Mental illness is on the rise in today’s ever-changing society. Mental illnesses can be some of the most disturbing and upsetting to family members and patients. Many family members can lose sight of the person that once was, as a person’s brain chemistry can absolutely destroy their personality. One of the most destructive and devastating diseases is schizophrenia. Schizophrenia is quite complex, and it can present with a vast array of symptoms. Patients can present with various delusions, and can often have other manifestations of those delusions. Patients can feel paranoid, scared, and this can all present as disorganized thoughts or speech. Patients with schizophrenia are classified to have both positive and negative symptoms. Negative symptoms occur due to deficits in a person’s mental capacity. These symptoms can present as lack of cognition, inability to pay attention, and lack of memory. These symptoms can be thought to be a deficit in brain function. Patients can also have positive symptoms with schizophrenia. Positive symptoms can be thought of as hyperactivity of the brain. This can manifest as delusions, paranoia, and hallucinations. Although these are thought to be the “typical” schizophrenia symptoms, both are classic for a schizophrenia diagnosis. Unlike other mental health diseases, schizophrenia treatment is unpredictable in terms of response rates. Only about 20% of patients report satisfaction with their schizophrenia regimen. Some of the most classic medications with benefit in patients with schizophrenia are the second-generation antipsychotics. Olanzapine, the generic for Zyprexa, is a second generation antipsychotic. It has been proven effective for patients, but the unfavorable weight gain associated with olanzapine has hindered patient adherence and satisfaction. This weight gain is the most significant of the second-generation antipsychotics, along with clozapine. New strategies have been developed to address this issue.(1)
A new medication was recently granted FDA approval for the management of weight when patients are being treated with olanzapine. In addition to the olanzapine to manage schizophrenia, there is another component added to the medication to help subside weight gain. Olanzapine/samidorphan was approved by the FDA in May 2021. It contains the second generation antipsychotic and an opioid receptor antagonist to curve the associated weight gain. Samidorphan works similarly to naltrexone in curving weight gain. It is contraindicated in patients with opioid use disorders or those undergoing opioid addiction withdrawal. Patients should also avoid treatment if there is active opioid use for chronic or acute pain management. In patients on short-acting opioids, there should be a 7 day period before use of olanzapine and samidorphan. In patients using long-acting opioids for pain management, there should be a minimum of 14 days before use.
When thinking about increasing patients’ gaps in care and adherence, addressing burdensome side effects is one of the main strategies. Of course, with adding a new medication comes new side effects. It is important to weigh the risks and benefits of starting a new medication with patients and families. Patients with severe schizophrenic symptoms must be appropriately treated, and addressing weight gain is a very important strategy to increase adherence.
References:
Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P T. 2014;39(9):638-645.
Lybalvi. Package insert. Alkermes; 2021.
Schizophrenia
Schizophrenia affects around 24 million people worldwide, with a slight incline in prevalence with males. This neurological disease can be defined as “a serious mental illness that affects how a person thinks, feels, and behaves.” This is an extremely difficult disease for the patient, as well as the patient’s family and friends to deal with because of the way schizophrenia affects the individual’s mental state. According to the National Institute of Mental Health, “people with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and for their family and friends. The symptoms of schizophrenia can make it difficult to participate in usual, everyday activities, but effective treatments are available.”
