and Psychosis Treatment
Length of Treatment & Side Effects
Table of Contents
How Long Should People With Schizophrenia Take Antipsychotic Drugs?
Antipsychotic medications reduce the risk of future psychotic episodes in patients who
have recovered from an acute episode. Even with continued drug treatment, some people who
have recovered will suffer relapses. Far higher relapse rates are seen when medication is
discontinued. In most cases, it would not be accurate to say that continued drug treatment
prevents relapses; rather, it reduces their intensity and frequency. The
treatment of severe psychotic symptoms generally requires higher dosages than those used
for maintenance treatment. If symptoms reappear on a lower dosage, a temporary increase in
dosage may prevent a full-blown relapse.
Because relapse of illness is more likely when antipsychotic medications are discontinued
or taken irregularly, it is very important that people with schizophrenia work with their
doctors and family members to adhere to their treatment plan. Adherence
treatment refers to the degree to which patients follow the treatment plans recommended by
their doctors. Good adherence involves taking prescribed medication at the correct dose
and proper times each day, attending clinic appointments, and/or carefully following other
treatment procedures. Treatment adherence is often difficult for people with
schizophrenia, but it can be made easier with the help of several strategies and can lead
to improved quality of life.
There are a variety of reasons why people with schizophrenia may not adhere to treatment.
Patients may not believe they are ill and may deny the need for medication, or they may
have such disorganized thinking that they cannot remember to take their daily doses.
Family members or friends may not understand schizophrenia and may inappropriately advise
the person with schizophrenia to stop treatment when he or she is feeling better.
Physicians, who play an important role in helping their patients adhere to treatment, may
neglect to ask patients how often they are taking their medications, or may be unwilling
to accommodate a patients request to change dosages or try a new treatment. Some
patients report that side effects of the medications seem worse than the illness itself.
Further, substance abuse can interfere with the effectiveness of treatment, leading
patients to discontinue medications. When a complicated treatment plan is added to any of
these factors, good adherence may become even more challenging.
Fortunately, there are many strategies that patients, doctors, and families can use to
improve adherence and prevent worsening of the illness. Some antipsychotic medications,
including haloperidol (HaldolŽ), fluphenazine (ProlixinŽ), perphenazine (TrilafonŽ) and
others, are available in long-acting injectable forms that eliminate the need to take
pills every day. A major goal of current research on treatments for schizophrenia is to
develop a wider variety of long-acting antipsychotics, especially the newer agents with
milder side effects, which can be delivered through injection. Medication calendars or
pill boxes labeled with the days of the week can help patients and caregivers know when
medications have or have not been taken. Using electronic timers that beep when
medications should be taken, or pairing medication taking with routine daily events like
meals, can help patients remember and adhere to their dosing schedule. Engaging family
members in observing oral medication taking by patients can help ensure adherence. In
addition, through a variety of other methods of adherence monitoring, doctors can identify
when pill taking is a problem for their patients and can work with them to make adherence
easier. It is important to help motivate patients to continue taking their medications
In addition to any of these adherence strategies, patient and family education about
schizophrenia, its symptoms, and the medications being prescribed to treat the disease is
an important part of the treatment process and helps support the rationale for good
What About Medication Side Effects?
Antipsychotic drugs, like virtually all medications, have unwanted effects along with
their beneficial effects. During the early phases of drug treatment, patients may be
troubled by side effects such as drowsiness, restlessness, muscle spasms, tremor, dry
mouth, or blurring of vision. Most of these can be corrected by lowering the dosage or can
be controlled by other medications. Different patients have different treatment responses
and side effects to various antipsychotic drugs. A patient may do better with one drug
The long-term side effects of antipsychotic drugs may pose a considerably more serious
problem. Tardive dyskinesia (TD) is a disorder characterized by involuntary movements most
often affecting the mouth, lips, and tongue, and sometimes the trunk or other parts of the
body such as arms and legs. It occurs in about 15 to 20 percent of patients who have been
receiving the older, typical antipsychotic drugs for many years, but TD can
also develop in patients who have been treated with these drugs for shorter periods of
time. In most cases, the symptoms of TD are mild, and the patient may be unaware of the
Antipsychotic medications developed in recent years all appear to have a much lower risk
of producing TD than the older, traditional antipsychotics. The risk is not zero, however,
and they can produce side effects of their own such as weight gain. In addition, if given
at too high of a dose, the newer medications may lead to problems such as social
withdrawal and symptoms resembling Parkinsons disease, a disorder that affects
movement. Nevertheless, the newer antipsychotics are a significant advance in treatment,
and their optimal use in people with schizophrenia is a subject of much current research.
Learn more about Schizophrenia...
They called me mad, and I called them mad,
and damn them, they outvoted me.