SCHIZOPHRENIA:WHAT ARE THE BEST TREATMENT OPTIONS

1
SCHIZOPHRENIAWHAT ARE THE BEST TREATMENT OPTIONS
?

• GAUTAM KHANNA
• ANCRUM MEDICAL CENTRE
• 26/09/06

2

• Prevalence of 0.2-0.7
• 20 recover fully
• Symptoms
• PositiveDelusions,Hallucinations,Thought
  Disorder
• NegativeWithdrawl,Lack of Volition,Poverty of
  Thought,Diff. with Abstract Thinking,Anhedonia.
• Aff.SymptomsUnstable Mood,Depression,Irritable
• Con.SymptomsImpaired attention,Inform.
  Process.,verbal fluency,Inability to shift
  construct

3
Early Intervention

• Early detection and assessment
• Key worker for the critical period
• Assessment of needs
• Atypical antipsychotics cognative therapy.
• Involvement of Family/Friends
• Relapse prev. treatment resistance.
• Basic needs to be met.
• Ass. t/t of co-morbidity.

4
COGNATIVE BEHAVIOURAL THERAPY.

• Recommended by NICE.
• CBT-effective early on.
• Improves general wellbeing.
• -ve cochrane review.
• reduced hospital stay,improved mental state
• No adv. after 1 year.

5
CONVENTIONAL ATYPICAL ANTIPSYCHOTICS

• SIDE EFFECTS
• Akathesiarestless legs,inability to sit
  still-onset within few days.
• Dystoniaacute within hrs or chronic over months
  or years.
• Parkinsonismusually within several weeks.
• Tardive dyskinesiaoften takes years.

6
CLOZAPINE TREATMENT RESISTANCE

• Incidence of neutropenia and agranulocytosis
• Regular monitoring is mandatory
• Weight gainDiabetes/cardiac problem
• Sedation
• Salivation

7
Do atypicals treat mood dysfunction and negative
symptoms

• Basis of claim-high 5HT2/D2 binding profile of
  (Olanzapine,quetiapine and risperidone) reduced
  propensity to cause movement disorder
• Amisulpride-selective dopamine D2/D3 antagonist.
• Superior efficacy in treating negative symptoms
• Fewer extrapyramidal s/e..fewer treatment
  dropouts.

8
Are atypicals effective in cognitive symptoms

• Cognitive deficit impact on patients
  functioning-within 5 yrs less that 20 are
  working.
• MATRICS is working towards finding best t/t for
  cognitive impairment.
• Conventionals do not improve
• Those with antichol. activity like CPZ may
  aggravate the problem.
• Atypical improve cognitive impairment-tentative
  claim.

9
Is There A Role For Typical Antipsychotics?

• NICE recommendation - atypical antipsychotics be
  used as a first choice treatment.
• Meta-analysis of 52 randomised trials concluded
  that no evidence that atypicals were better
  tolerated than conventionalscriticised about
  the adverse effect of conv. antipsychoclozapine
  more effective than convent. followed by
  amisulpride/olanzapine/risperidone.
• Other atypicals showed no adv.
• Typical antipsychotics have a place for t/t pts
  who have been stable and free of s/eesp. on long
  acting depots.