Schizophrenia is a disease that every psychiatrist is familiar with and scratching his or her head about. Most of the patients in the ward are schizophrenic and are hospitalized for a long time, and systematic mastery of antipsychotic medication is a necessary skill for every psychiatrist. Here I will combine my clinical experience to systematically elaborate on the knowledge of antipsychotic medication, and try to make the complex issues a little simpler to facilitate your understanding and mastery. After the ace drugs are finished, let’s talk about the general efficacy of drugs, focusing on the characteristics of the drugs themselves.
I. New antipsychotic drugs (atypical antipsychotic drugs)
The difference between the so-called atypical drugs and typical drugs is that the pharmacological characteristics of typical drugs are mainly blocking the brain’s DA (dopamine) receptors to exert efficacy, while the pharmacological characteristics of atypical antipsychotic drugs are: in addition to dopamine (DA) also acts on 5-hydroxytryptamine (5-HT), and the effect on 5-HT is more obvious.
1. Risperidone.
This drug is developed from the basis of haloperidol, and haloperidol is the king of drugs, indicating that the efficacy of this drug should be good, clinical practice does support this view, the efficacy of risperidone is still good, belong to the better efficacy of the range. Commonly used dose 2-6mg/day.
2. Quetiapine.
This drug has little side effects, strong sedative effect, strong sleep aid, commonly used dose of 200-750mg / day, the price of domestic 100mg a piece of about 2 yuan per piece, the imported 100mg about 10 yuan it. I have seen a patient with refractory schizophrenia take 1500mg orally daily, and the effect is better. But don’t read my introduction and increase the dosage blindly by yourself, please use the medication under the guidance of a psychiatrist. Overall, the efficacy is average, but the side effects are small. It is also more likely to cause sleepiness and obesity. For psychiatric symptoms in patients with dementia, small doses of quetiapine are more effective. For the patients with dementia, small doses of quetiapine are more effective.
3. Aripiprazole tablets.
This drug has complex pharmacological effects and is commonly used in doses of 10-30mg/day. The price of domestic 10mg is more than 6 yuan, the imported ones are about 3 times more expensive. The sedative effect is light and does not easily cause sleepiness. For the negative symptoms of the effect is better, the clinical also support this a conclusion.
4, ziprasidone.
The outstanding advantage of this drug is that it does not cause drowsiness, does not cause obesity, small side effects is its advantage, the disadvantage is to monitor the electrocardiogram, may cause QT interval prolongation, if the QT interval prolongation should be discontinued. Commonly used dose 80-120mg/day, the price of imported 40mg per capsule more than 16 yuan, domestic 40mg is about 6 yuan it. Take this drug with a little attention: to take with the meal, so that the absorption of good, not so, the absorption of the drug to reduce the amount of one-third. When you start to eat a small dose may cause the patient to activate, the patient may show some excitement, continue to increase the amount will be good, the manufacturer advertised the drug has a therapeutic effect on depression.
Second, the typical antipsychotic drugs (old antipsychotic drugs): low price is their common denominator.
1. Chlorpromazine.
The first antipsychotic drug used in psychiatric clinics seems to be the epoch-making drug in the 1950s, which ushered in a new era of drug treatment for schizophrenia. Before the invention of chlorpromazine, schizophrenic patients could only be treated by: electroconvulsive therapy, insulin coma therapy, fever therapy, etc. These non-pharmacological treatments were first used in the 1930s, and the only non-pharmacological treatment that is still in clinical use today and has proven to be highly effective is electroconvulsive therapy. Chlorpromazine is a low potency drug with strong sedative effect, commonly used in doses of 200-600 mg/day. The side effects of this drug are large, mainly extrapyramidal side effects, effects on lactogen, and effects on liver function, and are best used in small to medium doses. Chlorpromazine has an injection available for injection to control excitement, but can only be injected intramuscularly for 3-5 days, a long time, the muscle of the muscle injection site has stimulation, resulting in muscle damage, and can only be used temporarily.
2. Fenadrine.
This drug is good, belongs to the high efficiency and price of drugs, the extrapyramidal side effects are not significant, the sedative effect is light, the side effects on blood sugar, heart, etc., maintenance treatment is better. But because of the low price, there are no manufacturers now, I hope it can be produced as soon as possible for the benefit of the majority of patients. It has a long-acting drug, is an injection, called fluphenazine decanoate, once every 2 weeks intramuscular injection, 1-2 sticks each time, the efficacy of the negative symptoms is relatively good.
3. Sulpiride.
The effect on negative symptoms is better, the treatment of schizophrenia is generally effective, commonly used dose 300-1200mg/day, there is a big side effect is caused by elevated prolactin, a big impact on young women, not menstruation, this side effect is related to the dose, the dose is easy to appear.
4. Pentoxifylline.
The only oral long-acting drug, 20 mg per tablet, taken 2-3 times a week, one-half or one-third of a tablet each time, do not eat according to the instructions, prone to extra-pyramidal side effects. Treatment of schizophrenia in general, but maintenance treatment is good, simple to take, but also to patients who do not cooperate with the medication dark dose, convenient.