SCHIZOPHRENIA

NEGATIVE SYMPTOMS
POSITIVE SYMPTOMS o Blunted or flat affect
o Social withdrawal
 Delusions: erroneous beliefs involving misinterpretations of COGNITIVE SYMPTOMS
(passiveapathetic)
reality that are resistant to any evidence o Poor executive function
o Lack of personal hygiene
 Hallucinations: perceptual abnormalities can involve any o Impaired attention
o Prolonged time to respond
sensory system. auditory hallucinations are common. o Impaired working
o Poor rapport
 Disorganized speech: This manifests as frequent o Ambivalence
memory (does not learn
“derailment” of speech or incoherence. “Loose from mistakes)
(simultaneous,
associations”, “Tangential” or “Word salad” contradictory thinking);
prevents decision-making
First Gen : Second Gen :
1. Chlorpromazine (low potency D2 antagonist) : have Yg dalam table
anticholinergic,antihistaminic, and α-adrenergic blocking
properties)---can cause OH 1. Complex action involving
serotonin and dopamine
2. Haloperidol (high potenc D2 antagonist-high EPS and 2. Less risk of EPS & tardive
hyperprolactine)-sesuai utk older adult, dehydrated pt---less dyskinesia
anticholinergic effect 3. Effective in mood symptoms,
positive & negative sympts,
1.Direct dopamine (D2) and cognitive deficits.
antagonism 4. Better tolerated
2. High incidence of extrapyramidal 5. Lesser relapse rate
side effects (EPS) 6. Expensive
3. Effective in control of positive 7. Common side effects are
symptoms metabolic and weight gain
4. Poorly tolerated 8. Widely used
5. More relapse rate
6. Cheap
7. Common side effects are anticholinergic, EPS, antihistaminic
8. Less preferred
SCHIZOPHRENIA

AE : EPS
Parkinsonism and Dystonia (can be treated with anticholinergic)

Akathisia : treat by reduce dose/ change agent

Tardive dyskinesia : change to clozapine (kalau treat dgn

anticholinergic can worsen the symptom)

GOAL OF THERAPY :
1. Reduce the symptoms (positive & negative).
Non Pharmaco : Psychosocial support : Social skills trainig and
2. Prevent relapses.
cognitive behavioural therapy (CBT)
3. Improvement in the patient functioning and social
outcomes
Weight
Dyslip CV
Drug gain DM Sedation Miscellaneous
idemia

Hyperprolactin
emia
Risperidone
Daily doses > 6
mg/day
increase EPS
Active metabolite
Moderate Moderate Less OH Low risk
of Risperidone :
Paliperidone
Dose up to 6mg/day
(Depot injection)
No advantage in
increasing dose

Paliperidone Low Low None Possible Low Hyperprolactin

QTc emia
prolonga Daily doses > 9
SCHIZOPHRENIA

mg can cause
tion
EPS
Weight
Dyslip CV
Drug gain DM Sedation Miscellaneous
idemia

No EPS/tardive
dyskinesia

Associated with severe

neutropenia
(agranulocytosis) –
absolute neutrophil
count (ANC) less than
500/microliters.

New onset Indicated only for

DM and treatment of resistant
Clozapine
metabolic schizophrenia.
syndrome  Is the only
antipsychotic indicated
for the reduction of
suicidal thinking in
patients with
schizophrenia

Clozapine +
Lamotrigine :
beneficial for patient
with partial response
Highest risk Extreme sedation Not associated with
Olanzapine
DM and delirium agranulocytosis
SCHIZOPHRENIA

Weight
Dyslip CV
Drug gain DM Sedation Miscellaneous
idemia

High incidence of Low incidence EPS

somnolence (has
Quetiapine High OH
high affinity for Reasonable option for
H1 receptor) Parkinson patient
Low risk EPS, TD
None
Aripiprazole Minor cardiac Low sedation
High incidence of
effect
akathisia
Low incidence EPS

Better tolerated
Amisulpride
compared to
Haloperidol
200-1200 mg/day :
Pt with positive Low
More likely to cause
symptom propensity of No
hyperprolactinemia
weight gain
compared to
50-300 mg/day : Pt
Risperidone and
with negative
Olanzapine, but lower
symptom
potential for weight
gain and diabetogenic
effect
 Very low dose : Increase relapse
 Monitoring : monitored for weight, blood pressure, fasting glucose, lipids, and waist circumference at baseline and periodically
thereafter
 Maintaining the minimal effective dose continuously may be the best approach for most patients (relapse rates are > 50% after
discontinuation).
 Some first-episode patients may be tried off drugs after being symptom free for 2 years.
SCHIZOPHRENIA

 Those with a history of multiple episodes should probably be symptom free for 5 years before discontinuation is considered
 Benzodiazepine can be added for acute phase agitation and anxiety, but not effective for psychotic symptom…caution use in
schioz pt sebab high risk of substance use disorder