For people with Schizophrenia, the most common and best cure lies in sticking to a treatment plan that involves a daily dose of medication. But, what one must remember is the fact that these medications carry with themselves a large number of risk factors that may present some serious challenges. If consumed for a long period of time, the medications may result in diminished effectiveness as well as unwanted long-term side effects. In the United States, Phenothiazines have become more popular than Reserpine in the treatment of Schizophrenia (in spite of the latter’s cheaper price) due to the following: less delay in action and less frequent complications, such as depression and gastrointestinal hemorrhages.
There are three types of Phenothiazines. A Dimethylaminopropyl side chain will produce Promethazine (Phenargan), Promazine (Sparine), and Chlorpromazine (Thorazine). A Piperidine side chain will produce Thioridazine (Mellaril). A Piperazine side chain will produce compounds such as Trifluoperazine (Stelazine), Prochlorperazine (Compazine), Perphenazine (Trilafon), and so on. Chlorpromazine, which at present is the most widely used tranquilizer, will be taken as our paradigm for medication.
Cardiovascular disease symptoms may be different for men and women. For instance, men are more likely to incur chest pain, whereas women are more likely to have symptoms such as shortness of breath, nausea and extreme fatigue. While hypotension (low blood pressure) is very common especially after intramuscular administration, one may observe that within forty minutes the pressure may drop from 30 to 50 mm systolic, and 20 to 30 mm diastolic. A compensating tachycardia with complaint of palpitation may follow. To minimize the effect of the hypotension after the first injection the patient should be kept lying down, with head in low position and legs raised. In such cases, Noradrenaline rather than adrenaline is used to raise blood pressure because Phenothiazine may reverse the action of adrenaline. Some EKG changes have been reported, but these are usually reversible.
Jaundice occurs in a small percentage of cases, generally between the second and fourth weeks of therapy. The clinical picture is similar to that of infectious hepatitis of obstructive type, not with parenchymal damage. This complication is interpreted as a sensitivity reaction. It reverses quickly on withdrawal of the medication. History of previous liver disease does not exclude the use of chlorpromazine, but greater cautiousness is advised. Bloom and Davis (1970) made a follow-up second biopsy of eleven of twenty original patients who, a few years previously had shown liver histopathology as a consequence of tranquilizing medication. The study revealed that three patients had worsened, three improved, and five had remained the same. The authors could not individualize the factors responsible for these changes or variations. All the patients were reported to be anicteric and asymptomatic in general.
Agranulocytosis, according to Ayd (1963), occurs at the rate of one in 250,000 cases. Eosinophilia, leukopenia, hemolytic anemia, thrombocytopenic purpora, and other blood diseases have been reported in rare cases. These complications generally occur between the fourth and tenth weeks of therapy. Patients should be observed regularly, especially during this period, for sudden appearance of sore throat. Blood counts at regular intervals should be taken and it should be noted that a moderate diminution of total white blood cells is not an indication for discontinuing the drug. However, discontinuation is indicated if the white cell count falls below 4,000. Once agranulocytosis occurs, antibiotics, cortisone, or ACTH should be given.
These are very common. If an accurate neurological examination is done, minor signs of extrapyramidal involvement are found in the majority of patients who receive chlorpromazine. Masklike face, rigidity, tremor, salivation, slow gait, lack of associated movements, and so forth, occur in various degrees. According to Ayd (1961) extrapyramidal symptoms occur in 35 percent of cases treated with chlorpromazine and 60 percent of cases treated with trifluoperazine (Stelazine). These symptoms are reversible; they discontinue when treatment is terminated or interrupted. Moreover, they respond well to antiparkinsonian agents such as benztropine mesylate (Cogentin), trihexyphenidyl HCL (Artane), and procyclidine hydrochloride (Kemadrine).
This occurs in a minority of patients who have received neuroleptics for a long time. It is more frequent in elderly patients. Involuntary movements of the lips, tongue, and face and at times chorea like movements of other parts of the body occur. These involuntary movements often appear when the drug has been reduced or discontinued and unfortunately in most cases are not reversible. However, Sato, Daly and Peters (1971) in this regard have obtained good results in treating the condition with high doses of reserpine.
According to Hoch (1955) Depression has been reported in some cases of Schizophrenia. To fight and cure depression and its various side effects, Hoch recommends interruption of drug therapy and switching to electric shock treatment in severe cases.
This is a very common effect, especially during the early stages of therapy. Patients who drive motor vehicles or operate machinery should be warned against doing so early in their therapy cases, and, in some cases, for the whole duration of therapy, even if the other symptoms are not counter indicating. Most psychiatrists permit patients to drive if the dosage of their drowsiness-inducing medication has been reduced to 100 mg daily, and if the mental symptoms do not interfere with safe driving. Individual variations are, of course, to be taken into account.
Other miscellaneous side effects includes bladder disturbances, dermatologic allergic reactions, increased photosensitivity, inhibition of ejaculation, blurred vision, skin pigmentation, ocular opacities, mild fever, nasal congestion, increase in appetite, weight gain, engorgement of the breast with lactation and menstrual irregularity in female patients.
The Bottom Line
Treating Schizophrenia can be really tricky, and antipsychotic medications are often used, but it is important to combine the efforts of several clinicians and health professionals, including professionals in therapy or counseling, medicine, and psychopharmacology. Antipsychotic medications can be very effective at reducing symptoms, but they often come with a lot of additional considerations to keep in mind, like cost and the potential for unwanted side effects as mentioned above.