The following is therefore NSF(S)'s interpretation of that material.
Neuroleptic drugs are commonly the medication used to control the florid symptoms of schizophrenia, such as delusions, hallucinations and thought disorders. Negative symptoms (apathy, lack of motivation) may not be improved by drug treatments although some newer drugs are more helpful.
During the stay in hospital, in addition to drug treatment, psychosocial therapies should be available, for individuals or groups. These therapies may include behavioural psychological treatment to help patients deal with delusions and hallucinations, anxiety, phobic avoidance, obsessional thinking and compulsions.
Successful drug treatment permits subsequent participation in a range of non-drug therapies.
In a first episode, drugs are given orally to give the doctor fine control over dosage which can be adjusted rapidly or stopped if there are bad side effects. Later, depot drugs, given by injection can have effects lasting for a few weeks.
"Mega doses" usually don't help. They can increase sedation and side effects.
For the majority, relatively modest doses can be effective against acute symptoms.
Adequate time is needed to allow the desired therapeutic response to develop. It is good practice to change the dose gradually, balancing wanted and unwanted effects.
Although the use of one drug is best to minimise drug interactions and simplify observation, a few people respond well to a combination of drugs. The need for additional medication must be monitored and need rarely be used long-term.
Poor compliance is associated with the user's perception of distressing side-effects. When the condition is stabilised, gradual dose reduction may improve compliance.
It can take two or three months before drug treatment is fully effective. Likewise it can take two or three months for signs of relapse to appear after treatment is stopped.
Clozapine may be helpful but it needs to be monitored. It has 2 serious side-effects, agranulocytosis (2% of patients may have low white blood count), and epileptic seizures (5% of patients on doses over 600mg.). The high cost of clozapine can be balanced against an improved quality of life and less time spent in hospital.
Where drugs produce severe side-effects, other new drugs may offer a better balance between risk and benefit. Some new drugs are currently being tested.
Long-term care focuses on minimising chronic symptoms, improving the quality of life and psychological and social wellbeing, and the prevention of relapse.
Maintenance therapy doses are usually lower than in the acute period. Regular specialist review should monitor the dosage and side-effects.
Too low a dose of medication may lead to relapse, often some time after the dose is lowered. Necessary adjustments should be made as quickly as possible, when the earliesr signs of relapse become evident.
Stopping and starting medication can be effective in the first year but is later linked with a higher relapse rate.
Should drug treatment be stopped for any reason it is important to keep in close touch with the GP, Outpatient Clinic or CPN, so that treatment can be started again as quickly as possible in the event of relapse.