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Psycology » Psychiatry and psychotherapy » Schizophrenia » Schizophrenia: the treatment of disease

  1. Schizophrenia: Introduction
  2. Schizophrenia: signs and symptoms
  3. Schizophrenia: course and form of the disease
  4. Schizophrenia: etiology and pathogenesis
  5. Schizophrenia: differential diagnosis
  6. Schizophrenia: the treatment of disease

Currently, the diagnosis of schizophrenia, lechnie produced mainly using pharmacotherapy, but use other methods (insulinkomatoznaya therapy, electroconvulsive therapy, etc.). In the treatment of schizophrenia in the acute period of the disease requires active therapy in the future to maintain the improvement in maintenance therapy. The purpose of preventive therapy - preventing relapses and longer remission. Choice of psychotropic drugs is determined by features of positive symptoms and the type of the disease.

Malignant schizophrenia with continuous flow requires selection of drugs that can reduce severe catatonic, katatono-gebefrennyh, katatono-paranoid symptoms that require the use of antipsychotics with potent antipsychotic effect action. While chlorpromazine administered in daily doses of 600-800 mg, Tisercinum - 200 - 300 mg, propazin - 350 mg, haloperidol - 30-40 mg, trisedil - 10-15 mg, mazheptil - 30-40 mg, stelazin (triftazin) - 50-60 mg, azaleptin - 300-400 mg. Must take into account the increased sensitivity of many patients to these drugs with the possibility of severe complications of antipsychotic (typical neuroleptics in the treatment in the first place). In this regard, in such cases, the appointment of correctors such as tsiklodol in dosage 12-14 mg / day, akineton etc. It is also recommended the appointment of nootropics: Nootropilum (1200-1600 mg / day), etc.

To overcome treatment resistance to conventional therapy is recommended to use different techniques for its intensification. Appointed by high doses of antipsychotics, surpassing the usual standards by 2-5 times that in many cases to a substantial weakening of psychotic disorders. Long established itself as a positive method of single cancellation followed by the resumption of neuroleptics ("therapeutic teeth" by GI Salzmann 1963). Recently proved positive impact of immunomodulators such as levomizol (dekaris), which is administered at 150 mg twice a week, dimephosphone - 30 mg per 1 kg three times a day after meals (MV Zlatkovsky, 2009). In conjunction with neuroleptic medication used insulinkomatoznaya therapy forced method (GY Avrutsky, 1984). Wherein insulin is administered intravenously in saline infusion rate of 1.5 units per minute to produce coma (25-30 rate com). In the treatment of simple forms of schizophrenia with antipsychotics appointed stimulating effect actions stelazin (triftazin to 20-25 mg / day), etaperazin (up to 30 mg / day), Eglonylum (up to 600-800 mg / day), DITT (25-50 mg / day), mazheptil (up to 15 mg / day), Solian (up to 1200 mg / day). Used and atypical antipsychotics such as risperidone (up to 4 mg / day), Seroquel (up to 900 mg / day), olanzapine (15 mg / day), aripiprazole (abilifay, up to 30 mg / day).

Treatment of paranoid schizophrenia with continuous flow shown conduct typical neuroleptics having protivobredovym action, such as etaperazin (60-90 mg / day), triftazin (40-50 mg / day), haloperidol (20-30 mg / day). Of atypical antipsychotics effective leponeks (azaleptin, up to 300 mg / day). In cases with a predominance of hallucinatory delirium appoint etaperazin (35-40 mg / day) or triftazin (30-35 mg / day). In the later stages of the disease with the appearance of resistance to these drugs should be used DITT depot at a dosage of 25-75 mg intramuscularly (one injection three to four weeks).

Recently, in connection with the introduction into clinical practice of new antipsychotic drugs for the treatment of paranoid schizophrenia used zuclopenthixol (klopiksol), which gives a good effect as in the first episode, and in ekzotserbatsii delusional disorders, for which it is administered intramuscularly (klopiksol depot) at a dosage of to 100 mg / day. In such cases, the relief delusional disorders and drug olanzapine is conducted at a daily dose of 20 mg. In the treatment of delusional disorders these drugs wear off and negative symptoms. In cases of therapeutic resistance klopiksol depot dosage can be increased to 600 mg / day, or administered haloperidol-dekonoat to 200 mg once every seven days. In some cases, you can combine the introduction klopiksol depot in these dosages with piportilom L4, which gives a significant stabilization and promotes the formation of long-term therapeutic remission.

Episodic-therapy progradiently schizophrenia focused on mild acute affective psychoses delusional insulinkomatoznoy using methods or administration of neuroleptics (propazin to 350 mg / day, Tisercinum to 200 mg / day, leponeks to 300 mg / day) in combination with antidepressants - amitriptyline ( to 300 mg / day), Anafranil (up to 200 mg / day), ludiomila (up to 300 mg / day). The first attacks better cropped insulinkomatoznoy therapy, repeated appropriately apply antibredovye neuroleptics in combination with antidepressants or with lithium salts in the presence of manic structure affect.

In the treatment of schizophrenia with continuous flow maloprogredientnym prescribe neuroleptics (triftazin etaperazin, haloperidol, neuleptil, risperidone, olanzapine in moderate doses), joined by tranquilizers - Phenazepamum (up to 5 mg / day), Grandaxinum (up to 50 mg / day), lorazepam (up to 5 mg / day), bromazepam (4 - 6 mg / day), Stresam (up to 50 mg / day), alprazolam (5 mg / day). At the same time can be included in the treatment regimen biotic drugs - glycine (up to 800 mg / day sublingual) and Biotredin (up to 800 mg / day sublingually).

treatment of febrile schizophrenia

The main type of therapy at an early stage of disease development is intensive use of infusions aimed at correcting the underlying disorders in somatic sphere: vegetative, hypovolemic, cardiovascular, hemodynamic and metabolic syndrome (BD Tsigankov, 1997).

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