Pharmacotherapy for schizophrenia: Side effect management
- Stephen Marder, MD
Stephen Marder, MD
- Section Editor — Psychotic Disorders
- Professor of Psychiatry
- Semel Institute of Neuroscience at UCLA
- T. Scott Stroup, MD, MPH
T. Scott Stroup, MD, MPH
- Professor of Psychiatry
- Columbia University
Schizophrenia is a severe disorder involving chronic or recurrent psychosis and long-term deterioration in functioning . It is among the most disabling and economically catastrophic disorders, ranked by the World Health Organization as one of the top 10 illnesses contributing to the global burden of disease .
Antipsychotic medications are first-line medication treatment for schizophrenia. They have been shown in clinical trials to be effective in treating symptoms and behaviors associated with the disorder. The optimal medication, dose, and route of administration vary according to stage of illness, individual patient characteristics, and the clinical situation.
Antipsychotic medications have significant side effects, which influence selection among them. A table shows the side effect profiles of individual antipsychotics (table 1). Assessment for these side effects and management of them are essential parts of schizophrenia treatment.
This topic addresses the management of side effects during pharmacotherapy for schizophrenia. Pharmacotherapy for schizophrenia during acute and maintenance phase treatment is discussed separately. The clinical presentation, epidemiology, clinical manifestations, and diagnosis of schizophrenia are discussed separately. Common comorbid presentations of schizophrenia and an overview other psychotic disorders are also discussed separately. (See "Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment" and "Schizophrenia: Clinical manifestations, course, assessment, and diagnosis" and "Anxiety in schizophrenia" and "Depression in schizophrenia" and "Co-occurring schizophrenia and substance use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment and diagnosis" and "Clinical manifestations, differential diagnosis, and initial management of psychosis in adults".)
Patients receiving an antipsychotic should receive routine monitoring for manifestations of extrapyramidal symptoms (EPS), including akathisia, parkinsonism, and dystonias. All of the antipsychotic medications have the potential for causing EPS. They are common with some antipsychotics (eg, haloperidol, fluphenazine, thiothixene, and trifluoperazine), and uncommon with others (quetiapine, clozapine, and iloperidone).
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- EXTRAPYRAMIDAL SYMPTOMS
- Parkinsonian syndrome
- TARDIVE DYSKINESIA
- METABOLIC SIDE EFFECTS
- Clinical management
- - Behavioral weight loss interventions
- - Metformin
- PROLACTIN ELEVATION
- OTHER SIDE EFFECTS
- Orthostatic hypotension
- Neuroleptic malignant syndrome
- QT prolongation
- Sudden death
- Anticholinergic effects
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS