What medications are used to treat schizophrenia?

Antipsychotic medications are used to treat schizophrenia and schizophrenia-related disorders. Some of these medications have been available since the mid-1950's. They are also called conventional "typical" antipsychotics. Some of the more commonly used medications include:

• Chlorpromazine (Thorazine)
• Haloperidol (Haldol)
• Perphenazine (generic only)
• Fluphenazine (generic only).

In the 1990's, new antipsychotic medications were developed. These new medications are called second generation, or "atypical" antipsychotics.

One of these medications was clozapine (Clozaril). It is a very effective medication that treats psychotic symptoms, hallucinations, and breaks with reality, such as when a person believes he or she is the president. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. Therefore, people who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. Still, clozapine is potentially helpful for people who do not respond to other antipsychotic medications.

Other atypical antipsychotics were developed. All of them are effective, and none cause agranulocytosis. These include:

• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)
• Aripiprazole (Abilify)
• Paliperidone (Invega).

The antipsychotics listed here are some of the medications used to treat symptoms of schizophrenia. Additional antipsychotics and other medications used for schizophrenia are listed in the chart at the end.

Note: The FDA issued a Public Health Advisory for atypical antipsychotic medications. The FDA determined that death rates are higher for elderly people with dementia when taking this medication. A review of data has found a risk with conventional antipsychotics as well. Antipsychotic medications are not FDA-approved for the treatment of behavioral disorders in patients with dementia.

What are the side effects?

Some people have side effects when they start taking these medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

• Drowsiness
• Dizziness when changing positions
• Blurred vision
• Rapid heartbeat
• Sensitivity to the sun
• Skin rashes
• Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol.1 A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.

Typical antipsychotic medications can cause side effects related to physical movement, such as:

• Rigidity
• Persistent muscle spasms
• Tremors
• Restlessness.

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can't control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication.

Every year, an estimated 5 percent of people taking typical antipsychotics get TD. The condition happens to fewer people who take the new, atypical antipsychotics, but some people may still get TD. People who think that they might have TD should check with their doctor before stopping their medication.

How are antipsychotics taken and how do people respond to them?

Antipsychotics are usually pills that people swallow, or liquid they can drink. Some antipsychotics are shots that are given once or twice a month.

Symptoms of schizophrenia, such as feeling agitated and having hallucinations, usually go away within days. Symptoms like delusions usually go away within a few weeks. After about six weeks, many people will see a lot of improvement.

However, people respond in different ways to antipsychotic medications, and no one can tell beforehand how a person will respond. Sometimes a person needs to try several medications before finding the right one. Doctors and patients can work together to find the best medication or medication combination, and dose.

Some people may have a relapse—their symptoms come back or get worse. Usually, relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel they don't need it anymore. But no one should stop taking an antipsychotic medication without talking to his or her doctor. When a doctor says it is okay to stop taking a medication, it should be gradually tapered off, never stopped suddenly.

How do antipsychotics interact with other medications?

Antipsychotics can produce unpleasant or dangerous side effects when taken with certain medications. For this reason, all doctors treating a patient need to be aware of all the medications that person is taking. Doctors need to know about prescription and over-the-counter medicine, vitamins, minerals, and herbal supplements. People also need to discuss any alcohol or other drug use with their doctor.

To find out more about how antipsychotics work, the National Institute of Mental Health (NIMH) funded a study called CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness). This study compared the effectiveness and side effects of five antipsychotics used to treat people with schizophrenia. In general, the study found that the older medication perphenazine worked as well as the newer, atypical medications. But because people respond differently to different medications, it is important that treatments be designed carefully for each person. You can find more information on CATIE here.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 08-3929
Revised 2008

I am writing to give you an update regarding your student.

Your student is coping with psychosis, which is a brain condition that affects thinking and concentration.

