Schizophrenia

Without question, the most important development in the treatment of schizophrenia symptoms occurred in the 1950s, when antipsychotic medications were first discovered to reduce the symptoms of schizophrenia. Antipsychotic medications are also called neuroleptics because, in addition to their helpful effects, these medications often have side effects that are similar to the symptoms of some neurological (brain) disorders, such as Parkinson's disease. More information about side effects is given later in this chapter.

Neuroleptic medications were not originally developed to treat schizophrenia. It was not until the 1950s that a neuroleptic medication called chlorpromazine was first discovered to be very effective for calming schizophrenia sufferers. People in the mental health field now believe that neuroleptic medications work because they block the action of dopamine in the brain (see chapter four).

Research shows that neuroleptic medications reduce schizophrenia symptoms in about two-thirds of patients. For about one-third of people with schizophrenia, neuroleptics control their symptoms almost completely. For another third, the drugs work to reduce the symptoms but do not make them go away entirely. The remaining third suffer from severe symptoms that cannot be controlled by neuroleptic medications.

Neuroleptic medications work especially well for treating hallucinations and also help control delusions and disorganized speech. These medications do not work very well for treating negative symptoms, such as blunted affect, poverty of speech, and avolition.

Antipsychotic Drugs

Antipsychotic drugs vary in how long they take to work. Also, they work faster in some people than in others. Some individuals experience a dramatic improvement within two days of starting medication. For others, improvement takes several weeks.

Individuals also vary in how long they need to continue taking medication. Some people—about one quarter—recover completely after only one episode of schizophrenia. These people may be able to stop taking antipsychotic medication within a few weeks following their recovery. However, most people who stop taking antipsychotic medications experience a relapse, or return of symptoms. The treatment of schizophrenia can be compared to the treatment of diabetes. People who have diabetes take insulin to manage their symptoms, not to get rid of the causes of the illness. The insulin controls diabetes, but it does not cure it.

Like diabetes, there is no cure for schizophrenia; there are only medications to control its symptoms. Therefore, most people who take antipsychotic drugs to control schizophrenia symptoms need to remain on these medications for a long time, often for several years.

Negative Side Effects of Neuroleptics

Unfortunately, in addition to the positive effects of antipsychotic drugs (the reduction of schizophrenia symptoms), these medications sometimes produce unwanted side effects. Many people who take neuroleptics report that the medications make them feel “slowed down” and groggy. These medications can also cause dryness of the mouth, blurred vision, and weight gain.

Neuroleptics can also lead to disturbing movement problems, which are called extrapyramidal side effects (EPS). EPS resemble the symptoms of a neurological disease called Parkinson's disease. People with EPS often feel their muscles become very stiff. Typically, they shuffle their feet when they walk, and their hands shake or tremble.

Another kind of EPS leads a person to lose control of some of his or her movements. For example, people with this side effect might smack their lips or make chewing motions that they cannot control. This syndrome, which usually occurs in patients who have taken neuroleptics for at least several years, is known as tardive dyskinesia.

People who have tardive dyskinesia move their tongue and mouth uncontrollably. They often make involuntary jerking movements, such as chewing, sucking, smacking their lips, or pushing their cheeks out with their tongues. Sometimes they lose control over muscles in other parts of the body and make unusual jerky movements with their arms or legs.

Reducing the amount of medication the person is taking or having him or her switch to a different medication usually reduces the severity of tardive dyskinesia. Also, there are newer medical treatments for schizophrenia, discussed later, that do not seem to cause tardive dyskinesia.

Most people with schizophrenia who take neuroleptic medications do not experience severe side effects. Most people who do experience side effects report that the side effects are not as bad as the hallucinations, delusions, and disorganization that the medications control.

Some schizophrenia sufferers, however, stop taking their medication because of the side effects or because they feel that they do not need medication anymore when their symptoms go away. Unfortunately, most of these people will suffer a relapse of symptoms within a few months of stopping their medication.