Schizophrenia is a disease that every psychiatrist is familiar with and scratching his or her head. 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, and here I combine my clinical experience to systematically elaborate on the knowledge of antipsychotic medication, trying to make the complex issues a little simpler for everyone to understand and master, and also I hope that the majority of patients will recover soon.
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 range of better efficacy. The commonly used dose is 2-6mg/day.
Features are: positive, negative effect on patients are relatively good, the price is moderate, 1mg domestic more than 2 yuan, imported more than 3 yuan. Risperidone has aqueous, 1ml = 1mg, drops into the meal, suitable for patients who refuse to take medication dark medication (sneak medication),.
Disadvantages:Weak excitability control, prone to extrapyramidal side effects at high doses (above 4mg daily). The effect on central lactogen is considerable, resulting in side effects such as non-menstruation in women and sexual dysfunction in men, which are closely related to the dose. It is not recommended for young women and is also more likely to cause obesity.
As for paliperidone (Ryder) this drug, the price is very expensive, in fact, and risperidone is similar, he is actually the active metabolite of risperidone 9-risperidone, essentially and risperidone is similar, the price is much more expensive.
Hengde is a long-acting microsphere injection of risperidone, which facilitates maintenance treatment, 25-37.5 mg every 2 weeks, the dosage form has characteristics, but the price is too expensive, suitable for patients with better economic conditions for maintenance treatment.
2. Quetiapine.
This drug has few side effects, has a strong sedative effect, strong sleep aid, commonly used dose of 200-750mg / day, the price of domestic 100mg a piece of each piece is about 2 yuan more, 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. , 3.
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, and imported ones are about three times more expensive. The sedative effect is light and does not easily cause sleepiness. For negative symptoms, the effect is good, and the clinic also supports this conclusion.
For positive symptoms, the effect is average, but for negative symptoms, the effect is still possible. Low side effects and good efficacy for negative symptoms are the characteristics of aripiprazole. Maintenance medication is still possible.
4. Ziprasidone.
The outstanding advantage of this drug is that it does not cause drowsiness, does not cause obesity, small side effects are its advantages, the disadvantage is to monitor the electrocardiogram, may cause QT interval prolongation, if there is a QT interval prolongation to stop the drug. 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.
II. Typical antipsychotic drugs (old antipsychotics): low price is their common denominator.
1. Chlorpromazine.
The first antipsychotic drug used in psychiatric clinics seems to be the epoch-making drug of the 1950s, which ushered in a new era of pharmacological treatment of 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 injections available for injection to control excitement, but can only be injected intramuscularly for 3-5 days, for a long time, there is irritation to the muscle of the intramuscular injection site, resulting in muscle damage, and can only be used temporarily.
2. Flonase.
This drug is good, belongs to the high efficiency and price of drugs, extrapyramidal side effects are not significant, sedation is light, side effects on blood sugar, heart, etc., maintenance treatment is better. However, because of the low price, there are no more manufacturers now, and I hope it will be produced as soon as possible for the benefit of the majority of patients.
It has a long-acting drug, an injection called fluphenazine decanoate, which is injected intramuscularly once every 2 weeks, 1-2 sticks each time, and has relatively good efficacy on negative symptoms.
3. sulpiride.
It has a good effect on negative symptoms and is generally effective in the treatment of schizophrenia, commonly used at a dose of 300-1200 mg/day. A major side effect is that it causes elevated prolactin, which has a major effect on young women who do not have menstruation, and this side effect is related to the dose, which is prone to occur at high doses.
4. pentafluridol.
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, easy to cause extra-pyramidal side effects. Treatment of schizophrenia in general, but maintenance treatment is good, easy to take, also can be given to patients who do not cooperate with the medication dark medication, convenient.
There are also Teldene, trifluoperazine tablets, methiodiazine, hyperresistant, compound resistin, etc. These old drugs are basically no longer produced.
At present, the clinical tendency is to first choose non-classical antipsychotic drugs to treat patients, the reason is that the side effects are relatively small, the efficacy is still good, and the old drugs are also in use, with relatively less. Drugs that are easy to take and have few side effects will remain the mainstream medication in the future.
For each patient, no matter what kind of medicine you take, as long as you eat the effect is good and the side effects are small, this is a good medicine.
As for which drug is suitable for each patient, we have to consider the patient’s condition, previous medication experience and the effect after taking the drug, the patient’s tolerance of the drug, side effects, and the patient’s economic situation, and then make a decision after comprehensive consideration, and then follow up with the patient to adjust the treatment plan at any time, so that the patient can gradually move towards recovery and let the smile bloom on the face of each family member.
As a doctor, my heart will be filled with infinite pride and happiness.