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.
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.
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
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.
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.