CLINICAL HANDBOOK OF SCHIZOPHRENIA

16. Antipsychotics 161for at least 5 years after subsequent episodes. Any patient who poses a danger to self orothers should be treated indefinitely after the first episode.MEDICATION DECISION MAKINGVarious methods help to direct decisions about the utilization of antipsychotic medications.Some of the basic standards are as follows:1. Utilize treatment guidelines (see References and Recommended Readings).2. Utilize family history. If a family member has responded to a medication, thenthis may predict response in the patient.3. Always involve the patient; informed patients are more adherent with prescribedmedications.4. Utilize the STEPS decision model, which looks at a multitude of factors to helpdecide on medications for specific patients. The following sequence helps the clinicianchoose medications for specific patients:S: Safety. How safe are the medication choices for this patient?T: Tolerability. What are the side effects, and how do they compare to side effectsof other medications for this patient?E: Efficacy. Are there efficacy differences between the medications that may suggestresponse in the patient?P: Price. How much does this medication cost compared to alternative treatments,and can the patient afford these medications?S: Simplicity. How complex is the regimen (multiple dosages per day may reducemedication adherence rates)?ANTIPSYCHOTIC MEDICATIONSMedications used to treat schizophrenia have been classified into many different categories.Two primary classes referred to in the literature are the typical and atypicalantipsychotics. The typical antipsychotics include medications such as phenothiazines,butyrophenones, thioxanthenes, dihydroindolines, and dibenzoxazepines. The atypicalTABLE 16.2. Degree of Symptom Improvement withAntipsychotic TreatmentSymptomsInsight 10–15Judgment 20–25Sociability/interpersonal skills 40–45Delusions 45–50Appetite 50–55Sleep 55–60Negativism 55–60Hallucinations 55–60Tension/hostility 65–75Combativeness 75–80Percentage of patientsthat show improvement