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Checklist

Learning about Schizophrenia
Schizophrenia is a treatable medical illness of the brain with a wide range of severity. 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.

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.

Over the past 50 years, the medical care of schizophrenia has shifted from an inpatient institutional setting to community-based care. Today, many, but not all, people with schizophrenia, recover partially or completely from their psychotic symptoms and return to their baseline functioning in society with the help of effective antipsychotic and other medications like antidepressant and anti-anxiety medications.

For more resources, we invite you to check out our website, www.curesz.org.


Setting Goals with your Treatment Team

You should ask your psychiatrist to explain the illness and the various available treatments (including pills or injections once every 1-3 months without having to take pills) and assure you that all available treatments will be tried until you have achieved full recovery (a return to your baseline). For about 25 % of patients, a medication called clozapine may be necessary (see below, clozapine can eliminate hallucinations or delusions 50% of the time when 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 and other meaningful activities.

Recovery, not continued illness and disability, should be the expectation for most patients who suffer from schizophrenia.

Recovery, not progressive illness, should be the expectation in schizophrenia. https://www.madinamerica.com/2015/02/recovery-not-progressive-illness-expectation-schizophrenia/


Long- Acting Antipsychotic Medications

Memory difficulties are common in schizophrenia and may play a role in forgetting to take daily medications (or monthly injections) 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 every 2 weeks and risperidone Perseris once a month), paliperidone (Invega Sustenna, which is monthly, and Invega Trinza, every 3 months), monthly aripiprazole (Abilify Maintena), injections every 4, 6 or 8 weeks with aripiprazole lauroxil (Aristada), and once a month injections of olanzapine (Relprevv).

Ask your doctor about these injectables. They are an excellent alternative to daily pills. They protect against relapses that are often due to lack of full adherence with the antipsychotic medications that must be taken for many years by most patients with schizophrenia. Avoiding recurrence of psychosis is critical because it can cause brain damage and treatment resistance.

Monthly Shot Treats Schizophrenia. http://www.webmd.com/schizophrenia/news/20080507/monthly-shot-treats-schizophrenia#1


CAUTION! 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.

Psychoeducation and Recovery.
https://www.youtube.com/watch?v=zBleQcp4xGo


Clozapine Can Work if Other Antipsychotics Fail

Clozapine is considered the “last resort” medication in schizophrenia because it can work in about 50% when other antipsychotic medications fail to reduce persistent hallucinations or delusions. (These cases are called “treatment resistant” or “refractory” cases.)

Clozapine is associated with some side-effects. It 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 increased appetite and weight gain, sleepiness, constipation and increased salivation. In high doses, it may cause other problems, such as diabetes or seizures but most people do not need high doses.

Because patients on clozapine must be monitored for side effects, some psychiatrists avoid using clozapine, or use it rarely. In America, while 25% of patients deserve a trial of clozapine, yet less than 5% actually receive clozapine.

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

Clozapine. https://curesz.org/resources/clozapine-experts-panel/


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 harsh antipsychotics drugs like haloperidol. TD’s movements are often seen in the face, including the tongue lips, jaw and eye blinking/grimacing 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 one but usually many years of use), they should not be used to treat schizophrenia or bipolar disorder. The newer “atypical” antipsychotics have a much lower rate of TD.

Tardive Dyskinesia.
https://curesz.org/resources/tardive-dyskinesia/

 

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

The ABCs of Cognitive-Behavioral Therapy for Schizophrenia http://www.psychiatrictimes.com/schizophrenia/abcs-cognitive-behavioral-therapy-schizophrenia


The Anti-Inflammatory Supplement Fish Oil

Fish oil may help when added to the antipsychotic medication in early phases of psychosis When brain inflammation can occur. 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 may promote brain health. Consider talking to your doctor about a prescription for the more expensive, purified form.

Fish Oil May Fight Psychosis.
https://www.webmd.com/schizophrenia/news/20100201/fish-oil-vs-psychosis


Vitamin D3

Exposure to sunlight prompts the body to manufacture vitamin D which is important for brain health in schizophrenia, depression and even multiple sclerosis. It is especially important for pregnant women to have normal blood level of vitamin D3 to ensure normal brain development in their babies. Very low levels of vitamin D3 during pregnancy have been reported to increase the risk of developing schizophrenia in adolescence or early adulthood.

Vitamin D Deficiency raises risk of schizophrenia diagnosis. https://www.sciencedaily.com/releases/2014/07/140722142513.htm


The Antioxidant Supplement NAC (N-Acetyl Cysteine)

N-acetyl cysteine is a strong antioxidant and some studies suggest it may help neutralize the harmful effects of elevated levels of free radicals, which are known to occur during psychosis. People with schizophrenia have been found not to make enough antioxidant in their cells (like glutathione) to fight free radicals, and NAC helps increase glutathione levels. More research is being done on this supplement.

Schizophrenia Options: N-Acetyl Cysteine. http://www.schizophreniaoptions.com/n-acetyl-cysteine/

Thanks for visiting curesz.org!

Checklist

□ 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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