There are a variety of
treatments for schizophrenia, ranging from drugs to therapy and acupuncture, as
well as a variety of other treatments. A brief overview of these strategies is
presented below:
Possible
Drug Treatments:
Clozapine is an
anitpsychotic that was often prescribed until it was found to cause
agranylocytosis (a decrease in number of neutroplhils below 500 cells/mm^3) in
many patients (Young et al, 1997). This condition is
typically fatal, and thus the side effects were thought to be worse than the
disease itself. When it was used,
it proved effective in treating schizophrenic patients (Kane et al, 1988).
After time, clozapine was introduced back into the market under tight
regulations (Young et al, 1997).
The FDA has approved of
this drug only if two conditions are met: (1) the patient must be diagnosed with
severe schizophrenia and (2) must have shown intolerable adverse effects with
typical antipsychotic effects. Since
this drug is highly regulated, the adverse side effects are not as common.
The side effects are as follows:
·
Agranulocytosis occurs in 0.38% of
patients (death rate has decreased from 50% to 3.1%)
·
Seizures
·
Delirium
·
Sedation
·
Tachycardia
·
Orthostatic
·
Hypotension
·
Weight gain
·
Constipation
Thus the side effects are
numerous, and intense. It is for
this reason that clozapine is not often prescribed (Young et al, 1997).
In 1988, Kane et. al. found
in a double-blind study that 30% of treatment- refractory schizophrenic patients
responded to clozapine. In this
study “response” was defined as a 20% decrease in the Brief Psychiatric
Rating Scale (BPRS), which rates the severity of schizophrenia.
These results were reproduced in 1990 by Meltzer et al (Young et al,
1997). Meltzer also found that
increased duration of treatment for 6-12 months led to an increased response of
50-60%.
Clozapine’s effect in children has yet to be determined because there is relatively little data on the subject. In 1990, Schmidt et al (Young et al, 1997), found that in a sample of 57 patients from nine to twenty-one years of age, 67% showed significant improvement after treated with clozapine. Furthermore, 21% improved slightly, 7% were unchanged, and 5% became worse after treatment. Though these results are hopeful, more research must be done in order to completely understand how clozapine affects children.
Carbamazepine
Carbamazepine has been used in treating a variety of psychological disorders, though its effects in schizophrenia have not been explored in depth (Sramek et al, 1988). In the Sramek et al (1988) study, twelve patients were treated with carbamazepine for five weeks. Their improvements were assessed by formal examinations, neurological examinations, EEG with an awake patient, ECG, and the BRPS clinical ratings. It was found that the drug produced no overall positive effect on the patients. Four of the twelve patients significantly improved, though eight deteriorated during the trial. Despite these results, most of the patients showed an improvement on the BRPS depression scale. Thus, Carbamazepine does not seem to be very effective in the treatment of schizophrenia, though it may be useful in treating depression.
Zotepine
Zotepine is an antipsychotic
drug that affects the dopamine receptors (Cooper et al, 2000).
The Cooper et al. (2000) study was a double-blind, parallel group study.
There were two groups, a zotepine group and a placebo group.
The evaluations included time until recurrence, BPRS rating, SANS (scale
for the assessment of negative symptoms) rating, CGI (clinical global
impression) ratings, and EPS (extrapyramidal symptoms).
Cooper et al found that patients in the zotepine group experienced lower
recurrence throughout the duration of the 26 weeks (six times lower).
In addition, patients in the treatment group had lower scores on the BPRS
and CGI. The results showed no
difference between the treatment and control groups for EPS. Finally, both groups expressed equal levels of withdrawal
symptoms. Some side effects of this
drug include severe insomnia, weight gain, severe drowsiness, and anxiety.
Although some negative side effects may occur, this study shows that
zotepine is an effective in treating schizophrenia.
In 2001, Conley and Mahmoud,
tested the effects and the safety of risperidone and olzapine.
