back to it since it may reappear ("Clozapine"). "'No other drug in the United States is prescribed with such stringent controls,'" according to the FDA". Though beyond its grim side effects, Clozaril has proven to be very effective on those unresponsive or resistant to other treatment. The overall opinion of using Clozaril is that it is "a risk worth taking" once one considers that "as many as 30% of schizophrenics attempt suicide and 1 out of 10 succeeds," and fatal injuries, infections, and deaths from other diseases are higher in schizophrenics than in the general population. Clozaril is considered to be the hope to those thought to be "hopeless" (FDA).
A common medication for those afflicted with schizophrenia is Haldol. Haloperidol "Haldol" was a conventional typical antipsychotic drug that was introduced in the 1960s to replace Chlorpromazine. The drug was used to control the outward or "positive" symptoms of mental disorders and to quiet the chaotic mental asylums ("Evolution"). Haldol is used for "management of the manifestations of psychotic disorders" and can be taken orally "Haldol" or through intramuscular injection "Haldol Decanoate 50 or 100." The common medication for schizophrenics is the injection of the Haldol Decanoate 50 or 100 because it lasts for two weeks and is recommended for those who require prolonged treatment. It is recommended that all recipients take Haldol orally first to stabilize and "prevent unexpected adverse sensitivity to haloperidol." Adverse reactions to Haldol include possibly fatal bronchopneumonia, dehydration due to lethargy and decreased sensation of thirst, and reduced pulmonary ventilation, among others such as Neuroleptic Malignant Syndrome and extrapyramidal symptoms ("Haldol"). Haldol is one of the more common antipsychotics and has proven effective in many patients. It is also among one of the first to be administered through long-lasting, intramuscular injection ("Schizophrenia").
As with all medications, antipsychotics do come with an array of side effects. Depending on the specific medication, the side effects can vary, but in the most common antipsychotics, such as Haldol, some of the side effects are similar. Examples of such side effects include NMS "Neuroleptic Malignant Syndrome" and EPS "extrapyramidal symptoms" (PhyDeskRef). These symptoms tend to affect those taking the conventional or typical antipsychotics, but are not exclusive only to neuroleptics. NMS is characterized by side effects such as rigidity as well as other symptoms such as quickening of the heart, tremor, and delirium (Berkow). EPS and NMS are very similar, but EPS varies in of tardive dyskinesia, the most commonly seen side effect of EPS, which is the involuntary movement of the muscles in the face, especially the mouth, lips, and tongue. Typically both of these conditions can be avoided with proper dosage of medication (Berkow).
A growing market in medicine also includes complementary and alternative medicines to treat disorders. Treatment encompasses studies such as acupuncture, dietary supplements, massage, homeopathy, spiritual healing, herbal remedies, aromatherapy, etc (Myers 556-557). In schizophrenia patients, alternative treatments are available, but are never recommended without hospitalization or medical treament first. When used it is best for patients to be taking antipsychotics and to be under doctor's supervision ("Schizophrenia Treatment"). Two examples that seem to have shown effects in the disorder include dietary supplements and homeopathic treatment. Dietary supplements have shown dramatic effects on symptoms of schizophrenia. In particular, Glycine supplements, Omega-3 fatty acids, and antioxidants help reduce positive and negative symptoms and improve symptoms overall ("Schizophrenia Treatment"). Homeopathy treats the patient based on his overall health and the pathological condition. Homeopathic medicines are selected after an individual has had a full examination and case-analysis ("What is...?"). Homeopathic medicines have been used due to their "relative safety and absence of side-effects," but have been known to also cause aggravation of symptoms. The basic principle of homeopathic medicine is that the patient's vital force has become mistuned as a result of a disease and it can be treated by helping the patient "retune" ("Classical"). "I've never really trusted the concept of like treats like." (Richardson). Complementary and alternative medicine is "unproven health care treatments not taught widely in medical school, and not usually reimbursed by insurance companies" (Myers 557). Some have acknowledged the remedies as valid, but many professionals denounce the remedies as useless and ineffective, a "voodoo medicine" (Myers 556-557). There has been little or no efforts to conduct double-blind studies, so it is difficult to label the medicine as scientifically proven (Richardson).
