Schizophrenia: Medication for Schizophrenia

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Schizophrenia:  Medication 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, an inpatient psychiatrist here at MUSC.  We’ve been talking about schizophrenia treatment.  I wanted to, specifically, get into medications for schizophrenia.  This has really expanded in recent years, could you tell the listeners a little bit about some specific medicines that are being used to treat schizophrenia?


Dr. Christopher Pelic:  Thanks, Dr. Gray.  Well, as I said in an earlier recording, we’ve had medications for schizophrenia out for approximately 50, 55 years.  And we have come along way in treating various symptoms.  The older medications, there are probably, on the market, about 10 to 15 older medications that have been around since the 50s, 60s, 70s.  Those medications were quite effective for treating the primary symptoms of schizophrenia, of psychosis.  They also had some potential side effects, which is why we developed some of the newer drugs.  Those side effects included things like stiff muscles or symptoms of shaking arm, or shaking leg, or feelings of restlessness.  And so, really, in the last 20 years or so, we’ve developed some newer medicines that are hopefully less likely to do that.


Dr. Kevin Gray:  Tell me about some of those newer medicines.


Dr. Christopher Pelic:  Well, a lot of the newer medicines that people may have heard about, either from friends, family, or on commercials, are medications like Zyprexa, Risperdal, Geodon, Abilify, Seroquel, or even a medicine called Clozaril.  And these medications are what we call atypical antipsychotics or newer generation antipsychotics.  And they’re called that because not only do they address the primary symptoms of schizophrenia, like voices and hallucinations and paranoia, but they also target some of what we call negative symptoms of schizophrenia, like poor grooming and hygiene and amotivational syndrome, or not taking care of one’s self.  So, they address other symptoms, in addition, and they have some benefit over the older medications.


Dr. Kevin Gray:  How do these medications work?


Dr. Christopher Pelic:  Well, again, these medications work primarily on two brain chemicals.  And, without getting overly detailed, the two brain chemicals are dopamine and serotonin.  And we know that these chemicals, in various places in the brain, can sometimes be either too high or too low.  And by giving medications that can block or increase some of these chemicals in certain areas of the brain, they can help reduce symptoms.


Dr. Kevin Gray:  If I’m a patient that’s coming to you with schizophrenia, how do you choose which of these medications you’ll use to help me?


Dr. Christopher Pelic:  That’s a great question.  In this day and age, most psychiatrists will start with the newer medications when treating psychosis.  They will start with what we call the atypical antipsychotics, as mentioned earlier.  However, which medication we choose does vary for each patient.  We often look at a lot of different factors in choosing a medication.  Things that we often look at are, what other symptoms do they have?  What medical problems do they have?  What side effects might be helpful for them, make them sleepy or increase their desire to eat? Or, which side effects might be harmful to them?  And, what they can afford?  We put all of these things together and we come up with a specific medication that we think will be most helpful for that person.


Dr. Kevin Gray:  So, it sounds as though there’s not necessarily a flow chart or an algorithm you go by, medication by medication, but it’s a complex decision for each and every patient.


Dr. Christopher Pelic:  It is, and oftentimes we, as doctors, would like to have an easy answer and an easy choice, and frequently we have to use all of these factors to come up with a medicine that we think would be most helpful.  And sometimes we’re wrong.  Sometimes we need to try a different medication if one doesn’t work or intolerable side effects develop, so we’ll try something different.  Sometimes we don’t get it right on the first try.


Dr. Kevin Gray:  Is there any sense that, we spoke in an earlier podcast about some of these illnesses running in families, if I had a relative who had responded well to a certain type of medication, does that make me more likely to respond to that?  Or, on the converse, if they had adverse effects from a certain medicine, am I more likely to have that than other people?


Dr. Christopher Pelic:  Well, Dr. Gray, it isn’t the be-all end-all, but it certainly is a good place to start.  There have been a lot of cases, and in my practice, I’ve seen several cases where patient’s family members who did well on a medicine really predict how that person is going to do on the medicine.  But it isn’t a be-all end-all.  It’s a good starting place.  And that’s why we take a good, thorough family history, not only of mental illness but also the treatments that people in the family received.


Dr. Kevin Gray:  So, say I’ve come to you, you’ve started me on a medication for schizophrenia and I go home and begin taking it, what sorts of things should I be looking for in terms how long it should take for it to begin working, or what sort of side effects would I most commonly be seeing?


Dr. Christopher Pelic:  Well, usually it isn’t for a week to two weeks that we really start to see significant benefit in terms of the symptoms of schizophrenia.  Sometimes people can see benefits earlier than that, and sometimes it takes a much longer period, four, six, eight weeks, and maybe even longer, if dosage increases are necessary.  Oftentimes, patients will start to experience some side effects before they actually notice significant benefit from the medicine.  Specifically, some of the newer medicines which are good at helping, both, the positive and, as I said earlier, those negative symptoms of not taking care of one’s self, have increased potential to cause problems with things like weight gain and cholesterol, and sugar, and glucose in the blood, so we have to have careful monitoring with patients that are on these medicines.  They’re good medicines, but it just means that we have to monitor for these things while they’re taking them.


Dr. Kevin Gray:  So, if I’ve come back to you after a month, or two months, and I’ve actually noticed that my symptoms have gotten a lot better, would I typically stay on this medication for the long term or, what kind of happens to people down the road?  Do people stabilize and stay on the same medicine, or do they have to change medicine over time?


Dr. Christopher Pelic:  Well, generally speaking, if you came back in a few weeks to months and you were doing well, we would most likely keep you on the medication indefinitely, until either intolerable side effects developed or your symptoms worsened, or returned.  In general, patients with schizophrenia, because it’s a chronic illness, require life-long treatment.  As of now, we don’t have a cure.  There are some patients that do well on a medication for a period of time and their symptoms come back, and the medication kind of loses its effectiveness, in which case, we will switch.  But, if you’re doing well on it and you haven’t developed any significant side effects, our recommendation would be that you’d stay on it indefinitely.


Dr. Kevin Gray:  One of the things you mentioned, Dr. Pelic, was side effects with the newer medicines, or atypical antipsychotics, you mentioned things like weight gain and problems with blood sugar or lipids.  How are those things watched for, how are they managed, and how serious of a problem is this?


Dr. Christopher Pelic:  That’s a great question.  I think most people have seen in the media, and on the news, there were a lot of concerns with these kinds of medications.  The thing that I would stress is that they can be very effective at reducing the symptoms of schizophrenia.  And, for someone who isn’t able to leave the house because they’re so paranoid or that they’re hallucinating and they’re a danger to themselves or others, these medicines help, but we have to balance that out with the risk of side effects.  And, in many cases, the benefits of these medications well outweigh the risks.  Specifically, the concerns about weight gain and diabetes development, and problems with cholesterol are very real concerns, and they should be monitored closely, but most likely, in many cases, the medications are so helpful that we do our best to closely monitor and treat those conditions without having to necessarily stop them.


So, in summary, we do need to monitor for these things.  They’re very real concerns, and your doctor should be monitoring for these things.  But we know that they’re very helpful and they can really improve the quality of life of most patients.


Dr. Kevin Gray:  Thank you so much, 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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