In schizophrenia, antipsychotic medications are proven effective in treating acute psychosis and reducing the risk of future psychotic episodes. The treatment of schizophrenia thus has two main phases: an acute phase, when higher doses might be necessary in order to treat psychotic symptoms, followed by a maintenance phase, which is usually life-long. During the maintenance phase, dosage is often gradually reduced to the minimum required to prevent further episodes and control inter-episode symptoms. If symptoms reappear or worsen on a lower dosage, an increase in dosage may be necessary to help prevent further relapse.
Even with continued treatment, some patients experience relapses. The most common cause of a relapse is stopping medications.
The large majority of schizophrenia patients experience substantial improvement when treated with antipsychotic drugs. Some patients, however, do not respond to medications, and a few may seem not to need them.
Since it is difficult to predict which patients will fall into what groups, it is essential to have long-term follow-up, so that the treatment can be adjusted and any problems addressed promptly.
Antipsychotic drugs are the cornerstone in the management of schizophrenia. They have been available since the mid-1950s, and although antipsychotics do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook. The choice and dosage of medication is individualized and is best done by a physician who is well trained and experienced in treating severe mental illness.
The first antipsychotic drug was discovered by accident and then used for schizophrenia. This was Thorazine, which was soon followed by medications such as Haldol, Prolixin, Navane, Loxapine, Stelazine, Trilafon, and Mellaril. These drugs have become known as "neuroleptics" (meaning, "take the neuron") because, although effective in treating positive symptoms (acute symptoms such as hallucinations, delusions, thought disorder, loose associations, ambivalence, or emotional lability), they can cause cognitive dulling and involuntary movements, among other side effects. These older medications also are not so effective against so-called negative symptoms such as apathy, decreased motivation, and lack of emotional expressiveness.
In 1989, a new class of antipsychotics -- called atypical antipsychotics -- was introduced. At the correct doses, fewer of the neurological side effects -- which often include such symptoms as muscular rigidity, painful spasms, restlessness, or tremors -- are seen.
The first of the new class, Clozaril is the only drug that has been shown to be effective where other antipsychotics have failed. It is not linked with the side effects mentioned above, but it does produce other side effects, including possible decrease in the number of white cells, so blood counts need to be monitored every week during the first six months of treatment and then every two weeks and eventually once a month indefinitely in order to catch this side effect early if it occurs.