Treatment principles
1. early detection and early treatment.
2, medication can relieve the vast majority of symptoms, antipsychotic medication should be the preferred treatment measure, and medication should be an important part of treatment.
3. treatment needs to be adequate in quantity and duration and active for the whole course of treatment.
4. treatment of schizophrenia is long-term treatment, and drug selection takes into account symptoms, side effects, and individual tolerability, as well as affordability and accessibility.
5. the dosage of medications should be individualized and adjusted with different treatment phases
6. patients will face psychological and social problems as part of the disease manifestation and as a psychological stress response after the disease, and psychosocial interventions are usually required
7. families play a very important role in the treatment and rehabilitation of patients, and family members need to understand the knowledge of the disease, support the patient’s treatment, and help choose the correct treatment path.
8. schizophrenia treatment is long-term treatment, and patients and families must master self-management skills for the disease to prevent recurrent episodes and maintain long-term stability of the disease
9. Patients, family members, and health care workers establish a good therapeutic alliance to deal with the disease together.
Medication
Medication can relieve the vast majority of symptoms, and antipsychotic medication should be used as the first choice of treatment.
1. Second-generation (atypical) antipsychotic drugs: should be chosen as first-line treatment drugs with relatively small side effects, with high 5-hydroxytryptamine receptor blocking effects and also blocking dopamine receptors, called dopamine/5-hydroxytryptamine antagonists. They include risperidone, olanzapine, clozapine, quetiapine, ziprasidone, aripiprazole, paliperidone, and amisulpride. Clozapine is used as a second-line drug because of its large side effects.
2, the first generation (typical) antipsychotic drugs: should be used as second-line treatment drugs, the main mechanism of action is the brain dopamine receptor blockers, currently commonly used types include: chlorpromazine, haloperidol, pentafluridol, fenadine, fluphenazine, sulpiride.
3, long-acting drugs: mainly used for maintenance treatment and patients with poor compliance with medication. The first generation drugs long-acting injection include haloperidol sunflowerate, fluphenazine sunflowerate, perphenazine palmitate, pentafluridol is oral haloperidol long-acting preparation. The second-generation drugs risperidone and paliperidone long-acting injections have been used in China, which are dominated by fewer side effects and can be considered for patients with high quality of life requirements.
Treatment course
The whole course of treatment and all-round treatment, continuous pharmacological treatment and psychosocial interventions are needed.
1.Acute phase treatment: relief of the main symptoms, adequate drug therapy, duration of treatment at least 4-6 weeks.
2.Recovery period (consolidation period) treatment: prevent the relapse of the relieved symptoms, continue treatment with the original effective medication and dosage for at least 3-6 months.
3, maintenance (recovery) treatment: maintain the stability of the disease, prevent the relapse of the disease, adhere to drug therapy, according to individual conditions to determine the maintenance drug dose, the course of treatment for not less than 2-5 years. Many scholars have proposed that for those who stop medication and relapse, long-term maintenance treatment should be given. For patients who are refractory, have serious suicide attempts or violent aggressive behavior, continuous maintenance therapy is recommended. In conclusion, the dose and duration of maintenance treatment should be individualized and related to the disease duration, relapse history, disease severity, remission level, environment, pre-morbid personality, dose and duration of previous medication, etc., which need to be considered comprehensively.
4. Discontinuation period: If the medication is discontinued, the condition needs to be closely observed, and medication should be resumed as soon as possible if there are aura of relapse.
Psychosocial intervention
1.Psychotherapy: to help solve patients’ psychological problems and crisis intervention.
2.Skills training: to help patients restore social functions and master the management of the disease
3.Family intervention: to establish a family environment conducive to the patient’s disease treatment and recovery
4.Community services: provide patients with various possible services to enable them to adapt to a normal life in the community and promote their overall physical and mental recovery.