Patients with schizophrenia should receive comprehensive, lifelong, or even lifelong treatment that includes antipsychotic medications.
Acute phase treatment
C To relieve the main symptoms
C To prepare for the restoration of social function and return to society
C Prevent suicide and impulsive behavior
C Prevention of serious adverse drug reactions
Treatment in the consolidation phase
C Prevent recurrence of symptoms
C Promote return to social functioning
C Preventing suicide
C Prevention of adverse drug reactions associated with long-term drug use
Maintenance treatment
C Further relief of symptoms
C Improving medication adherence
C Restoration of social functioning
Principles of the full course of anti-schizophrenia medication
The principle of adequate dosage and full course of treatment: In order to follow this principle and achieve the goal of full treatment of schizophrenia, the selection and application of antipsychotic drugs are bound to be more stringent! –take into account safety, tolerability, and efficacy.
Principles of drug selection
Selection must be based on the individualized characteristics of the patient’s disease duration, clinical manifestations, efficacy, adverse effects and pharmacogenetics, combined with the receptor pharmacological characteristics, pharmacokinetic characteristics and pharmacodynamic characteristics of antipsychotic drugs.
Schizophrenia treatment course
Acute phase: Acute treatment with effective dose within 2 weeks until symptoms are controlled, usually at least 6-8 weeks
Recovery phase: consolidation therapy with continued application of the effective dose for 4-6 months
Consolidation therapy (continuation of treatment) is used for the recovery period after the acute symptoms are controlled, and the treatment is continued with the original effective dose.
C Previous data suggest 6-8 weeks or 1-2 months
C APA (1997) At least 6 months
C At least 4-6 months is recommended
Stabilization phase: maintenance therapy, maintenance dose usually lower than effective dose
Ben et al. (1981) suggested that the duration of maintenance therapy varies from person to person
C Acute onset, short duration of symptoms (less than three months), rapid resolution of symptoms without fluctuation after prompt systemic treatment, about 6 ~ 12 months
C Should be maintained for 2 ~ 3 years after the first onset
C Those with second onset should be maintained for 5 years
C Lifelong maintenance treatment should be considered for those who have had 3 or more episodes or whose symptoms have never completely resolved with various treatments.
The American Textbook of Comprehensive Psychiatry, 7th Edition, refers to
C 1-2 years of medication maintenance for first episode
C Medication maintenance for at least 5 years for multiple episodes
C Longer medication maintenance for those with suicidal, violent, or aggressive behavior
C Relapse is more likely in the first 3-6 months after the acute phase and should be adequately consolidated
There is no best drug, only the most suitable one! There is no absolutely safe drug, only good safety conscious doctors!