CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 16ANTIPSYCHOTICSERIC C. KUTSCHERThe treatment of schizophrenia has significantly evolved since the early 20th century.The discovery of chlorpromazine in 1954 helped shape the current pharmacological optionsin the treatment of schizophrenia. Although many medications target various subtypesof receptors, their general mechanisms of action are similar in that they decreasedopamine activity to some degree. Various treatment algorithms and guidelines exist tohelp direct practice by individualizing therapy, and utilization of these resources improvespatient outcomes drastically.This chapter is organized into various sections based on the classification ofantipsychotic medications. Additionally, current treatment guideline recommendationsfor various aspects of the illness are discussed to provide a concise, evidence-based approachto decision making.PHARMACOLOGICAL TREATMENT GOALSAcute IllnessOftentimes patients with schizophrenia are first seen in the acute hospitalization setting.Many patients present with thoughts of self-harm and agitation. During the initial statesof the acute stabilization, many treatment goals should be achieved:1. Reduce the potential for harm.2. Decrease agitation and uncooperativeness.3. Reduce the severity of the patient’s positive symptoms.4. Improve sleep and self-care issues.During the first few days of acute stabilization, clinicians may administer many asneededmedications to control the patient’s symptoms, realizing that improvement in thecore features of schizophrenia will take 4–6 weeks (Table 16.1). However, this does notpreclude the use of medications to control the acute symptoms. Patients should be encouragedto take oral medications prior to the administration of injectable medications.Treatment guidelines suggest that benzodiazepines and/or antipsychotic medications159