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.
Etiology of schizophrenia.
It is currently believed that the onset of schizophrenia is related to a variety of factors: personality traits, adverse events, stress, accidental factors, genetic factors, etc. The true cause of the disease is unknown. Schizophrenia and other psychiatric disorders are diseases of the brain. As the most complex organ: the brain, the internal structure is extremely complex, and the nerve cells of the brain, which are measured in billions, have unusually complex connections with each other. It is now believed that there is an imbalance of neurotransmitters in the brain of schizophrenic patients, especially abnormalities of dopamine (DA) and 5-hydroxytryptamine (5-HT) are most related to schizophrenia. Then antipsychotic drugs can treat mental illness for this reason: they act on the brain’s neurotransmitter system to bring the brain’s neurotransmitters into balance and normal.
Classification of antipsychotic drugs.
1, according to the sequence of drug invention, divided into old drugs: chlorpromazine, fenazepam, sulpiride, clozapine, etc., and new drugs: olanzapine, aripiprazole, ziprasidone, quetiapine, amisulpride, risperidone, etc..
2. According to the pharmacological differences, they are divided into classical antipsychotics: chlorpromazine, haloperidol, sulpiride, etc. and non-classical antipsychotics: clozapine, olanzapine, risperidone, quetiapine, etc.
3. According to the dosage of drugs, they are divided into high potency drugs: haloperidol, fenetylline, risperidone, etc. and low potency drugs: chlorpromazine, clozapine, quetiapine, etc. The way to differentiate is to look at the unit of each piece: if the dose of one piece is 1mg, 2mg is the high-efficiency drugs. If the dose is 25mg or 50mg, it is a low potency drug. Each of the two drugs has different pharmacological characteristics and clinical use precautions.
4, according to the drug’s length of action, and divided into long-acting drugs: only one oral long-acting drugs: pentafluoridol, tube a week, other long-acting drugs are injections: Halidol, Fluphenazine decanoate, Piperazine palmitate, Risperidone long-acting microspheres, etc., playing once can manage 2-4 weeks of the disease. As well as short-acting drugs: almost all oral drugs are short-acting drugs.
5, the price is different and divided into cheap drugs and expensive drugs. If the economic conditions are not good, eat cheap domestic drugs on the line, if the economic conditions are very good, then eat imported, imported drugs are slightly better quality, but domestic drugs are more cost-effective, we do not blindly believe in imported drugs.
Note: the efficacy of drugs and prices are not proportional, expensive drugs are not necessarily better.
6, according to the efficacy can be divided into good and general efficacy of the drug.
7, according to the size of the side effects can be divided into drugs with high and low side effects.
Therefore, to evaluate a drug, we should analyze it from several levels: efficacy? Price? side effects? Pharmacological characteristics? Each drug has its own advantages and disadvantages, and it is not a simple matter to choose the right antipsychotic drug and use it correctly.
I mainly evaluate drugs in terms of efficacy and side effects, after all, a drug with good efficacy and few side effects is the goal we all seek.
The key to determining efficacy is the pharmacological effect of the drug, which depends on the chemical structure formula of the drug.
Note: Regular blood tests, liver function, blood glucose, and electrocardiogram are required for taking any antipsychotic medication to detect problems and solve them early.
Generally speaking, patients with the first onset of the disease tend to have a good outcome, but if there are multiple relapses and a longer duration of the disease, the more difficult it is to treat and the outcome is often not good.
1, if the patient is in the acute phase or relapse, symptoms are obvious, a lot of hallucinations and delusions, impulsiveness, etc., or early use of strong drugs (ace drugs) in order to control the symptoms as soon as possible.
2. If the patient’s positive symptoms (hallucinations and delusions) are not obvious, but the negative symptoms are heavy, you can consider choosing drugs with relatively good efficacy for the negative symptoms, such as amisulpride, sulpiride, aripiprazole, etc.
3. If the condition is stable and the side effects of the original drug are heavy, you can add drugs to relieve the side effects; you can also gradually reduce the amount of the original drug and switch to a drug with fewer side effects for maintenance treatment.
Several methods of medication
1, in general, the amount of medication should be added slowly, and slowly reduced, depending on the patient’s condition and the patient’s tolerance of the drug.
2, generally speaking, the principle of medication is a single use of drugs, systemic treatment: the amount of drugs to be enough, take enough time, the efficacy is not good, adjust the treatment plan: increase the amount, change the drug or a combination of drugs.
3, if a single use of a variety of drugs with different pharmacological effects is not effective, or side effects, the combination of drugs is also often used, and sometimes the combination of drugs will play a better effect.
The principle of combining drugs: do not combine drugs with similar pharmacological effects, but combine drugs with different pharmacological effects, combine high-efficiency drugs with low-efficiency drugs, and combine long-acting drugs with short-acting drugs. It is hoped that the effect of 1+1>2 will be achieved.