Schizophrenia is a disease of a biological nature, its manifestations are eliminated by influencing the metabolism of biologically active substances in the brain.
Since the discovery in the 1950s of the first psychotropic drug, chlorpromazine, there has been a revolution in the treatment of mental disorders, especially schizophrenia. Until this time, the most popular treatments for schizophrenia were insulin therapy, electroconvulsive therapy, and lobotomy. Medical treatment was more symptomatic and usually included anti-anxiety drugs.
With the advent of antipsychotics, it became possible to chemically influence and eliminate the symptoms of the disease, whereas previously such patients had to be isolated from society in anticipation of short-term spontaneous remissions.
Modern pharmacology greatly progressed and to date, there is a fairly extensive range of products, in varying degree of impact on symptoms of schizophrenia. These drugs are called “antipsychotics” or “antipsychotics”. They have one thing in common – they all first of all eliminate the manifestations of psychosis: delirium, hallucinations, psychomotor agitation. The mechanism of their action is the blockade of receptors for the mediator – the biologically active substance of the brain – dopamine, due to this , the antipsychotic effect of the drugs arises. In addition, they have an affinity for other receptors (for acetylcholine, adrenaline, serotonin, histamine), which explains a fairly wide range of their action, including the occurrence of some side effects. There are many classes of antipsychotics, which differ in chemical structure, which means that they affect the body in different ways , to a greater or lesser extent affecting the various manifestations of schizophrenia.
The action of antipsychotics
The antipsychotic effect of neuroleptics itself is distinguished: general – the effect on all manifestations of psychosis and the prevention of further development of the disease, and selective – targeting effect on productive symptoms (delirium, hallucinations, obsessive states, catatonia). Due to the sedative (inhibitory) effect, antipsychotics are effective for various types of psychomotor agitation and insomnia. Some antipsychotics, on the contrary, have an inherent activating effect; it is used in the treatment of negative symptoms (apathy, catatonic stupor, autism).
Cognitotropic action is an effect on higher cortical functions (memory, attention, thinking, perception). Neuroleptics also have a neurological effect – they bind to dopamine receptors located in the centers of movement regulation, which causes side effects such as muscle stiffness, restlessness, trembling of the limbs … These undesirable phenomena are eliminated by the appointment of correctors such as cyclodol or akineton.
Antipsychotics also affect the autonomic nervous system and the endocrine system , which can manifest itself as dry mouth, urinary retention, low blood pressure, decreased sex drive, menstrual irregularities, and weight gain. In different groups of antipsychotics, the listed effects are expressed to varying degrees and the use of one or another class of drugs depends on the form of schizophrenia and the characteristics of its course.
Recently, preference is given to the modern class of antipsychotics, which appeared in the 90 – s of the 20th century, the so-called “atypical” antipsychotics. They are atypical, because, unlike the drugs of previous generations, they practically do not have a neurological effect, i.e. do not cause side effects associated with movement disorders, which is a very valuable quality, because movement disorders usually cause great discomfort to patients and require the appointment of additional corrective drugs. At the same time, modern antipsychotics are as effective in eliminating the symptoms of schizophrenia as the old drugs. Another advantage of atypical antipsychotics is their positive effect on cognitive functions (cognitotropic effect), which was not the case with the drugs of the past; due to binding to serotonin receptors in the brain, atypical antipsychotics also have an antidepressant effect .
Modern drugs are convenient to use – the peculiarities of their distribution in the body are such that they can be taken only once a day. With regular use, the drugs begin to fully work after 2-3 weeks, so they must be continued to be taken, even if at first glance there is no expected effect. However, even at the peak of the drug’s action, not all symptoms of the disease can be immediately eliminated; in order to completely reduce the symptoms and to prevent relapses of the disease, the drug should be drunk for an average of two years.
For the convenience of long-term use of drugs, prolonged forms of antipsychotics have been released in the form of injections (rispolept – consta) – one such injection is enough for 2-4 weeks. In addition to eliminating specific schizophrenic symptoms, it is useful to carry out restorative treatment, because the disease is usually accompanied by general disorders of the nervous system. For this purpose, drugs are used that improve the metabolism in the nervous tissue: picamilon, mexidol, cerebrolysin, milgama, mildranat, gliatillin, nootropil.
Therapy for drug-resistant schizophrenia
The main problem that can arise in the treatment of schizophrenia is drug resistance . This phenomenon is rare, however, it can occur with certain forms of schizophrenia, the characteristics of the patient’s metabolism, or prolonged and inadequate treatment with psychotropic drugs. In such cases, as well as for the termination of acute attacks of schizophrenia with delirium and catatonia, electroconvulsive therapy (ECT), insulinocomatous therapy, hemosorption and plasmapheresis, laser blood irradiation are used.
Electro-convulsive therapy sessions are performed in an intensive care unit under general anesthesia to minimize the risk of complications. At the head of the patient and the electrodes applied to artificially induce a seizure. The course of treatment includes 4-8 ECT sessions, patients completely forget the seizures, and the effectiveness of this method can be quite significant. Another method of shock therapy for schizophrenia is insulinoma therapy. This technique is based on the introduction of doses of insulin to achieve hypoglycemic coma (loss of consciousness due to a decrease in blood sugar ), 10-20 minutes after reaching a coma, the patient is removed from it by intravenous administration of a glucose solution. In order to interrupt an attack of psychosis, 10-20 sessions are required .
Sometimes it is effective to use detoxification (cleansing of toxins) of the body using hemosorption or plasmapheresis. The patient’s blood is driven through a special apparatus, where it is cleansed of toxins, immune complexes, in the case of prolonged drug therapy – from medicinal substances. This can contribute to both a decrease in the manifestations of productive schizophrenic symptoms, and to overcome drug resistance due to the “cleansing” of receptors. Radiation of blood with a laser has a similar effect .
The listed methods of the so-called “non-drug” therapy are used in extreme cases of intolerance, drug resistance or for the termination of acute psychosis. In all other cases, drug therapy is sufficient. Also, for greater efficiency, it is possible to combine drug therapy with non-drug methods of treatment.
With the modern development of psychiatry, when it is possible to carry out therapy with modern drugs, with a timely visit to a doctor (no later than 2 years after the appearance of the first signs of the disease), with the appointment of adequate drug therapy and adherence to the medication regimen, effective treatment can be carried out with a minimum of side effects, with elimination of schizophrenic symptoms and defects that the disease has managed to inflict on the patient’s personality. With a long-term current disease, it is possible to achieve a significant improvement in the condition and prevent the further development of the disease process.
At the same time, biological therapy alone for the effective treatment of schizophrenia is clearly not enough and requires mandatory psychotherapy (individual, group, family), psychological correction of memory, attention, thinking disorders, as well as a set of social measures aimed at the rehabilitation of a person suffering from this disease. …