We'll discuss the treatment of Schizophrenia which includes both pharmacological and psychological intervention. The side effects of antipsychotics are also mentioned related to Central nervous system, cardiovascular system, anticholinergic and metabolism. The psychological intervention is discussed including CBT. The duration of the CBT. The social aspect is also discussed that how patient should be helped by the community.

1. Treatment of Schizophrenia

2. Criterion C. Continuous signs of the disturbance persist
for at least 6 months.
This 6-month period must include at least 1 month of
symptoms (or less if successfully treated) that meet
Criterion A (i.e., active-phase symptoms) and may include
periods of prodromal or residual symptoms.
During these prodromal or residual periods, the signs of
the disturbance may be manifested by only negative
symptoms or by two or more symptoms listed in Criterion
A present in an attenuated form (e.g., odd beliefs,
unusual perceptual experiences).

3. Interventions and Clinical
Management
Treatment Goals
A. During an acute psychotic episode:
1. To prevent harm to the patient and others
2. To control disturbed behavior
3. To reduce the severity of psychosis and associated
symptoms (agitation, aggression, negative
symptoms, mood symptoms)
4. To address any reversible factors that triggered the
episode
5. To promote recovery to the best level of functioning
attainable (Hasan et al. 2012)

4. Interventions and Clinical
Management
Treatment Goals
In the maintenance phase:
To promote recovery by sustaining symptom
remission or stability
To prevent or reduce the frequency of relapse
To lessen the impact of the disease on the patient's
life
To maximize the patient's social function and
quality of life (Tandon 2011)

5. Optimal treatment includes
both pharmacological and
psychosocial interventions.

6. Antipsychotic Drugs
1. Antipsychotic medications the modulate the
effects of dopamine and block postsynaptic
dopamine type 2 (D2) receptors to varying
degrees (Miyamoto et al. 2012; Tandon 2011).
2. Antagonism of dopamine in the mesolimbic and
mesocortical pathways is thought to account for
the drugs' antipsychotic effect.
3. Antipsychotics also interact with other
neurotransmitter systems (that contributes to
their side-effect profiles and may possibly
influence their therapeutic effects).

7. • Antipsychotics address there effect at positive
symptoms (mostly for hallucinations and
delusions, less for symptoms of disorganization)
• Antipsychotics have limited effects on negative
symptoms. Their effect is strongest when the
negative symptoms are caused by positive
symptoms (termed "secondary negative
symptoms").
(recently they believed, that new generation of
antipsychotic drugs (atypical neuroleptics) were
effective in treatment of negative symptoms and
that these drugs don’t cause EPS side effect)

9. • The onset of antipsychotic drug action
appears in patients within a few days of
starting treatment, and the effect often builds
over several weeks.
• The full effect may take several months to
develop.
• There is great heterogeneity in treatment
response, and not all antipsychotic
medications work for all patients.

10. Adverse Effects of Antipsychotics
Neurological extrapyramidal side effects (EPS).
• Rigidity, bradykinesia, and tremor resembling
Parkinson's disease;
• Severe restlessness known as akathisia;
• Abnormal involuntary movements known as
tardive dyskinesia.
(so-called second-generation antipsychotics, which
are now used predominantly, are less likely to cause
EPS and tardive dyskinesia) .

11. Adverse Effects of Antipsychotics
Cardiovascular effects
• Relatively benign (tachycardia, orthostatic
hypotension). Orthostatic hypotension can be
problematic early in treatment and with
elderly patients at risk of falling.
• Severe and potentially life threatening (QT
prolongation, myocarditis)

12. Adverse Effects of Antipsychotics
Metabolic side effects
Weight gain, diabetes, hyperlipidemia, and
hypercholesterolemia are common - effects of
antipsychotic treatment, especially among
patients taking clozapine, olanzapine,
quetiapine, or risperidone.

13. Adverse Effects of Antipsychotics
Anticholinergic side effects
1. Drowsiness or sedation, Blurred vision.
2. Dizziness, Urinary retention.
3. Confusion or delirium, Dry mouth,
Constipation
4. Hallucinations.
.

