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How to Treat Schizophrenia?

Things to note:
  • Supporting psychotherapy for patients and family members and psycho- educational group therapy.

Medical Treatment:
Psychotic episode
Acute management

* Haloperidol, IM, 2- 5 mg for agitated and acutely disturbed patients.
  • If necessary, this can be repeated in 60 minutes.
  • Monitor signs of vital importance and beware of acute dystonia.
  • Caution if the total dose exceeds 10 mg because the patient may be exposed to an increased risk of side effects without neceBetaarily adding to the antipsychotic effect.
To reduce dystonia and improve sedation:
* Promethazine, IM, 50 mg.
  • In adults: 25 mg.
If the response is poor,
Repeat benzodiazepine as needed, e.g:
* Lorazepam, IM, 1- 4 mg.
  • IM, Clonazepam, 0.5- 2 mg.
* IV, 10 mg, Diazepam.
  • Once containment is reached, switch to oral route.
If patients are known to have schizophrenia:
* Acetate of Zuclopenthixol, IM, 50-150 mg.
  • Repeat if necessary after 2-3 days.
  • Dystonia, i.e. beware. Muscle spasm that can involve any group of muscles but can also affect the respiration and is usually experienced as a patients distress.
* Biperid, IM, 2 mg when acute dystonic reactions develop.
Benzodiazepines may be necessary.
Repeated doses of high- power antipsychotics could lead to the development of a malignant neuroleptic syndrome. Any increase in temperature, muscle rigidity and changes in consciousness should lead to caution and investigation in this respect.If suspected, stop antipsychotic drug use and monitor medically.
Maintenance therapy
Initiated specialist.
Review patients by a psychiatrist every six months.
* Haloperidol, oral, 1.5-10 mg daily before proceeding to long- term therapy.
  • Chlorpromazine, oral at divided doses of 75- 300 mg daily.
If adherence is a problem, i.e:
* Flupenthixol decanoate, IM, 20- 40 mg every 4 weeks.
  • Decanoate with fluphenazine, IM, 12.5-50 mg every 4 weeks.
  • Decanoate Zuclopenthixol, IM, 200 mg every 4 weeks.
If haloperidol and chlorpromazine fail and problems with adherence have been excluded, refer to clozapine or other antipsychotics, including atypicals Risperidone, oral, daily 1-4 mg.Initiated psychiatrist.
* Oral, clozapine 300-450 mg per day. Initiated psychiatrist.
  • Titrate up to 2 to 3 weeks of therapeutic dose.
  • Requires frequent monitoring of the WCC- see package insert.
If extrapyramidal side effects occur at the lowest effective dose of antipsychotic drugs, e.g:
* Orphenadrine, oral, 50-150 mg daily according to individual response
  • Usual dose: 50 mg 12 hours.
  • Maximum daily dose: 150 mg.
  • Use cautiously in the elderly, as confusion and urinary retention can occur.
Parenteral therapy for acute dystonia, e.g:
* Biperid, IM / slow IV, 2 mg
  • Repeat up to a maximum of 4 doses daily every 30 minutes if necessary.
  • Used higher doses up to 5 mg.

When to refer:
  • Uncertain diagnostic psychotic patients.
  • Patients who relapse and refuse treatment or become aggressive or suicidal refer to the involuntary treatment act of mental health.
  • Complicated patients because of medications that can not be easily managed.