Symptoms for schizophrenia are important because early detection would mean treatment could be initiated earlier, hopefully yielding results faster. Symptoms for schizophrenia can be put into one of three categories: psychotic symptoms, negative symptoms or cognitive symptoms. Psychotic symptoms affect the way in which the patient thinks and feels, sometimes making it seem like they are a completely different person. These symptoms can be any of the following: hallucinations, thought disorders, movement disorders and delusions. Hallucinations can include visual, auditory, or any of the other sensory hallucinations. Hearing voices is the most common symptom of schizophrenia and usually happens for a while before it is noticed by family or friends. The patient’s thoughts and movements will be very unusual and a little out of whack, making this symptom very noticeable. Delusions can include a patient being paranoid about doctors wanting to rob them or wholeheartedly believing they are a spy. Negative symptoms are all the negative things that are associated with this neurological disorder, meaning anything that shows that the patient is uninterested in things they once were, a loss of motivation, withdrawal from friends and family, or any difficulty with showing emotions or functioning normally. These symptoms can include: having trouble planning and attending activities, experiencing no pleasure in everyday life, speaking in a dull voice and having no facial expressions and showing no emotion, avoiding social interactions or having only awkward interactions and having extremely low energy. Cognitive symptoms would be difficult in areas like thinking, focusing and remembering things. These symptoms tend to affect the patient’s life the worst, due to the big impact it has on their independence. Because simple things such as remembering appointments and eating breakfast become dangerous, they now need another person to remind them to do these tasks. These symptoms can include: having difficulty making decisions and processing the information necessary to make these decisions, difficulty using information right after it is learned or taught to the individual and difficulty keeping focus or attention.
There are many risk factors associated with schizophrenia that are categorized into genetics, environmental factors and brain structure or function. In terms of genetics, schizophrenia can sometimes run in a family, but this does not mean it is genetic. There have been many studies and while there are certain genes that were found that increase a person’s likelihood of developing the mental disorder, there is no proof that this disease is hereditary. The other genes that have been found can be tested for if an individual is suspected of having schizophrenia or has a family member who suffers from it. The environmental factor is a combination of the genetic factors and aspects of the individual’s environment along with their life experiences. These three things can play a critical role in a patient developing schizophrenia. The individual environmental factors include living in poverty, stressful or dangerous areas, and/or exposure to illnesses (like viruses) or nutritional problems before birth. The brain factors can be examined through medical x-rays. According to studies, “people with schizophrenia may be more likely to have differences in the size of certain brain areas and in connections between brain areas.” This proves to be a more definitive risk factor because this is something tangible and can actually be seen by doctors, medical professionals and the patient and/or their family. It is also stated that these defects could be present from before birth, meaning this was the way the brain was developed from within the womb.
After correctly identifying risk factors and assessing symptoms, the diagnosis for schizophrenia is made, which means the next step will be choosing a medication regimen. Most treatments will be patient centered, meaning managing their symptoms and improving their quality of life are top priorities when choosing their medications. It is also essential to consider any life goals or personal goals that the patient may have and want to accomplish, such as an education path or fulfilling a personal relationship. Antipsychotics are the top choice for treating schizophrenia because they can ease symptoms and make them less intense and less frequent. There are an abundance of options into terms of what route of administration the patient would prefer, which can help eliminate the issue of nonadherence. There are pills that the patient can take daily, or there are antipsychotic injections that patients can have once or twice monthly, if taking pills is an issue or they tend to forget to take their meds. Like with any other medication, there is no guarantee that every medication will work for all patients. When taking antipsychotics, there will be a lot of trial and error, and if the antipsychotics prove to be ineffective, there is also the option of taking clozapine. The only difference with clozapine is that the patient must be getting blood tests regularly to check on their ANC (absolute neutrophil count) levels in order to prevent neutropenia, a very dangerous side effect associated with the use of clozapine. Side effects for the antipsychotic medications include: weight gain, dry mouth, restlessness, and drowsiness. It is important to inform the patient of these side effects so they know what to expect when they begin taking them. They should also be informed that most of them will subside after continuous use, but some will stay for as long as they’re on the medication.
References:
“Schizophrenia.” National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/topics/schizophrenia. Accessed 28 Aug. 2023.
“What Is Schizophrenia?” What Is Schizophrenia?, https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia. Accessed 28 Aug. 2023.
