Side Effects Of Medication For Schizophrenics

Antipsychotics, also known as neuroleptics, are the mainstay of treatment for patients with schizophrenia. Since schizophrenia is a life-long illness, medications must be taken indefinitely. Antipsychotics are broadly divided into two types. Typical antipsychotics, such as haloperidol, are an older class of medication that are more likely to cause neurological side effects. Atypical antipsychotics, such as olanzapine, are a newer class of medications that are more likely to cause metabolic side effects.

Neurological Side Effects

These side effects are also known as extrapyramidal symptoms, or EPS. They occur more commonly with typical antipsychotics but can occur with atypicals, too. They can occur immediately upon initiation of the medication or can appear at any time during treatment. They can also appear when a medication is discontinued. Many of these movements mimic Parkinson's disease, including tremor and rigid muscles. Dystonia is a potentially life-threatening condition in which there is acute spasm of muscles. For example, it can affect the jaw muscles or the muscles inside the larynx, which can interfere with the patient's ability to breathe. Akathisia is extreme restlessness, which can be very uncomfortable for the patient. The most worrisome long-term neurological side effect is tardive dyskinesia. According to "Kaplan and Sadock's Textbook of Psychiatry," it usually appears after at least several months of treatment. It consists of uncontrollable movements of the mouth and tongue. Tardive dyskinesia doesn't subside if the medication is stopped, and there is no cure for this condition.

Metabolic Side Effects

Metabolic side effects include weight gain, increase in blood lipids and diabetes. Any patient who is being treated on a long-term basis with these medications should have routine monitoring of weight and blood sugar and lipids, since these are all risk factors for heart disease. Sometimes the weight gain is so severe that a different medication must be tried. Persons who develop diabetes might require the addition of a medication to lower blood sugar. Lifestyle changes, such as proper diet and exercise, should be part of the treatment of schizophrenia in order to counteract the side effects of the medications.

Cardiac Side Effects

Several of these medications, especially the atypical ones, can cause changes in the patient's electrocardiogram, or ECG. Under certain circumstances, these changes can cause a fatal disturbance in the heart rhythm. If the ECG shows these changes, the medication must be discontinued and the patient switched to a different antipsychotic.

Other Side Effects

Most antipsychotics lower the seizure threshold. According to "Kaplan and Sadock's Textbook of Psychiatry," clozapine, one of the atypical antipsychotics, is especially likely to cause seizures. Clozapine also can cause agranulocytosis, which is a reduction in the number of white blood cells that can lead to life- threatening infections. For this reason, every patient on clozapine requires monitoring of their white blood cells on a regular basis, and there are specific protocols detailing what to do if the blood count drops.