From the Guidelines
The treatment for psychosis, particularly in schizophrenia, should involve a combination of antipsychotic medications and psychosocial interventions, with a focus on reducing morbidity, mortality, and improving quality of life. According to the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1, the initial assessment of a patient with a possible psychotic disorder should include a review of psychiatric symptoms and trauma history, an assessment of physical health, and a mental status examination.
Key Components of Treatment
- Antipsychotic medication: First-line medications include second-generation (atypical) antipsychotics such as risperidone, olanzapine, quetiapine, or aripiprazole, which work by blocking dopamine receptors in the brain, particularly D2 receptors, to reduce hallucinations, delusions, and disorganized thinking 1.
- Psychosocial interventions: Cognitive behavioral therapy, family therapy, and social skills training are essential complements to medication, and can help address both positive and negative symptoms of psychosis 1.
- Treatment-resistant cases: Clozapine may be used, though it requires blood monitoring due to the risk of agranulocytosis, and is recommended for patients with treatment-resistant schizophrenia 1.
Recent Evidence and Recommendations
A recent study published in 2021 1 suggests that antipsychotic polypharmacy may be effective in reducing treatment side effects and residual symptoms in some patients, particularly when combining aripiprazole with clozapine. However, another study published in 2021 1 notes that most guidelines still recommend monotherapy, and that antipsychotic polypharmacy should only be considered in certain individual cases, such as patients with treatment-resistant schizophrenia.
Prioritizing Morbidity, Mortality, and Quality of Life
In prioritizing morbidity, mortality, and quality of life, the most recent and highest quality study 1 recommends a comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments. This approach can help reduce the significant psychosocial and health consequences of schizophrenia, and improve overall outcomes for patients.
Key Takeaways
- A comprehensive treatment plan that includes antipsychotic medication and psychosocial interventions is essential for managing psychosis in schizophrenia.
- Clozapine may be used for treatment-resistant cases, but requires careful monitoring due to the risk of agranulocytosis.
- Antipsychotic polypharmacy may be considered in certain individual cases, but should be approached with caution and careful consideration of the potential risks and benefits.
From the FDA Drug Label
1.1 Treatment-Resistant Schizophrenia Clozapine tablets are indicated for the treatment of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment
1.2 Reduction in the Risk of Recurrent Suicidal Behavior in Schizophrenia or Schizoaffective Disorder Clozapine tablets are indicated for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for re-experiencing suicidal behavior, based on history and recent clinical state
The treatment for psychosis, particularly in conditions like schizophrenia, includes the use of clozapine for patients who have failed to respond adequately to standard antipsychotic treatment. Clozapine is indicated for:
- Treatment-resistant schizophrenia: For severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment.
- Reduction in the risk of recurrent suicidal behavior: For patients with schizophrenia or schizoaffective disorder who are at chronic risk for re-experiencing suicidal behavior. 2
From the Research
Treatment Options for Psychosis
The treatment for psychosis, particularly in conditions like schizophrenia, typically involves the use of antipsychotic medications. These medications are considered the mainstays in the treatment of schizophrenia and other psychotic disorders 3.
Antipsychotic Medications
- Antipsychotic medications can reduce psychotic symptoms and prevent relapse, which can prevent hospitalization and facilitate psychosocial re-integration 4.
- The choice of antipsychotic medication should be decided on an individual patient basis, taking into account the patient's experiences with previous treatments 4.
- Clozapine is the only effective medication for treatment-resistant schizophrenia 3.
- Atypical antipsychotics, such as risperidone and olanzapine, are generally less likely to cause troublesome extrapyramidal effects or hyperprolactinaemia compared to traditional antipsychotics 5, 6.
Treatment Strategies
- A comprehensive treatment programme that includes pharmacotherapy, psychological therapies, and social therapies is recommended for schizophrenia 4.
- Antipsychotic medications should be prescribed at an early stage to increase the likelihood of a favourable treatment outcome, and for long enough to reduce the risk of relapse 4.
- Treatment strategies should be tailored to the individual patient, taking into account their specific needs and circumstances 4, 5.
Co-occurring Substance Use Disorders
- Substance use disorder is common in patients with schizophrenia and can dramatically worsen their outcome 7.
- Atypical antipsychotic medications, such as clozapine, may be effective in reducing substance use in patients with schizophrenia 7.
- Medications for the treatment of alcohol use disorders, such as disulfiram, naltrexone, and acamprosate, may also be useful in patients with co-occurring substance use disorders 7.