Written by Justin Ayob and Antonio Ortega
Schizophrenia is a chronic, severe, and disabling thought disorder that occurs in ~1% of all societies regardless of class, color, religion, or culture. The cause is multifactorial and includes altered brain structure and chemistry, primarily involving dopamine and glutamine. Genetics (inherited susceptibility) and environmental factors are important in disease development. Patients suffer from hallucinations (sensing something that is not present), delusions (false beliefs), and disorganized thinking/behavior. They can withdraw from the world around them and enter a world of psychosis, where they struggle to differentiate reality from altered perceptions. Schizophrenia ranges from relatively mild to severe. Some people can function adequately in daily life, while others need specialized, intensive care. Treatment adherence is important and often difficult to obtain, primarily due to the patient's inability to recognize their illness. Many patients with schizophrenia live a life of torment where they cannot care for themselves. This condition has one of the highest suicide rates.
Schizophrenia is a thought disorder involving abnormal neurotransmitters. Patients with schizophrenia have increased dopamine levels, and may also have changes in glutamate levels. Dopamine and glutamate modulate each other, but the role of glutamate in schizophrenia is not well understood. Genetics, environment, stressors and some drugs can also be contributing factors.
Below is a detailed chart overview of the treatment and management of Schizophrenia
References:
2021 RxPrep: Chapter 64 : Schizophreina/Psychosis. Pages 892-900.
Schizophrenia is a chronic disorder of the brain that affects less than one percent of the United States population. When a person a diagnosed with schizophrenia, some of the symptoms they experience are delusions, hallucinations, disorganized speech, trouble with thinking and lack of motivation. There is currently no cure for schizophrenia and there is always research being conducted to lead a safer and innovative advancement in treatment options. Experts are also learning more about the cause of the disease by studying genetics, conducting behavioral research, and using advanced imaging to examine the brain’s structure and function. These new approaches are more promising in leading us towards more efficacious treatments.
There is a ton of misinformation about schizophrenia that spreads throughout the public population. Some people believe it can mean having multiple personalities or split personalities, but that is not really the case. There is also an idea that people with schizophrenia are dangerous, which is also not true. They are jus as dangerous as the average person. It is also thought that, due to the lack of mental health resources in the community, it leads to schizophrenia patients being homeless or living in hospitals. However, most patients with schizophrenia live with their family, in group home, or on their own.
There is research that shows schizophrenia affects men and women fairly equally, but men may have an earlier onset of this condition compared to females. Patients with this condition also are more likely to die younger than the general population because of the high rates of co-occurring medical conditions such as heart disease and diabetes.
There are many different symptoms of schizophrenia can affect and individual’s daily life. Some symptoms that are present are hallucinations, such as hearing voices or seeing things that do not exist, paranoia, and exaggerated or distorted perceptions, beliefs, and behaviors. Patients will also experience a loss or decrease in the ability to initiate plans, speak, express emotions, or find pleasure. Another symptom is confused and disordered thinking and speech, trouble with logical thinking and sometimes bizarre behavior or abnormal movements. Schizophrenia also has an impact on cognition where patients have issues with attention, concentration and memory, and declining educational performance. These patients also are at a higher risk for drug abuse than the general population.
Although there is no cure, many patients have minimal symptoms and tend to do okay. There are many antipsychotic medications prescribed to treat schizophrenia and they tend to be more effective in reducing symptoms during the acute phase of the condition. These medications also help reduce future acute episodes and their severity. Some of the medications used are first generation or typical antipsychotics and second generation or atypical antipsychotics. Some of the first generation drugs would be chlorpromazine, fluphenazine, haloperidol, perphenazine, and more. Some of the second generation antipsychotics are aripiprazole, clozapine, lurasidone, olanzapine, paliperidone, quetiapine, ziprasidone, and more. There are many side effects of taking antipsychotic medications as well such as weight gain, sexual problems, drowsiness, dizziness, restlessness, dry mouth, constipation, nausea, blurred vision, low blood pressure and seizures. They also have to have regular doctor visits when taking these medications. There are many difficulties living with schizophrenia and there should be more education surrounding this illness and mental health awareness overall.
References:
1. “What Is Schizophrenia?” What Is Schizophrenia?, https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia.
2. “Medications Used to Treat Schizophrenia.” WebMD, WebMD, https://www.webmd.com/schizophrenia/medicines-to-treat-schizophrenia.