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Is Medication The Only Option?

Dr Francis Ngui Medical Director & Senior Consultant Psychiatrist Adam Road Medical Centre & Camden Medical Centre 8 Dec 2012 SAMH Public Forum: Schizophrenia – The Real Deal l. Is Medication The Only Option?. Schizophrenia. Spectrum of Symptoms ranging in frequency and intensity

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Is Medication The Only Option?

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  1. Dr Francis Ngui Medical Director & Senior Consultant Psychiatrist Adam Road Medical Centre & Camden Medical Centre 8 Dec 2012 SAMH Public Forum: Schizophrenia – The Real Deall Is Medication The Only Option?

  2. Schizophrenia • Spectrum of Symptoms ranging in frequency and intensity • Hallucinations • Paranoid beliefs • Disorganised/disconnected thinking • Volitional symptoms • Cognitive symptoms • Loss of insight

  3. Prognosis • A chronic brain disorder with a variety of outcomes • Chronic course in 4 out of 5 patients • About 20% have only one psychotic episode and recover fully with treatment • About 50% respond well to medication but need long-term medication to prevent relapse • Up to 30% respond inadequately to medication and have recurrent hospitalisations

  4. Prognosis • Good prognostic factors • Acute/sudden onset • Female gender • Later age of onset • Triggering stressor/precipitant • Mood symptoms • Intact insight • Early treatment, short DUP (duration of untreated psychosis) • No family history

  5. Prognosis • Poorer prognostic factors • Gradual/insidious onset • Male • Early age of onset • No stressor • Lack of mood symptoms • Previous psychotic episode • Poor insight • Delayed treatment • Positive family history of psychiatric illness

  6. How to improve prognosis/outcome • Early treatment • Treatment Combination • Medication/Pharmacotherapy • Psychotherapy • Improving insight • Psychoeducation • Stress / anger management • Family support • Social support

  7. Why is early and continuous treatment important? • Structural brain changes in untreated schizophrenia • Larger lateral ventricles • Abnormal connectivity/synapses in • Hippocampus • Dorsolateral prefrontal cortex • Dorsal thalamus

  8. The importance of medication • Antipsychotic medications work by acting on the dopamine system in the brain

  9. The Consequences of Refusing Treatment • Untreated schizophrenia – Prolonged psychotic symptoms leads to: • Depression • Agitation and Aggression • Cognitive decline • Emotional distress to the family • Withdrawal from school/studies • Job loss • Homelessness • Suicide

  10. Types of Antipsychotic Medication • First generation “Typical” antipsychotics • Second generation “Atypical” antipsychotics

  11. Antipsychotics: First Generation • Chlorpromazine • Flupentixol • Haloperidol • Sulpiride • Trifluoperazine

  12. Antipsychotics: Second Generation • Amisulpride • Aripripazole • Asenapine • Clozapine • Olanzapine • Paliperidone • Quetiapine • Risperidone • Ziprazidone

  13. Intramuscular Injections • 1st Generation • Fluanxol Depot • Clopixol Depot • 2nd Generation • RisperdalConsta • InvegaSustenna

  14. Differences between 1st and 2nd generation antipsychotics • 1st generation antipsychotics • Economical and effective • Generally tend to give more motor side-effects like tremor and slowness in movement • May require benzhexol or benztropine to reduce side-effects

  15. Differences between 1st and 2nd generation antipsychotics • 2nd generation antipsychotics • Higher cost • Less motor side-effects • Tend to cause weight gain and metabolic syndrome with prolonged use

  16. Other Augmentation Medications • Antidepressants for depressive symptoms • Mood stabilisers for agitation

  17. Electroconvulsive Therapy (ECT) • Used in • Catatonic schizophrenia • Severe depression • High suicidal risk • Refractory schizophrenia

  18. Psychotherapies • Individual • Supportive counselling • Supportive psychotherapy • Cognitive behavioural therapy (CBT) • Compliance therapy: to enhance insight and compliance to treatment • Family therapy • Family involvement is crucial • Social skills training and vocational rehabilitation

  19. Is Medication The Only Option? • The 5 D’s • The 6 F’s

  20. The 5 D’s • Diagnosis • Get it correct • Drug • May require combinations • Dose • Duration • Dynamics • The F factors…

  21. The 6 F’s: Non-pharmacological Factors • Family • Friends • Occupational Functioning • Finance • Fitness • Physical exercise, Healthy lifestyle • Faith • Spiritual support, Mindfulness

  22. Is Medication The Only Option? • Medication is the most essential factor • Non-pharmacological factors (6F’s) are crucial

  23. Thank you for your attention

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