14. Adverse Effects of Antipsychotics
Anticholinergic side effects
• Orthostatic hypotension or exercise hypotension
• Sedation. altered thought process, depression
• Dry mouth.
• Nausea and vomiting.
• Sexual problems, especially in men, are also
prominent.

15. Drug Recommended
dosage range
(mg/day)
Half-life
(hours)
Weight/met
abolic side
effects
EPS/TD Prolactin
elevation
Sedation Anticholine
rgic side
effects
Hypotension
Aripiprazole 10-30 75 - + - + - -
Asenapine 10-20 24 + + ++ - +
Chlorpromazine 300-1,000 6 +++ + ++ +++ +++ +++
Clozapine 150-600 12 +++ - +++ +++ +++
Fluphenazine 5-20 33 + +++ +++ + -
Haloperidol 5-20 21 + +++ +++ ++ - -
floperidone 12-24 14 ++ - + + + +++
Loxapine 30-100 4 ++ ++ ++ ++ + +
Lurasidone 40-120 18 + ++ - ++ - -
Olanzapine 10-30 33 +++ + + ++ ++ -
Paliperidone 6-12 23 ++ ++ +++ + - +
Perphenazine 12-48 10 ++ ++ ++ ++ - -
Quetiapine 300-750 6 ++ - - ++ - ++
Risperidone 2-8 20 ++ ++ +++ + - ++
Thioridazine 300-800 24 +++ + ++ +++ +++ +++
Thiothixene 15-50 34 ++ +++ ++ + - -
Trifluoperazine 15-50 24 ++ +++ ++ + - +
Ziprasidone 120-160 7 - + + + * +

16. Other Somatic Treatments
Guidelines suggest that electroconvulsive
therapy (ECT) may be useful as an addition to
antipsychotic treatment, especially for
treatment-resistant patients not responding to
clozapine or for patients who do not tolerate
clozapine.
Catatonic patients seem most responsive to ECT
(Hasan et al. 2012).

17. Psychological Interventions
Cognitive-behavioral therapy (CBT) is
recommended by the American Psychiatric
Association's schizophrenia treatment guidelines
for people with psychotic symptoms that persist
in spite of treatment with antipsychotics (Dixon
et al. 2009).

18. Cognitive-behavioral therapy (CBT)
• The patient chooses symptoms and problem
areas, and the therapist supportively guides the
patient to implement coping methods and to
develop more rational cognitive perspectives
about the symptoms.
• The therapist does not challenge the patient's
beliefs as irrational, but rather elucidates the
patient's beliefs about the symptoms and draws
on the natural coping mechanisms the patient
has developed to deal with the symptoms.

19. Cognitive-behavioral therapy (CBT)
Specific techniques include
• belief modification (gently challenging delusional
beliefs, starting with loosely held delusions first)
• behavioral experiments (examining evidence for and
against distressing beliefs),
• focusing/ reattribution (helping patients to reattribute
auditory hallucinations to an internal source)
• normalizing psychotic experiences (helping patients to
view symptoms as responses to life stresses, making
the symptoms seem more normal and less "crazy")
• thought challenging (identifying "mistakes" in
thinking).

20. Social Interventions
The American Psychiatric Association
recommends several social interventions:
1. Assertive community treatment
2. Supported employment
3. Social skills training

21. Social Interventions
Assertive community treatment is
recommended particularly for individuals who
are frequently hospitalized. The model uses a
multidisciplinary team that includes a
medication prescriber. Team members share a
caseload, and there is a low patient-to-staff
ratio. The team provides direct patient services,
frequently contacts patients, and performs
outreach to patients in the community (Dixon
eta). 2010).

22. Social Interventions
The core principle of supported employment is that
any person with schizophrenia who wants to work
should fee offered assistance in obtaining and
maintaining employment.
• Individually tailored job development
(emphasizing patient preference and choice)
• Rapid job search (rather than prolonged
preemployment preparation)
• Ongoing job supports, and integration of
vocational and mental health services

23. Social Interventions
Social skills training includes “life skills
programs”, which target communication skills,
money management household tasks, and self-
care.