Recovery From Schizophrenia: Psychiatry And Political Economy

ANTIPSYCHOTIC DRUGS: USE, ABUSE AND NON-USE 239increased morbidity and mortality is attributable to the introduction of the novelantipsychotic drugs. Reacting to this situation, some mental health agencies haveintroduced exercise and diet programs for mentally ill clients to attempt to reducetheir health hazards, 67 and others have established health care clinics within themental health programs to directly manage their mounting physical ailments.There are good reasons, it is clear, to limit the use of the antipsychotic drugs. Allpatients can benefit from a user-friendly approach that minimizes the dosage ofthese medications.USER-FRIENDLY MEDICATION STRATEGIESThe following strategies are designed to insure that a patient with schizophreniareceives the lowest dose of medication that will improve his or her illness andquality of life with the least risk of adverse effects.When beginning treatment, start with a low dose of medication and work upgradually. Blood tests to estimate the serum level of the medication may behelpful. Serum levels are most useful when the patient is getting little benefit fromthe medication and the level is reported as being low; this lets the doctor andpatient know that the poor response may be due to inadequate dosage. If theserum level is high, this suggests that the medication is just not effective for thepatient. Therapeutic levels are not well established for the antipsychoticmedications, however, so they have to be interpreted with a certain amount ofcaution.If an antipsychotic medication is ineffective, do not keep increasing the dosage; considerstopping or decreasing it or trying another type of antipsychotic medication. Oneof the benefits of the introduction of the novel antipsychotic drugs is thatpsychiatrists have become more rational in their use of antipsychotic medication.Before there was a choice of different types of medication psychiatrists rarelythought in terms of a trial of an antipsychotic medication; since there was onlyone basic type of antipsychotic available, there was a tendency to keep increasingthe dosage if there was no response. Now the usual practice is to try differenttypes of medication within the usual dosage range. If none of the antipsychoticmedications work well, before turning to big doses of these drugs one should tryother supplementary medications, such as lithium carbonate, anticonvulsants likecarbamazepine (Tegretol) or sodium valproate (Depakote), or antidepressants likefluoxetine (Prozac). It is especially important to avoid increasing the medicationevery time the patient has an acute increase in symptoms; there may be manyreasons for increasing symptoms, one being that the medication isineffective. Another possibility is that the symptoms are precipitated by acutestress; in these cases, short-term use of a minor tranquilizer such as diazepam(Valium) can be very effective (see below).Be cautious about concluding that every exacerbation of the person’s condition is due tothe schizophrenic illness. Sometimes the underlying problem is that the patient isexperiencing severe restlessness as a side effect from the antipsychotic