Medication is surely not the only method of treatment to those patients suffering from schizophrenia. The main non-drug-related treatment is psychotherapy, based on supporting and rectifying problems caused by a particular disorder. There has been 250 different psychotherapies identified and many psychotherapists usually use an eclectic approach, using a blend of therapies, or even psychotherapy integration which is aiming to combine therapies into a single coherent system (Myers 660). Psychotherapy can be very helpful to those who suffer from schizophrenia. Helpful psychotherapy for schizophrenia patients includes cognitive therapy, psychoeducation, and family therapy. Psychotherapy aims to help schizophrenics deal with their symptoms and learn to function correctly behaviorally and occupationally in modern society. Psychotherapy has been shown to improve the life and reduce the relapse in patients. Of patients receiving psychotherapy an estimated 70% improve and patient's relapse rates were cut down almost in half to 40% ("Schizophrenia Treatment").
Other support for schizophrenics comes with education of all about such disorders (and therefore more understanding and less stigma), family, self-help groups, and community and social support. Support can be vital to a schizophrenia patient's community tenure and sometimes their life (as some can be so disabled by the disorder that they cannot live independently). Education and understanding is an important part of making a life with schizophrenia, either for patient or people around the patient, easier and better. It's also very important for people to be educated in the disorder so they may be able to spot it in a friend or relative and help them get through a very difficult disorder. Many support and education sites can be found online, such as www.schizophrenia.com and www.mentalhealth.com. Support groups are also available for victims of schizophrenia, such as Schizophrenics Anonymous, and victims of all mental disorders in general, such as the National Association for the Mentally Ill or NAMI (which also has a website at www.nami.org).
Since there is no cure for schizophrenia, many different treatments have become available to help. Thanks to progress in research development of pharmaceuticals and the acceptance of people to realize schizophrenia as a serious disorder, those who suffer from it may not have such a hard time recovering and possibly finding a new and better life for themselves. An example of such possibility is Green Bay Packers defensive end Lionel Aldridge. Aldridge played in two superbowls with the legendary team of the 1960s, but suffered from schizophrenia in the 1970s and was even homeless for 2 and a half years. He battled with the disorder and slowly recovered enough to give inspirational talks and be written about in National Association for the Mentally Ill's newspaper. Easily one could say, that 100 years ago, he may not have even lived to recover, let alone talk about his disorder and be an inspiration to those that suffer presently. The open-mindedness of society is helping the progression of understanding and acceptance in the modern society. Progression is also strong in study and financing of schizophrenia, for example insurance now helps to pay for treatments. There are many obstacles and people still have to deal with a social stigma only matched by AIDS, medication side effects, the problems the disorder brings in general, but patients can now be a lot more optimistic than they were years and years ago.
Berkow, Robert, M.D., ed. The Merck Manual of Diagnosis and Therapy. 15th Edition. New Jersey: Merck Research Laboratories, 2006-2008.
"Classical Homeopathic Management of Schizophrenia." Alternative Mental Health. 2002. International Guide to the World of Alternative Mental Health. 18 February 2008. <http://www.alternativementalhealth.com/articles/manageschizophrenia.htm>.
"Clozapine." Physician's Desk Reference. 59th Edition. 2005.
"Evolution of Treatment." RisperdalConsta.com. 30 Jan 2008. <http://www.risperdalconsta.com/risperdalconsta/consumer/living_evolution.html>.
FDA (Federal Drug Administration). "Clozaril: Schizophrenic Drug." eNotAlone.com. 30 Jan 2008. <http://www.enotalone.com/article/7768.html>.
"Haldol." Physician's Desk Reference. 59th Edition. 2005.
"History of Schizophrenia." Schizophrenia.com. 30 Jan 2008. <http://www.schizophrenia.com/history.htm>.
Myers, David G.. Psychology. 7th Edition. New York: Worth Publishers, 2004.
Richardson, Sherri. Personal Interview
"Schizophrenia Etiology and Treatment." Mental-Health-Today.com. Mental Heath Today. 30 Jan 2008 <http://www.mental-health-today.com/sphra/schiz.htm>.
"Schizophrenia Treatment." Epigee. Epigee Women's Health. 18 February 2008. <http://www.epigee.org/mental_health/schizophrenia_treatment.html>.
"What is Schizophrenia?" Hpathy. 1 September 2007. Hpathy. 18 February 2008. <http://www.hpathy.com/diseases/schizophrenia-symptoms-treatment-cause.asp>.