What is schizophrenia?

From the Guidelines

Schizophrenia treatment should prioritize antipsychotic monotherapy, with clozapine considered if two monotherapy trials with other antipsychotics have failed, to minimize side effects and optimize outcomes. According to the most recent and highest quality study 1, antipsychotic monotherapy is the preferred treatment approach for schizophrenia, as it reduces the risk of side effects compared to polypharmacy. The study suggests that clozapine should be tried if two monotherapy trials with other antipsychotics have failed and no absolute contraindications exist.

Some key points to consider in the treatment of schizophrenia include:

• The importance of social support, therapy, psychoeducation, and overall case management in addition to pharmacotherapy 1
• The use of antipsychotics, such as second-generation (atypical) antipsychotics, as the primary pharmacological treatment for schizophrenia 1
• The need for regular monitoring of side effects, such as metabolic changes, movement disorders, and cardiovascular issues 1
• The potential benefits of psychosocial interventions, such as cognitive behavioral therapy, family therapy, and social skills training, in complementing medication treatment 1

In terms of specific treatment recommendations, the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia suggests:

• Treating patients with schizophrenia with an antipsychotic medication and monitoring for effectiveness and side effects 1
• Continuing treatment with an antipsychotic medication if symptoms have improved, and considering clozapine for treatment-resistant schizophrenia 1
• Using long-acting injectable antipsychotic medications for patients with a history of poor or uncertain adherence 1

Overall, the goal of schizophrenia treatment is to reduce symptoms, improve quality of life, and minimize morbidity and mortality. By prioritizing antipsychotic monotherapy and considering clozapine for treatment-resistant cases, clinicians can help patients with schizophrenia achieve the best possible outcomes.

From the FDA Drug Label

ZYPREXA is a prescription medicine used to treat: schizophrenia in people age 13 or older The symptoms of schizophrenia include hearing voices, seeing things that are not there, having beliefs that are not true, and being suspicious or withdrawn.

• Schizophrenia Treatment: Olanzapine (ZYPREXA) is used to treat schizophrenia in people age 13 or older 2.
• Symptoms of Schizophrenia: The symptoms of schizophrenia include hearing voices, seeing things that are not there, having beliefs that are not true, and being suspicious or withdrawn.
• Key Consideration: ZYPREXA has not been approved for use in children under 13 years of age.

From the Research

Overview of Schizophrenia Treatment

• The primary objectives in the treatment of schizophrenia are to reduce the frequency and severity of psychotic exacerbation, ameliorate a broad range of symptoms, and improve functional capacity and quality of life 3.
• Treatment includes pharmacotherapy and a range of psychosocial interventions, with antipsychotics being the cornerstone of pharmacological treatment for schizophrenia 3.

Antipsychotic Medications

• There are 65 antipsychotic medications available, classified into two major groups: first-generation (conventional) agents (FGAs) and second-generation (atypical) agents (SGAs) 3.
• Clozapine is found to be more efficacious than other agents among otherwise treatment-refractory schizophrenia patients, while other differences in efficacy between antipsychotic agents are minor 3.
• The choice of antipsychotic medication should be based on prior treatment response, individual preference, medical history, and individual patient vulnerabilities 3.

Treatment Strategies

• Guidelines and algorithms recommend starting with a low dose or the lowest licensed/effective dose and then titrating the dose upwards 4.
• For non-response, guidelines recommend increasing antipsychotic dose towards the upper end of its approved dose range and switching to another antipsychotic, particularly clozapine 4.
• Initiating clozapine after failure to respond to 2 different antipsychotics is endorsed by all guidelines 4.

Prescribing Practices

• Inpatients with schizophrenia receive higher doses of antipsychotics and benzodiazepines compared to outpatients 5.
• The treatment setting needs to be taken into consideration in treatment recommendations for schizophrenia spectrum disorders 5.

Cognitive Function

• Atypical antipsychotic drugs, such as clozapine, olanzapine, and risperidone, have been found to improve cognitive function in schizophrenia, with different drugs producing significant differences in specific cognitive functions 6, 7.
• A meta-analysis found that atypical antipsychotics produce a mild remediation of cognitive deficits in schizophrenia, with specific atypicals having differential effects within certain cognitive domains 7.