Treatment of Schizophrenia

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II. TREATMENT MODALITIES FOR SCHIZOPHRENIA
Management of schizophrenia depends largely on medications and on psychosocial interventions. No single approach is widely considered effective for all patients, though in the United States and most Western countries, psychiatric medication is often the primary method of treatment. Currently, there is a movement towards utilizing a recovery model that emphasizes hope, empowerment and social inclusion, though this is not yet a mainstream mental health concept. (Bellack AS (July 2006). "Scientific and Consumer Models of Recovery in Schizophrenia: Concordance, Contrasts, and Implications" p.432) A. MEDICAL MANAGEMENT:

The medical management of schizophrenia often requires a combination of antipsychotic, antidepressant, and anti-anxiety medication. Antipsychotic medications help to normalize the biochemical imbalances that cause schizophrenia. They are also important in reducing the likelihood of relapse. (Psych Central, National Mental Health Association, National Institute for Mental Health, National Alliance for the Mentally Ill, Internet Mental Health) Psychopharmacology

a. Typical Antipsychotics

The typical antipsychotics work by blocking postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla. They also demonstrate varying affinity for cholinergic, alpha1-adrenergic, and histaminic receptors. Antipsychotic effects may also be related to inhibition of dopamine-mediated transmission of neural impulses at the synapses.

Examples of typical antipsychotics include:
* chlorpromazine(Thorazine)
* fluphenazine (Prolixin)
* perphenazine (Trilafon)
* prochlorperazine (Compazine)
* thioridazine (Stelazine)
* thiothixene (Navane)
* haloperidol (Haldol)
* loxapine (Loxitane)
* molindone (Moban)

b. Atypical Antipsychotics

The atypical antipsychotics are weaker dopamine receptor antagonists than the conventional antipsychotics, but are more potent antagonists of the serotonin type 2A (5-HT2A) receptors. They also exhibit antagonism for cholinergic, histaminic, and adrenergic receptors.

Examples of atypical antipsychotics include:
* Clozapine (Clozaril)
* risperidone (Risperdal)
* paliperidone (Invega)
* olanzapine (Zyprexa)
* quetiapine (Seroquel
* ziprasidone (Geodon)
* aripiprazole (Abilify).

B. NURSING MANAGEMENT:
The nurse may assess a client with a known history of schizophrenia or a client with a unknown to the mental health care system. Assessment begins with an interview and focuses on establishing the client's signs and symptoms, degree of impairment in the thought process, risk for self injury or violence towards others, and available support systems. The nurse may wish to interview the client with a family member or a friend to obtain all information regarding family history, previous episodes of psychotic symptoms, onset of symptoms, and thoughts of suicide or violent behavior. Assessment:

1.       Assessing mood and cognitive state:
The nurse is alert for the signs and symptoms such as :
* Absence of expression of feelings
* Language content that is difficult to follow
* Pronounced paucity of speech and thoughts
* Preoccupation with odd ideas
* Ideas of reference
* Expression of feelings of unreality
* Evidence of hallucinations such as comments that the way they things appear, sound, or smell is different. The nurse can also inquire about recent stressors, which can precipitate a psychotic episode in the client with a thought disorder, and signs and symptoms of impending relapse. These signs include disturbed sleep cycle, significant mood changes (mostly depression), decreased appetite, and somatic complaints such as headache, malaise, and constipation. Relapse leads to client withdrawal, resistance, and preoccupation with psychotic...
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