556 CHAPTER 12
Treating Schizophrenia
The Genain sisters were treated at NIMH and then subsequently in hospitals, resi-
dential settings, and community mental health centers. During the early years of the
quads’ illness, antipsychotic medications were only just beginning to be used, and
treatments that target psychological and social factors have changed substantially
since then. Today, treatment for schizophrenia occurs in steps, with different symp-
toms and problems targeted in each step (Green, 2001).STEP 1: When the patient is actively psychotic, fi rst reduce the positive symptoms.STEP 2: Reduce the negative symptoms.STEP 3: Improve neurocognitive functioning.STEP 4: Reduce the person’s disability and increase his or her ability to function in
the world.As we’ll see, the last step is the most challenging.Targeting Neurological Factors
in Treating Schizophrenia
At present, interventions targeting neurological factors generally focus on the fi rst
two steps of treatment: reducing positive symptoms and reducing negative symp-
toms. Some such treatments focus on the third step: improving cognitive function.Medication
The fi rst progress in using medication to treat symptoms of schizophrenia began
in the 1950s, with the development of the fi rst antipsychotic (also called neuroleptic)
medication, thorazine. Since then, various antipsychotic medications have been de-
veloped, and two general types of these medications are now used widely, each with
its own set of side effects. In this section we examine these medications and their
side effects. We begin with the traditional antipsychotic medications, and discuss
their potential drawbacks; we then consider the new generations of medications,
and their benefi ts and drawbacks; following this, we examine what happens when
people with schizophrenia stop taking their medication; fi nally, we consider whether
it would be helpful to give medication to people with early signs of schizophrenia.Traditional Antipsychotics
Thorazine(chlorpromazine) and other similar antipsychotics are dopamine an-
tagonists, which effectively block the action of dopamine. Positive symptoms—
hallucinations and delusions—diminish in approximately 75–80% of people with
schizophrenia who take such antipsychotic medications (Green, 2001). Since their
development, traditional antipsychotics have been the fi rst step in treating schizo-
phrenia. When taken regularly, they can reduce the risk of relapse: Only 25% of
those who took antipsychotic medication for 1 year had a relapse, compared to
65–80% of those not on medication for a year (Rosenbaum et al., 2005). Tradi-
tional antipsychotics have sedating properties, which affect patients quickly; above
and beyond such sedation, improvement in psychotic symptoms can take anywhere
from 5 days to 6 weeks (Rosenbaum et al., 2005).
Some of the side effects of traditional antipsychotics create problems when a
person takes them regularly for an extended period of time. Patients can develop
tardive dyskinesia, an enduring side effect that produces involuntary lip smacking
and odd facial contortions as well as other movement-related symptoms. Although
tardive dyskinesia typically does not go away even when traditional antipsychotics
are discontinued, its symptoms can be reduced with another type of medication. It is
interesting to note, however, that decades before antipsychotic medications existed,
clinicians described motor symptoms very similar to those of tardive dyskinesia in
some patients who had what would now be labeled schizophrenia (Turner, 1989).
This observation implies that it is possible that at least in some cases of tardiveTardive dyskinesia
An enduring side effect of traditional
antipsychotic medications that produces
involuntary lip smacking and odd facial
contortions as well as other movement-
related symptoms.