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Treatment Issues, Checklist Only

Learning about Schizophrenia
In schizophrenia, knowledge of the disease itself is important. Spend time learning about the disease, and ask your psychiatrist and treatment team all the questions you can think of.

Schizophrenia is a treatable medical illness of the brain. It is very diverse in its causes, symptom severity and outcome, similar to the diversity among different types of cancer. Persons who have it will each have some similar but also different experiences.
Since the 1960s, state hospitals all over America have been shutting down and replaced by community based care. Today, people recover from schizophrenia and live full lives in society.

For more resources, we invite you to check out our website,

Setting Goals with your Treatment Team

Your psychiatrist should explain the illness and the treatments to you and assure you that all available treatments will be tried until you have achieved full recovery (a return to your baseline). For about 20% of patients, clozapine may be necessary (see below, Clozapine Can Work if Other Antipsychotics Fail). Once you start improving, your doctor and the mental health team should work with you to establish goals for the future, such as returning to school or work, spending more quality time with family and friends, and engaging in hobbies.

Recovery, not progressive illness, should be the expectation in schizophrenia.

Long- Acting Antipsychotic Medications

Memory problems are common in schizophrenia and may play a role in forgetting to take medications that are vital to prevent the recurrence of psychotic episodes. Several injectable medications have been available for many years, which eliminate the need to take pills every day. Some injections work for two weeks, others can be given monthly, while some may work for six weeks, two months, or even for three months. These include injectable forms of risperidone (Risperdal Consta), paliperidone (Invega Sustenna, which is monthly, and Invega Trinza, every 3 months), aripiprazole (Abilify Maintena), aripiprazole lauroxil (Aristada), and olanzapine (Relprevv).

Ask your doctor about these injectables. They are an excellent alternative to daily pills. They protect against relapses that could occur due to lack of full adherence with the antipsychotic medications that must be taken for many years by most patients with schizophrenia.

Monthly Shot Treats Schizophrenia.

Discontinuing Psychiatric Medications Can Lead to Psychotic Relapses

When your doctor prescribes a medication, ask what you should do if a strong side effect occurs. If you are experiencing side effects from your medication, do not stop your medications abruptly, but get in touch with your doctor right away. Discontinuing medications can lead to psychotic relapses, and in some cases it can cause withdrawal symptoms like insomnia or agitation. Additionally, psychiatric medications are generally less effective every time they are restarted.

There are about twelve newer medications available today (called “second-generation antipsychotics”). Though these medications may cause significant weight gain, they do not likely to cause stiffness or involuntary movements and other side effects associated with older medications (called “First Generation Antipsychotics”) used from 1950s to the 1990s. If you are experiencing side effects, know that there are many treatment options for schizophrenia. Every person’s experience is different.

Discontinuing Medications: When, Why, and How-To.

Clozapine Can Work if Other Antipsychotics Fail

Clozapine is considered the “last resort” medication in schizophrenia because it can work when other antipsychotic medications fail to reduce hallucinations or delusions. (These cases are called “treatment resistant” or “refractory” cases.)

Clozapine can cause a reduction in white blood cell count in very rare cases (less than 1%). That’s why weekly white blood cells have to be measured with a quick blood test. Clozapine also may cause significant weight gain , sleepiness, and increased salivation. In high doses, it may cause other problems, such as seizures.

Because patients on clozapine must be monitored for side effects, some psychiatrists do not use clozapine, or use it rarely. In America, while 20% of patients deserve a trial of clozapine, 4-5% actually receive clozapine.

All patients who have not achieved full remission — which means they are asymptomatic or nearly free of delusions or hallucinations — deserve a trial of clozapine.


Tardive Dyskinesia as a Side Effect of Antipsychotics

Tardive Dyskinesia (TD) is an involuntary movement disorder which is a serious neurological side effect of all antipsychotic medications, but especially older drugs like haloperidol. TD’s movements are commonly often seen in the face, including the tongue lips, jaw and eyes but can also affect the neck, trunk, arms, fingers, legs, toes or diaphragm.

Fortunately, two effective medications were recently approved by the FDA. Valbenazine was approved by the FDA in April 2017, and deutetrabenazine was subsequently approved in August 2017. These medications can significantly reduce or eliminate TD movements.

Because the older antipsychotics like haloperidol are much more likely to cause acute muscle stiffness, tremor, rigidity or restlessness (in the first few hours or days) or weeks, and a high rate of TD (after a year or more of use), they should not be used to treat schizophrenia or bipolar disorder.

Tardive Dyskinesia.


Cognitive Behavioral Therapy (CBT) as Adjunctive Therapy
Since the 1990s, research has proven the effectiveness of Cognitive Behavioral Therapy in depression and anxiety, and for some symptoms of schizophrenia. It is considered one of the most effective psychotherapy methods in both the United States and Europe.

The ABCs of Cognitive-Behavioral Therapy for Schizophrenia

The Anti-Inflammatory Supplement Fish Oil

Fish oil may help adjunctively in early phases of psychosis. Fish oil is relatively cheap, and has few side effects. You can find it at any drug store.

Fish oil contains an omega-3 fatty acid called DHA (docosahexaenoic acid) which promotes brain health. Consider talking to your doctor about a prescription for the more expensive, purified form.

In addition to improving your brain health, fish oil also has other benefits, such as lowering your blood pressure and reducing your risk of having a heart attack or stroke.

Can fish oil prevent schizophrenia and other psychotic disorders?

Vitamin D3

Sitting in the sun, or taking vitamin D3, may help various psychiatric disorders including schizophrenia, by improving psychotic symptoms. It is especially important for pregnant women to get enough vitamin D3. Very low levels of vitamin D3 during pregnancy can lead newborns to have a higher risk of developing schizophrenia in adolescence or early adulthood.

Vitamin D Deficiency raises risk of schizophrenia diagnosis.

The Antioxidant Supplement NAC (N-Acetyl Cysteine)

N-acetyl cysteine is a strong antioxidant and may help neutralize the harmful effects of elevated levels of free radicals during psychosis. More research is being done on this supplement.

Schizophrenia Options: N-Acetyl Cysteine.

Thanks for visiting!


□ Learning about schizophrenia
□ Setting goals with your treatment team
□ Long-acting antipsychotic medications
□ Discontinuing meds can lead to psychotic relapses
□ Clozapine can work if other antipsychotics fail
□ Tardive dyskinesia as a side effect of antipsychotics
□ Cognitive-behavioral therapy as adjunctive therapy
□ The anti-inflammatory supplement fish oil
□ Vitamin D3
□ The antioxidant supplement NAC (N-Acetyl Cysteine)


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