Schizophrenia: Treatment for Schizophrenia

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Schizophrenia:  Treatment for Schizophrenia




Guest:  Dr. Christopher Pelic – Psychiatry & Behavioral Sciences

Host:  Dr. Kevin Gray – Psychiatry & Behavioral Sciences


Dr. Kevin Gray:  Hello.  This is Dr. Kevin Gray, from the Medical University of South Carolina.  I’m speaking with Dr. Christopher Pelic, inpatient psychiatry, here at the medical university.  Today’s topic is schizophrenia. 


Dr. Christopher Pelic:  Thanks, Dr. Gray.


Dr. Kevin Gray:  Dr. Pelic, my understanding is that treatments for schizophrenia have come a long way over the years.  Where are we at now, and, say, if I have a family member who, say, is hospitalized with an episode of schizophrenia, what is that person’s treatment, what do you model treatment around?


Dr. Christopher Pelic:  Well, we have come a long way.  And I always like to start by telling some of my patients, who’ve been newly diagnosed with schizophrenia, about how we’ve discovered medications for schizophrenia.  Most of what we discover in medicine is often by accident.  They were using some medications back in the 50s for both nausea and to help patients that were going under anesthesia for procedures, and they found that patients with problems with their thinking not being clear were helped by some of these medications.  So, we looked medications that were similar to that, over the last 50 years, to help with problems like paranoia, hallucinations and delusions.  We have come a long way.  Our medications now are very effective for a subset of patients.  And, as we’re starting to understand the illness more, I think we’ll come out with even better drugs.


Dr. Kevin Gray:  So, it seems that one of the cornerstones of treatment is medication?


Dr. Christopher Pelic:  It is.  And since the illness of schizophrenia is primarily what we consider a thought disorder, or a disorder of thinking, although therapy has been used in some cases with limited effectiveness, the treatment of choice has, primarily, been medication, with the idea being that folks’ thinking is so impaired that they’re not able to participate meaningfully in talk therapy, unlike like patients with depression or anxiety.  So, medications, really, are the mainstay of treatment, at this point, for schizophrenia.


Dr. Kevin Gray:  It’s almost difficult to imagine that symptoms as complex as hearing voices, being paranoid that someone’s out to get you, or not taking care of your hygiene, things as widespread as that, could be treated by a single medication.  How is that?


Dr. Christopher Pelic:  Well, again, since we’re in the infancy of understanding what actually causes schizophrenia, and we discovered some of the medications almost by accident, we don’t fully understand that.  We know that most of the medicines that we use right now for schizophrenia work on, primarily, two brain chemicals, a chemical called dopamine and a chemical called serotonin.  And we think they help for different reasons.  And we have some ideas of where those chemicals are located in the brain, but we’re not sure.  We know that those chemicals are probably involved to some degree, but to what extent, we just don’t fully grasp it yet.


Dr. Kevin Gray:  Once somebody starts on the medicine for schizophrenia, how long does it take before they start to see some resolution or some improvement in symptoms?


Dr. Christopher Pelic:  That’s a fantastic question, and often a question that families, medical students, other medical personnel, have frequently forming.  One of the things that I will usually tell families about what to expect is that frequently it can take upwards of a few weeks to really see significant benefits.  Most likely, after a few days, oftentimes the tranquilizing effects of the medicine can be helpful.  Some of the patients with schizophrenia may not have slept or eaten in days, and so the medicines will initially help even after a few days for those things.  But for the full-blown symptoms of schizophrenia, the paranoia, the hallucinations, the delusions, usually it’s a minimum of a week before we see much improvement.  And then usually, even after that, it’s often several weeks with dosage increases.


Dr. Kevin Gray:  Oftentimes with illnesses like high blood pressure, we’ll see patients who tend to do really well with medication, after a while, see that their blood pressure is normal and they’ll stop taking it.  Is this an issue with schizophrenia medicine as well?


