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page 7.  Schizophrenia:  Understanding the Disorder



                The New Treatments:


        Thanks to an ever increasing understanding of the brain’s mechanisms, unique treatments have been developed for schizophrenia.  These therapies treat symptoms previously untreated by older medications.


        Conventional antipsychotics are effective against the delusions and hallucinations in some individuals with schizophrenia, but they do not control the debilitating negative symptoms such as social and emotional withdrawal.  In addition, people taking these drugs often suffer from side effects known as extrapyramidal symptoms (ex. Uncontrollable shaking, tremors, muscle stiffness…)


        This new class of therapies treat both the positive (ex. Delusions and hallucinations) and negative (ex. Social withdrawal, lack of desire or motivation) symptoms of schizophrenia.  And during the course of treatment they have been shown to produce a lower incidence of side effects than older medications – especially the serious extrapyramidal symptoms discussed earlier.


        The positive and negative symptoms of schizophrenia are thought to be caused by abnormal levels in the brain of the the neurotransmitters, including both dopamine and serotonin.  Brain messengers like serotonin and dopamine, carry messages from certain specific nerve cells to other cells, or receptors, in the brain.  Researchers have suggested that people with schizophrenia have too many dopamine receptors in certain areas of the brain, or else they have receptors that are overly sensitive to dopamine.  So in the brain of a person who has schizophrenia, too many messages may be sent along these communication pathways. 


        Conventional antipsychotic drugs work by blocking dopamine receptors on brain cells that use this chemical as a neurotransmitter.  It is believed that abnormal levels of dopamine are responsible for the positive symptoms of schizophrenia.


        New treatments, called Serotonin-Dopamine Antagonists, work differently.  Not only do they block the dopamine receptors, they also block serotonin receptors in specific areas of the brain.  These two receptors appear to interact with each other, and drugs which influence both seem to be able to treat both the positive and negative symptoms of schizophrenia.


        Because of this unique mode of action, side effects that are seen with conventional antipsychotics  - ex. Uncontrollable shaking, tremors and muscle stiffness… are greatly reduced.  So, many individuals with schizophrenia find these drugs easier to live with. 



                How to Talk to Your Healthcare Professional about  Medication:


        Learning as much as possible about the disorder, the treatments available, and the side effects of the drugs used in the treatment is important. 


        Asking questions of your doctor is justifiable, considering the nature of the disorder and the course of treatment.  Open-ended questions like “what do you think about the new treatments?” will enable the person with schizophrenia and perhaps their family/caregivers to discuss new treatments.  Arriving at the best antipsychotic medication and the right dose of that medication should always be a shared effort between the doctor and person with schizophrenia.  So if there are concerns about current treatments, whether due to side effects, or lack of symptom control (positive and/or negative) talk to your healthcare professional.