Schizophrenia medication treatment history

The 2004 Practice Guideline for the Treatment of Patients With Schizophrenia recommends indefinite maintenance treatment for patients who have had at least two episodes of psychosis within 5 years or who have had multiple previous episodes (Lehman et al. 2004). Maintenance therapy should involve the lowest possible doses of antipsychotic drugs, and patients should be monitored closely for symptoms of relapse. If the patient is compliant with treatment, oral medications are usually sufficient. However, if the patient s treatment history suggests that the patient may not reliably take daily oral medication, a long-acting depot preparation may be indicated. 

Psychiatric medications do not currently play a prominent role in the treatment of cocaine-dependent patients (see Table 6.4). Although researchers have labored to find medications to treat cocaine addiction, there have not been any notable breakthroughs. As with other substance use disorders, the presence of a psychiatric disorder for which medication is indicated (i.e., depression, anxiety disorders, bipolar affective disorder, or schizophrenia) should prompt appropriate treatment. Similar to the presence of alcohol intoxication, deferring a diagnosis for a day or two in a new patient with no past history is often the more prudent course. 

Evidence indicates that the long-term outcome for a patient with schizophrenia is better when treatment of the acute episode is initiated rapidly. After a patient s first psychotic episode, treatment with the antipsychotic medication should be continued for at least 1 year after a full remission of psychotic symptoms. A trial period without medication may then be considered, except for patients with a history of serious suicide attempts or violent aggressive behavior... 

Although we include clozapine as a newer atypical antipsychotic medication, it does have a long history and in some texts may be listed as a traditional antipsychotic. Known by the brand name Clozaril, clozapine was originally synthesized in 1957 and in 1960 was one of the first antipsychotics released on the European market (Hippius, 1989). It was believed to be more successful than the typical antipsychotics because it did not seem to have the same negative side-effect profiles. Years later, eight documented cases of death were attributed to infections secondary to clozapine-induced agranulocytosis, and the product was withdrawn from unrestricted use (Davis Casper, 1977). Based on later studies that supported the success of clozapine with strict monitoring for treatment-resistant schizophrenia, the FDA approved it in 1990 (Barnes McEv-edy, 1996). 

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