The treatment of schizophrenia is currently based on medication, which is safe and effective, accessible and easy to use, and has high patient compliance with treatment. Targeted medications are selected according to whether the treatment is acute or chronic, and whether positive or negative symptoms predominate. In principle, a small amount of medication is used to gradually increase until improvement, and a small amount of medication is used to maintain treatment. Different clinical periods have different treatment goals, and different treatment strategies are used during different clinical periods.
1. Clinical manifestations involve all aspects of human mental activity
Schizophrenia involves all aspects of human mental activity, and clinical manifestations are characterized by multidimensional symptoms, i.e., positive symptoms, negative symptoms, mood disorders, aggressive behavior, and cognitive dysfunction. Positive symptoms, such as hallucinations, delusions, thought disorders, speech disorders, and catatonia; negative symptoms, such as emotional indifference, impoverished thinking, diminished volition, lack of interest, and social withdrawal; and mood disorders, such as anxiety, depression, and suicidal ideation and behavior; the above five-dimensional symptoms lead to patients’ diminished social functioning, decreased social, work, and learning abilities, difficulties in interpersonal relationships, and negligent self-care. Due to the multidimensional nature of schizophrenia symptoms, comprehensive treatment of the entire course of the illness is required. A full course of active treatment will significantly improve the prognosis of patients.
2.Medication as the main means
The treatment of schizophrenia is currently based on medication as the main means, which is safe and effective, available, easy to use, and has high patient compliance with treatment. According to the acute phase or chronic phase, positive symptoms or negative symptoms are the main choice of targeted drugs, in principle, a small amount to start gradually increasing, to improve, then gradually reduce a small amount of drugs to maintain treatment. If the patient does not cooperate in taking the drug, it can be applied intramuscularly or intravenously for a short period of time, and then be changed to oral after cooperation.
3.Treatment objectives
Acute treatment goals: ① eliminate the main symptoms and strive for clinical remission; ② prevent the occurrence of suicide and impulsive behavior; ③ minimize the adverse drug reactions and prevent the occurrence of serious adverse reactions; ④ prepare for the restoration of social functions and return to society. Treatment goals: The treatment goals set out in the guidelines for the prevention and treatment of schizophrenia prepared by China in 2003 are integrated with China’s national conditions and are in line with international standards, and can be used by clinical workers for reference.
4. Different treatment strategies are used in different clinical periods
4.1. Acute phase treatment
① Conduct a comprehensive examination to clarify the diagnosis and make a baseline assessment before treatment, including mental status, severity of symptoms, physical condition, and laboratory tests such as electrocardiogram, electroencephalogram, blood and urine routine, liver and kidney function, blood glucose, lipids, and other biochemical indicators.
② Conduct intensive drug therapy to seize the effective time for treatment and strive for the best prognosis.
4.2, Consolidation and stabilization treatment
After the patient’s symptoms have been relieved by the acute treatment, attention should be paid to consolidation treatment to stabilize the disease.
①Treat with the effective dose of the original effective drugs for a period of 4-7 months.
②Treatment sites include family (outpatient), community, rehabilitation ward or rehabilitation base.
③Family education and psychotherapy.
4.3. Maintenance period for relapse prevention
After the above treatment, the patient’s condition is in basic remission and the general performance is normal, adhere to the maintenance treatment to prevent relapse and deterioration of the condition.
①Continue the original effective drug therapy, adjust the dose as appropriate, grasp the dose of relapse prevention, and if there is no special adverse reaction, do not change the drug as much as possible.
②The course of treatment will be determined as appropriate.
③Treatment sites, mainly family (outpatient) and community treatment.
4.4. Treatment of refractory schizophrenia
There is no exact definition of drug-refractory schizophrenia, but it generally refers to those who have been ineffective after a full course of three different types of antipsychotic drugs.
Treatment should pay attention to.
(1) Revisit the original schizophrenia diagnosis to further rule out other disorders.
(2) Perform blood concentration measurements, if necessary, to clarify the patient’s compliance with medication and whether the patient has problems with drug metabolism.
(3) Reformulate the treatment plan, including: increasing the dose, changing medication, combining medication or combining booster therapy, and also consider electroconvulsive therapy.
(4) The course of treatment should be no less than 3 to 5 years.
4.5. Chronic schizophrenia
Sometimes it overlaps with refractory schizophrenia, but the two should not be the same concept. The former is mostly dominated by negative symptoms the latter may refer to positive symptoms distinct and ineffective treatment, and treatment measures are similar for both.