Schizophrenia is a disease that has a biological nature, its manifestations that eliminate the effects on the metabolism of biologically active substances in the brain.
Since the discovery of the first psychotropic drug aminazine in the 50s of the 20th century, there has been a revolution in the treatment of mental disorders, especially schizophrenia. Until that time, the most popular methods for treating schizophrenia were insulin therapy, electroconvulsive therapy and lobotomy. Drug treatment to a greater extent was symptomatic and usually included sedative drugs.
With the advent of neuroleptics, the possibility of chemical exposure to it and the elimination of symptoms appeared, whereas before such patients had to be isolated from society in anticipation of short-term spontaneous remissions.
Modern pharmacology, including in the open air. These drugs are called “neuroleptics” or “antipsychotics.” They have one thing in common – they all, first of all, eliminate the manifestations of psychosis: delusions, hallucinations, psychomotor agitation. The mechanism of their action is the blockade of receptors to the mediator – a biologically active substance of the brain – dopamine, thanks to this and the appearance of the antipsychotic effect of drugs. In addition, they have affinity for other receptors (for acetylcholine, adrenaline, serotonin, histamine), which explains a fairly wide range of their actions, including the occurrence of some side effects. There are many classes of neuroleptics that differ in chemical structure, which means that they affect the body in different ways, to a greater or lesser extent, affect the various manifestations of schizophrenia.
Action of neuroleptics
The actual antipsychotic action of neuroleptics is distinguished: the general effect on all manifestations of psychosis and the prevention of further development of the disease, and the selective effect on the productive symptoms (delusions, hallucinations, obsessive states, catatonia). Due to the sedative (retarding) action, antipsychotics are effective in various types of psychomotor agitation and insomnia. Some neuroleptics, on the contrary, have an activating effect, it is used in the treatment of negative symptoms (apathy, catatonic stupor, autism).
Cognitropic action is an effect on higher cortical functions (memory, attention, thinking, perception). Neuroleptics also have a neurological effect – they are associated with dopamine receptors, which are located in the centers of regulation of movements, which cause such side effects as muscle stiffness, restlessness, trembling limbs . These adverse events are eliminated by the appointment of correctors, such as cyclodol or akineton.
Neuroleptics also affect the autonomic nervous system and the endocrine system, which can manifest dry mouth, delayed urination, lowered blood pressure, decreased sexual desire, menstrual disorders, weight gain. In different groups of neuroleptics, the listed effects are expressed in varying degrees, and the use of a particular class of drugs depends on the form of schizophrenia and the characteristics of its course.
Recently, preference is given to the modern class of neuroleptics, which appeared in the 90s of the 20th century, the so-called “atypical” neuroleptics. They are atypical because, unlike previous generations of drugs, 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 deliver great discomfort to patients and require the appointment of additional drugs-proofreaders. At the same time, modern antipsychotics are as effective in eliminating the symptoms of schizophrenia as the old drugs. Another advantage of atypical neuroleptics is their positive effect on cognitive function (cognitotropic action), which was not the case with drugs from previous years; due to binding to serotonin receptors in the brain, atypical antipsychotics also have an antidepressant effect.
Modern drugs are easy to use – the characteristics of their distribution in the body are such that they can be taken only once a day. With regular intake, the drugs begin to fully operate in 2-3 weeks, so they need to continue to be taken, even if at first glance there is no expected effect. However, at the peak of the drug’s action, not all symptoms of the disease can be immediately eliminated, for a complete reduction of symptoms and for the prevention of recurrence of the disease, medicines should be drunk on average for two years.
For the convenience of long-term use of drugs released prolonged forms of neuroleptics in the form of injections – one such injection lasts for 2-4 weeks. In addition to the elimination of specific schizophrenic symptoms, it is useful to have a general strengthening treatment, since the disease is usually accompanied by general disorders of the nervous system. For this purpose, drugs that improve metabolism in the nervous tissue are used: picamilon, mexidol, cerebrolysin, milgam, mildranate, gliatillin, nootropil.
Drug-resistant Schizophrenia Therapy
The main problem that may arise during the treatment of schizophrenia is drug resistance (resistance). This phenomenon is rare, however, it can occur in certain forms of schizophrenia, metabolic features of the patient, or prolonged and inadequate treatment with psychotropic drugs. In such cases, as well as to break the acute attacks of schizophrenia with delusions and catatonia, electro-convulsive therapy (ECT), insulin-comatose therapy, hemosorption and plasma exchange, laser irradiation of blood are used.
Electroconvulsive therapy sessions are performed in the intensive care unit under general anesthesia to minimize the risk of complications. Electrodes are applied to the patient’s head and artificially cause a convulsive fit. The treatment includes 4-8 sessions of ECT, patients completely forget seizures, and the effectiveness of this method can be quite significant. Another method of shock therapy for schizophrenia is insulin therapy. This technique is based on the introduction of insulin doses to achieve a hypoglycemic coma (loss of consciousness due to a decrease in blood sugar), 10-20 minutes after reaching the coma, the patient is removed from it by intravenous administration of a glucose solution. In order to break the attack of psychosis requires 10-20 sessions.
Sometimes it is effective to use detoxification (purification from toxins) of an organism using hemosorption or plasmapheresis. The blood of the patient is driven through a special apparatus, where it is cleaned of toxins, immune complexes, in the case of long-term drug therapy – of drugs. This can help both to reduce the manifestations of productive schizophrenic symptoms and to overcome drug resistance due to the “cleansing” of receptors. Similar exposure has blood irradiation with a laser.
The listed methods of the so-called “non-medicinal” therapy are used in extreme cases of intolerance, drug resistance, or for the termination of acute psychosis. In all other cases, there is enough drug therapy. Also, for greater efficacy, a combination of drug therapy with non-drug therapies is possible.
With the modern development of psychiatry, when it is possible to conduct therapy with modern drugs, with timely access to a doctor (no later than 2 years after the first symptoms of the disease appear), with prescribing adequate drug therapy and following the regimen of drugs, it is possible to conduct effective treatment with a minimum of side effects elimination of schizophrenic symptoms and defects that the disease managed to cause the patient’s personality. With a long-term disease it is possible to achieve a significant improvement in the condition and prevent further development of the disease process.
At the same time, a single biological therapy for effective treatment of schizophrenia is clearly insufficient and requires mandatory psychotherapy (individual, group, family), psychological correction of memory disorders, attention, thinking, as well as a set of social measures aimed at rehabilitating a person suffering from this disease.