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Psycology » Psychiatry and psychotherapy » Schizophrenia and schizoaffective disorder » Treatment of patients with schizophrenia

The success of treatment depends on whether the doctor will be able to establish a good relationship with the patient, in order to secure his assistance. To achieve this it is sometimes not easy, especially if you are dealing with chronically ill, suffering from paranoia or emotionally indifferent, but as a rule, the progress achieved skill and patience. It is important to set realistic goals, especially in the treatment of patients with the most severe disabilities. Overly optimistic, forced rehabilitation plans may exacerbate symptoms in a patient and be an undue burden on his family (if he is treated at home).

Acute stage of the disease

Hospital treatment, it is usually necessary, and at the first episodes of schizophrenia and acute relapses. Hospitalization provides an opportunity to carefully assess the patient's condition and provide for him a safe and peaceful environment. In addition, while receiving respite for some time the patient's family, who often unwittingly causes his relatives in serious trouble during the prodromal symptoms (see: Johnstone et al. 1986). Provides significant advantages surveillance by for a few days without prescribing, and if possible, it should not be overlooked, although some patients in an acute disorder may require immediate treatment. Period, free from drugs, allows you to thoroughly assess the patient's mental state and behavior as described above. It also shows whether there is a likelihood of improvement and elimination of mental and behavioral disorders due to a change of scene. If signs of improvement is not observed, it is necessary to appoint a neuroleptic, determining the dose depending on the severity of symptoms.

There is a wide choice of drugs (see Ch. 17), but the clinician enough to know very well a few of them. For patients with acute disorders important sedative effect of chlorpromazine. For patients less excited is an alternative means of trifluoperazine (stelazin, triftazin. Ed.), Which is expressed weaker sedative effect. Although these drugs should be given only once a day because of their extended antipsychotic action is often more appropriate to prescribe them in divided doses. In this case, the more likely that they were quickly manifested sedation affect the precise moment when the patient is most excited. Dosage and timing of drug administration should be reconsidered frequently together with personnel department, adapting to changes in the patient's condition. At this stage are often given drugs by mouth, although acutely disturbed behavior can sometimes require intramuscular injections. If there is any doubt that the patient swallows the pill can give medicine to a syrup. Other phenothiazine derivatives are equally effective, there is no reason to give preference to a particular drug, since they do not have distinct advantages, unless there are no problems with the individual tolerability or side effects (additional guidance on the use of antipsychotics, see Ch. 17) .

After the first days of therapy continues to selected drug for several weeks, and during this period the daily dose remained stable and gradual transition to a two-single dose or a single dose of whole cottage for the night. If there are worrisome side effects such as parkinsonism, should appoint anti-Parkinsonian drugs, but their reception should not be routine. With regard to symptoms such as agitation, anxiety, insomnia, irritability, and they are usually eliminated within several days. Affective symptoms, delusions and hallucinations are treatable slower, often persisting for six to eight weeks. Lack of improvement at this stage suggests an inadequate dose or that the patient does not take prescribed drugs, although sometimes there are cases that are resistant to treatment, in spite of all these efforts. As soon as there are unmistakable signs of sustained improvement, the dose can be carefully reduced, at the same time continuing to closely monitor the condition of the patient, not to miss a possible resumption of symptoms. This reduced dose continue to give in the next step (see below).
In the first days of treatment, the doctor needs to collect history, interviewing the patient, his relatives and other informants in order to get an idea of ​​the patient's personality in the period preceding the disease of premorbid adaptability and social circumstances, as well as any disease precipitating factors. For as long as there is a gradual easing of symptoms, the physician must identify a preliminary plan further treatment. Although at this stage it is difficult to forecast the long-term, should form a judgment about the likely near the end, given how intense response to treatment, how quickly it occurs, and based on the factors listed in Table. 9.8. Develop such an opinion is necessary in order to decide the extent to which the patient will need to monitor, support and treatment after discharge, and depending on it to make real plans.

Subsequent call of patients with a good prognosis

Undergone the first episode schizophrenia patients whose nearest forecast is considered good, after discharge from the hospital in need of medical activities carried out in two main directions: the first is taking medicines to gradually reduce the dosage for at least three months; vtoroesoblyudenie recommendations to avoid stressful situations clearly. For several months after discontinuation of the drug and the symptoms disappear regularly doctor examines a patient in an outpatient setting. Then you can give moderately optimistic forecast, but you should be careful and be sure to warn the patient and his family about the need to consult your physician immediately if you have any reason to resume hints disease.

Subsequent call of patients with a poor prognosis, but without serious social insolvency

In cases where it is probable relapse in the future, the patient requires constant monitoring and probably preventive drug therapy.

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