Schizophrenia 2: Treating Schizophrenia

Psychiatrist Zafar Sharif of Columbia University talks about treatments for schizophrenia.

Hi, my name is Zafar Sharif. I’m a psychiatrist. I’m with Columbia University in New York. I do treatment research in schizophrenia and I also take care of patients.

So as I said earlier, in schizophrenia it’s critically important that treatment be continuous. This is something that has been born out of over 50 years of research. We’ve tried many different things. We’ve tried to take patients off medicines, to see if they could do well without medicines. This research was done back in the late 60s and 70s, and the results were very clear: if the patients are taken off their medications, 95% of them will relapse within 1.5-2 years. So that was settled years ago: that patients need to be on continuous treatment for this disease to remain under control. We have also tried reducing the medications to very small amounts, we did that research over 20 years ago and the results of that were very clear: that if you reduce your medications below a certain minimum, they don’t work. So you have to give an adequate amount of medicine for the long term. And the third thing that was tested was “Can we do stop and start treatment?” – give it when the patient is sick, then stop it, watch him, and if he begins to get sick again, start the medicine again. That doesn’t work either.

So the evidence is very clear that for optimal outcomes with this illness, we need to maintain the patient on an adequate amount of antipsychotics. That varies from one person to the other – and we can only find that out by trial and error – but for any given individual they need a certain amount of medicine, they need to stay on it, they need to take it on a regular basis for the foreseeable future. We really are not in a position at this point to even remotely recommend that a patient should stop their medications once the diagnosis of schizophrenia has been established.

So antipsychotic medications come in many different forms. There are the old drugs like haloperidol or chlorpromezine, and then the newer drugs that we call Atypical Antipsychotics, these would be drugs like risperidone or olanzapine, zyprexa, or quetiapine are typical antipsychotics as well. All these are available in tablets. The main difference between the old drugs and the new drugs is that the old drugs are more likely to cause what we call movement disorders. Many patients who took them, especially at high doses, looked like zombies: they were slowed down, they couldn’t talk much, they were having shakes. So what we call Parkinsonian-type side effects are less likely to occur with the newer medications.

So, in tablet form, these are the many different drugs that are available. The problem with tablets is that many patients, over time, just forget to take them, they stop taking them, once they feel better they think they don’t need the medicine anymore. This is a big issue that we face in the treatment of this illness: that these medications end up getting discontinued. For that reason injections were developed. We have injections for some of the older drugs.

These are the different choices available to patients and to family members when choosing among different medications and also the different forms of those medications for treatment.

In terms of how well the drugs work, the old drugs seem to work just about as well as the new drugs. Finding the right dose may be a little more difficult, but again, an experienced clinician can find the right dose of any drug for an individual patient.

What is the right drug for any particular individual? That is a decision that is made in consultation with the patient, with the family member, and the knowledge that the clinician has. So there is no right drug for any given person. There’s no one drug better than the other. This decision is really based on the combination of clinical factors for that individual patient. It’s a decision made in consultation with your psychiatrist and with other members of the clinical team.

Thank you for listening, I wish you all well and keep working at it – it’s a long process, long haul and you have got to keep your spirits up.

More information

	This is the second of three videos. To watch the next video in the series, see Schizophrenia 3: Caring for a Loved One. To watch the first video in the series, see Schizophrenia 1: About Schizophrenia.
	For more information on schizophrenia and its treatments, and some useful tools, animations and videos, see Schizophrenia.