Accommodations are essential for this student to function in the academic program. Specific accommodations will need to be devised for this student in collaboration with the youth and family. A general list includes the following:

Support Re-Integration

• Ensuring that educators are aware that this student is going through a difficult period, so that they can be more understanding, i.e. that any current difficulties in learning are more because of an illness, rather than an attitude problem or poor parenting
• Designate key school personnel (e.g. resource teacher, guidance counselor, etc.) to regularly meet and check in with the student to see how things are going
  • Do not expect this student to be able to take the initiative in going to teachers; rather, teachers should take the initiative in checking with the student
• Specific areas to ask would include:
  • How are things going?
  • What's going well?
  • What's not going well, i.e. what is stressful?
  • Is there anything we can do to problem-solve this stress?

Reduce sensory stress

• Work with the student to come up with a way for the student to let you know when s/he is becoming overwhelmed by sensory stress
• Agree upon a low-stimulation, quiet, soothing place where the student can go if s/he is starting to feel overwhelmed
• This student has problems with sensory stress, in that this student can be easily overwhelmed by seemling normal levels of sensory input
  • Auditory stress
    • Give advance notice of fire drills
    • Allow her to use ear plugs in class
    • Allow her to sit nearer the front of class (if she desires)
    • Provide quiet places when needed for intense work
  • Visual stress
    • Allow her to wear baseball cap or sweatshirt with a hood (in order to block out fluorescent light)
    • Consider glasses that automatically darken with glare
  • Tactile stress
    • Due to the stress of bumping into peers during busy hallway times, give her the option of going between classes when it is less busy
    • Do not touch this student unexpectedly or without permission

Accommodations for thinking difficulties

• Accept that the student may require more time for doing school work as well as for tests
• Medications are often prescribed for this student's condition
• If the student appears tired and drowsy, realize that this may be an unavoidable medication side effect, and is not the student's fault

Help monitor for worsening

• If you notice that this student's function is worsening, then inform parents

Thank you for your time. Feel free to contact me if you have any further questions!

To whom it may concern:

I would like to give you an update regarding this individual.

Unfortunately, your employee has been off-work due to a health condition.

Fortunately, your employee is feeling better, and would like to return to work.

The following section has a list of common recommendations that may maximize the chances of a successful return to work, which are in both employee and employer’s best interests.

The suggested recommendations are only a general guide, and it is always best to speak with the employee and customize the recommendations for your specific employer/employee situation.

Recommended Accommodations/Modifications for Employers

• A flexible schedule that has
  • Flex-time or a part-time position
  • Time off for scheduled medical appointments

• Workspace where visual and auditory distractions are minimized.
  • Visual sensitivity: Too much visual stimulation, which may include visual clutter, or bright lighting (e.g. fluorescent lighting) may be stressful. Allow the employee to make accommodations if necessary such as dimmer lighting, or wear a cap to block out overhead ambient light.
  • Auditory sensitivity: Too much sounds may be stressful.
     
• Flexible break times that meet the individual's needs rather than following a fixed schedule. As with a worker with back pain, if a worker is feeling overwhelmed, it is sometimes the case that the worker will need to immediately sit down, rather than keep on working and risk re-injuring his/her back. Thus, ideally the work can be structured so that if absolutely necessary, the worker can take more flexible breaks, depending on how the worker is doing that day.
   
• Additional leave from work after a hospitalization. With the current trend towards shorter and shorter inpatient hospital admissions, even if your employee has been discharged from hospital, it does not mean that your employee is ready for work. Most of the time, there is additional time at home that is required for the patient’s recovery.
   
• Giving the employee opportunities to phone his/her health professionals during the day if necessary. From time to time, your employee may be needing to contact his/her health care team during the daytime, for issues such as making medication adjustments, discussing side effects. Allowing your worker those opportunities will help your employee to stay healthy, ultimately resulting in less sick days.
   
• Giving the employee opportunities to meet regularly with his/her employer and/or supervisor, and/or job coach.

Sincerely,

Name