For patients with first-episode or relapsing schizophrenia, antipsychotic medication should be the first treatment measure, while health education, work recreation therapy, and psychosocial interventions should be used throughout the treatment process. For some patients with poor medication results, mucoid defiance, frequent suicides, and aggressive impulses, anti-convulsive therapy can be used alone or in combination during the acute treatment period.
Drug treatment
General principles: early, adequate dose (individualized minimum effective dose), full course, single dose, individualized dosing principle; the rate of drug dose increase depends on drug properties and patient characteristics. The maintenance dose is often 1/2-2/3 of the dose during consolidation therapy, and the drug cannot be stopped suddenly under normal circumstances.
1. pharmacotherapy can relieve the vast majority of symptoms, and antipsychotic medication should be the treatment of choice.
2. Second-generation (atypical) antipsychotic drugs, which should be chosen as first-line treatment drugs with relatively small side effects, have a high 5-hydroxytryptamine receptor blocking effect and also block 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 high side effects.
3, 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; ④ long-acting drugs: mainly used for maintenance treatment and patients with poor compliance with medication. The first generation drugs long-acting injections include haloperidol sunflowerate, fluphenazine sunflowerate, perphenazine palmitate, and pentafluridol is an oral haloperidol long-acting preparation.
Principles of drug selection.
Patient compliance with the drug, individual efficacy of the drug, size of adverse effects, long-term treatment plan, age, gender, economic status, etc.
Degree and duration of drug therapy.
Acute treatment period (at least 4-6 weeks), consolidation treatment period (at least 6 months) and maintenance treatment period. In general, the duration of maintenance treatment depends on different situations. For patients with first-episode, slow onset disease, the duration of maintenance treatment is at least 5 years; for patients with acute attacks and complete remission rate, the duration of maintenance treatment can be correspondingly shorter. Ultimately, less than 1/5 of patients are likely to discontinue the drug.
1. acute treatment period: remission of the main symptoms, adequate drug therapy, duration of treatment at least 4-6 weeks.
2, consolidation treatment period: prevent the relapse of the remitted symptoms, continue treatment with the original effective drugs and doses for at least 6 months.
3, maintenance treatment period: maintain the stability of the disease, prevent the disease from recurring, adhere to drug therapy, according to individual conditions to determine the maintenance drug dose, the course of treatment for at least 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, degree of remission, environment, pre-morbid personality, dose and duration of previous medication, etc., which need to be considered comprehensively.
4. If the medication is discontinued, the condition needs to be closely observed, and medication should be resumed as early as possible if there is a harbinger of relapse.
Combination of drugs.
It is more appropriate to combine drugs with different chemical structures and pharmacological effects, and it is still appropriate to use a single drug after achieving the expected therapeutic goal.
Safe medication use.
Blood pressure, heart rate, blood picture, liver, kidney and heart function, blood glucose and lipids should all be routinely checked before antipsychotic treatment. And the comparison should be reviewed regularly during medication administration.
Psychological and social interventions
The ideal state is that the patient has recovered the energy and physical strength decline due to the disease, reached and maintained a good state of health, restored the original study or learning ability, and rebuilt appropriate and stable interpersonal relationships, so as to achieve full social rehabilitation.
1. Behavioral therapy (social skills training): no significant efficacy in reducing psychopathological symptoms and re-hospitalization, enabling patients to acquire certain purposeful skills and improving the social adaptation of individuals.
2. family interventions: to establish a family environment that is conducive to the treatment and rehabilitation of the patient’s illness.
3. community services: to provide patients with various possible services to enable them to adapt to a normal life in the community and to promote their overall physical and psychological recovery.