The 377 participants were placed in either the risperidone or the
olzapine group. This double blind
study showed that both treatments are well tolerated, though risperidone
produced greater side effects and had a more positive effect in the control of
schizophrenia. Olzapine was not
superior in treating the symptoms of schizophrenia, and caused a greater weight
gain than risperidone.
Although risperidone was
found to be a better treatment in this study, Azorin et al (2001) found that
risperidone was not as effective as clozapine in treating Schizophrenia.
In addition, risperidone caused greater side effects than clozapine.
Thus, it appears that neither risperidone nor olzapine should be
considered effective treatments for schizophrenia.
An important issue with drug treatments regards treatment dosage. Carpenter et al (1987), found that there was no significant difference between continuous medication, given once every two weeks, and targeted medication, given only when there was a “need” for medication. Although there was no significant difference, the patients that received the continuous medication remained out of the hospital more often than in the targeted medication group.
Though there are many
studies that support the use of drug treatments in schizophrenics, other studies
have found that drug treatments may not be the best option.
May et al (1977), found that there is no evidence from the literature and
that there is a “greater outcome” from psychotherapy than from
hospitalization and nursing care. One
of the major concerns associated with drug treatments regards its negative side
effects. May et al, believe that some of the more “promising”
medications are not worth the possible side effects.
However, technology has changed since 1977, and now there are better
methods for detection of how persons will respond to medication.
See the section, entitled Improved Technology for
more information.
Alternative
Treatments:
In addition to the typical
treatments of schizophrenia, including drugs and therapy, there are also
alternative treatments that have proved to be effective.
In 1977, Wagemaker and Cade reported
that hemodialysis was effective in treating schizophrenia.
Since then, persons seeking alternative treatments have been interested
in dialysis. Scheiber et al (1981),
decided to retest this hypothesis. They
reasoned that if dialysis is effective in schizophrenics, then the process of
dialysis must remove “toxins” from the blood.
In this study, 12 participants received
three dialysis treatments per week for three weeks (total of nine treatments).
Before, during, and after each dialysis, blood samples were taken from
the patient and sent to the lab to be analyzed.
If dialysis was providing beneficial care, there should be toxins in the
blood sample taken before the dialysis that are not present in the sample taken
after dialysis. In addition to
blood samples, each patient’s psychological status was measured using the MMPE,
the Psychiatric Status Scale, as well as the Inpatient Multidimensional
Psychiatric Scale.
The study found that only three patients
showed dramatic improvement, while three showed moderate improvement.
None of the patients became worse during dialysis treatment.
In addition, no toxins were discovered in any of the blood samples.
Though no toxins were found, there was a significant decrease in symptoms
when dialysis was occurring.
Since medical tests do not explain the
decreased symptoms, there may be a placebo effect associated with this
treatment.
Many people seek acupuncture due to its
wide use and acceptance in China. Kane
and De Scipio (1979) wanted to study its affects in schizophrenic patients.
This blind nine week study consisted of 45-minute sessions with two sets
of acupuncture. One set was true
acupuncture, while the other set was pseudo-acupuncture.
In the pseudo-acupuncture treatment, the therapist placed the needles
close to the meridians, though not exactly on any true points. Thus, a patients’ te Chi’ should not be affected
in the pseudo-treatment.
All three patients in this
study showed a greater positive response to the actual acupuncture treatment
than the pseudo-acupuncture treatment. In
addition, the staff rated the patient as “improved” during the true
acupuncture test.
The results from
acupuncture seem promising, though more tests need to be done before drawing any
conclusions.
From the data presented
above, it is clear that the “perfect” treatment for schizophrenia has yet to
be found. Perhaps a combination of
alternative and drug therapies may result in the best control of symptoms.
*** Disclaimer: Though the information presented on this page was found solely in peer-reviewed journals, do not use this information as a treatment guide. If you are looking for treatments for Schizophrenia, please seek professional help. Thank you. ***
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Davidson College Psychology Department
© Copyright 2002 Department of Psychology,
Davidson College, Davidson, NC 28036
Send comments, questions, and suggestions to: meshafer@davidson.edu