"Schizophrenia is a most complex and puzzling disease. And now, after 100 years of enigmatic puzzling, I believe we may be on the threshold of an entire new era of understanding." -- Dr. Peter Liddle, Jack Bell Chair in Schizophrenia Research Head, Schizophrenia Division, University of British Columbia.
ACCORDING TO DR. LIDDLE, THE MORE WE UNDERSTAND THE HIGHER FUNCTIONS OF THE BRAIN AND ITS INTERACTIONS, THE MORE WE CAN EXPLORE, IN A MEANINGFUL WAY, HOW THE MIND AND THE BRAIN WORK TOGETHER.
In other words, we can finally go beyond notions and provide rational bases for why certain treatments work. The reason for this is the development of tools and techniques that now allow us to systematically explore patterns of brain activity...
|- EEG's (Electroencephalograms) show that electrical impulses used by the brain to send messages to other parts of the body are abnormal in many people with schizophrenia. - CT (Computerized Tomography) and MRI (Magnetic Resonance Imaging) scans show that brain structures of some people with schizophrenia are different from people without the illness. One important anomaly in schizophrenia, for example, is enlarged ventricles (the small spaces in the brain through which cerebral spinal fluid circulates.) - PET (Positron Emission Tomography) uses a radioactive compound to help measure blood flow in different parts of the brain. It is possible to see, for instance, how the brain activity in people with schizophrenia differs from that of people who are not ill -- and to identify the specific areas where such differences occur. Partly because of the development of these new tools, treatment for schizophrenia has greatly improved -- and will continue to be influenced by new research discoveries.
"There is no way at present to predict who will respond best to which medication." -- E. Fuller Torrey
Trying to understand a bewildering array of medication terminology can be frustrating. It's always a good idea to learn at least some of the technical "lingo" that mental health professionals use. A user-friendly reference book, such as Fuller Torrey's Surviving Schizophrenia, is a great help. Generally, medications for treating psychotic symptoms of schizophrenia are referred to as antipsychotics, or sometimes neuroleptics.
"STANDARD" ANTIPSYCHOTICS Until recently, doctors referred to antipsychotic medications neuroleptics because of their tendency to cause neurological side effects. Medications that have been around for a number of years are now called "standard" antipsychotics. Examples of standard antipsychotics include Thorazine, Mellaril, Modecate, Prolixin, Navane, Stelazine and Haldol.
Side Effects (EPS) Side effects can be a major problem with standard antipsychotic medications. These neurological side effects are called "extrapyramidal symptoms" (EPS for short). Specific examples of EPS include akinesia (slowed movement), akathisia (restless limbs), and tardive dyskinesia (permanent, irreversible movement disorders.) "ATYPICAL"
ANTIPSYCHOTICS The newer antipsychotic drugs are called "atypical" antipsychotics. Atypical medications are being used more and more frequently. They are called "atypical" because they:
- do not have the same chemical profiles as standard medications;
- seem to work in a different way than standard medications; and
- cause fewer side effects than standard medications, helping patients to stabilize
At the moment, there are four atypical antipsychotics available in BC -- risperidone (Risperdal), clozapine (Clozaril), olanzapine (Zyprexa) and the newest medication, quetiapine (Seroquel).
Risperidone (also known as Risperdal) The use of risperidone to date has been encouraging. While not effective for everyone, it is now generally accepted as first-line treatment for newly-diagnosed patients. Side effects -- which often discourage people from taking their medication -- are usually minimal at regular maintenance dosages.
Clozapine (Clozaril) Clozapine has been acclaimed because about one-third of patients with treatment-resistant (called refractory) schizophrenia who do not respond to other medications show at least some improvement on clozapine. It is also recommended for people who are showing signs of tardive dyskinesia, since it rarely causes or worsens this condition. The major drawback of clozapine is the slight risk (1%) that it will cause white blood cells to decrease, thereby decreasing the person's resistance to infection. People taking clozapine must have their blood counts monitored very regularly (once a week or every two weeks.)
Olanzapine (Zyprexa) Reports to date on the use of olanzapine are very encouraging, showing high rates of efficacy and a low side effect profile. All of this makes it ideal as a first-line treatment. Unfortunately, it is still not available for this purpose on the BC Pharmacare formulary -- a situation which we hope will change in the near future. The BC Schizophrenia Society continues to encourage government to make all new medications equally available to all patients.
Quetiapine (Seroquel) Quetiapine, the most recently-approved medication, also shows high rates of efficacy and low side effects, making it also a good choice for first-line treatment. It is now accessible to all patients in BC through the province's Pharmacare formulary.
Other New Antipsychotics Several new antipsychotic medications are being tested or waiting for approval. Most of the new drugs are "atypicals" -- meaning they fall into the same category as risperidone, olanzapine, quetiapine, and clozapine. In most cases, switching medications from standard to "atypical" can be done at any time. The person who is ill should take lots of time to think about it and talk it over with family, friends, and their treatment team. People should also be aware that atypical antipsychotics may have side effects of their own, such as weight gain and sexual dysfunction. It's true that the newer medications tend to produce less side effects -- but they may still cause some. Patients taking atypical antipsychotics must continue to be monitored for side effects.