Dr. Christopher Pelic:  It’s an issue with schizophrenia medicine, probably, even more since most of our patients, by definition, have what we call a psychotic thought disorder; their thinking isn’t as clear.  So, they stop the medications for several reasons, one, they don’t feel that they’re ill.  Another subset of patients, although they recognize that they’re ill, they’re just too ill to remember to take the medicine or go get the medicine from the pharmacy.  And then there’s another subset that stop the medication because of side effects.  We have several different medications with various side effects.  Patients don’t fully understand the reasons for taking the medicines and they have what they consider bad side effects, and they stop them.  Just like diabetes and high blood pressure, in fact, probably even to a greater degree, our patients are at risk for stopping medicines even when they’re helpful.


Dr. Kevin Gray:  And it really sounds as though there’s not one particular medicine that works for every person with schizophrenia.


Dr. Christopher:  Not at all.  And although we have several new medications that have been out on the market that can help any one individual, it’s often a combination of factors when we’re looking at choosing a medicine, from the actual symptoms to the other medical problems the person has, to the cost of the medicines.  There are a lot of factors that go into play when we’re trying to choose a medicine for any one patient.


Dr. Kevin Gray:  So, in addition to being able to find the right medicine for a patient, what are some other factors that are really important in terms of either remission or recovery from this illness?


Dr. Christopher:  Well, interestingly, although the patients can often respond to the medicine, and they need to stay on the medicine to stay well, frequently the other things that are needed for someone to do well with this illness, they need to have the social support to not only get them to doctor appointments or to help get their prescriptions at the pharmacy, but ensure their medical health is being cared for and that they’re working or employed or if, in fact, they’re not, that they’re not out on the street using drugs.  So, a supportive family with some degree of structure is critical to ensure that these folks do well and stay on their treatment plan.


Dr. Kevin Gray:  And, as I understand, schizophrenia is an illness with symptoms that, really, can alienate someone from his, or her, family or from other supports. Are there supports out there, in the community, or are there other resources that help to take care of people who, maybe, are more isolated?


Dr. Christopher Pelic:  There are resources.  In fact, local mental health centers often are very good resources to help hook people up with different groups, not only groups, but vocational rehabilitation and day programs.  There’s, obviously, the National Alliance for the Mentally Ill, which is really a support system for families and even patients, but families and patients with schizophrenia and other mental illnesses.  And oftentimes, in meetings, and in groups, families can really learn a lot and get a lot of needed support in caring for their loved ones.


Dr. Kevin Gray:  It sounds like we’ve come an awfully long way in terms of treating schizophrenia, what further directions are we going in with respect to research?  What’s on the horizon?


Dr. Christopher Pelic:  Well, I mentioned earlier that we’re looking at a couple of brain chemicals that are probably at work in this illness.  The scientists, lately, have discovered that, maybe, there are other things too.  We’re just at the forefront of trying to figure out what those are.  I suspect that there’s going to be a variety of medications that come out.  There may even be other treatments, if we find out what area of the brain is malfunctioning, or what things are not working well.  There may even be procedures down the road that can be helpful, or things that we’re not even thinking about now.  But, as it is now, the main thing we have is medication treatment with good social support systems to make sure that people stay on the treatment.


Dr. Kevin Gray:  And probably even beyond the horizon, one would think it would be enormously helpful to have ways to prevent this illness from beginning, is that something that’s being looked at?


Dr. Christopher Pelic:  It is.  And we know that there, probably, is an increased risk for people with a family history of either psychosis or schizophrenia.  And, in those patients, especially, things like avoiding drugs and alcohol may be important, caring for one’s self and making sure that one doesn’t let one’s medical health go down, or making sure that you’re getting adequate sleep and nutrition could be even more important for those people who have a history in the family.  Right now, we haven’t been very successful at picking things out, or predictors, that we can actually manipulate to prevent someone from going on to develop schizophrenia.  But we know that the earlier we diagnose and treat it, it probably improves the overall prognosis and treatment.


Dr. Kevin Gray:  Thank you so much for all of your input, Dr. Pelic.


Dr. Christopher Pelic:  Thank you, Dr. Gray.

If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.


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