Schizophrenia is a chronic mental disorder that affects an individual’s thoughts, perceptions, emotions, and behaviours. Treatment is primarily based on the use of antipsychotic medications. In Australia, these medications can significantly improve the quality of life for individuals with schizophrenia. However, they come with potential side effects, necessitating careful monitoring. This essay explores the different types of antipsychotic medications used in Australia, their side effects, and methods for monitoring treatment, using evidence from peer-reviewed literature and clinical guidelines.

1. Types of Medications Used to Treat Schizophrenia

There are two main classes of antipsychotic medications: typical (first-generation) and atypical (second-generation) antipsychotics.

1.1 Typical Antipsychotics Typical antipsychotics, also known as first-generation antipsychotics, were developed in the 1950s and primarily work by blocking dopamine receptors in the brain. Common medications in this class used in Australia include haloperidol, chlorpromazine, and fluphenazine (Galletly et al., 2016). These medications are highly effective in reducing positive symptoms of schizophrenia, such as hallucinations and delusions.

1.2 Atypical Antipsychotics Atypical or second-generation antipsychotics were introduced in the 1990s and have largely replaced typical antipsychotics as the first-line treatment. Medications in this class include risperidone, olanzapine, quetiapine, clozapine, and aripiprazole (Siskind et al., 2017). Atypical antipsychotics not only target dopamine receptors but also affect serotonin receptors, providing a broader range of symptom control, including for negative symptoms like apathy and social withdrawal.

2. Side Effects of Antipsychotic Medications

Although antipsychotic medications can be effective in managing schizophrenia, they are associated with various side effects, which can range from mild to severe. The side effects differ between typical and atypical antipsychotics.

2.1 Typical Antipsychotic Side Effects Typical antipsychotics are more likely to cause extrapyramidal symptoms (EPS), including tardive dyskinesia (involuntary muscle movements), dystonia (muscle spasms), and parkinsonism (tremors and stiffness) (Leucht et al., 2013). These side effects are linked to the potent dopamine receptor blockade in the nigrostriatal pathway. Additionally, they may cause sedation, weight gain, and anticholinergic effects such as dry mouth and blurred vision.

2.2 Atypical Antipsychotic Side Effects Atypical antipsychotics generally have a lower risk of EPS but are more likely to cause metabolic side effects, including weight gain, hyperglycemia, and dyslipidemia (Citrome, 2020). Clozapine, for example, is highly effective for treatment-resistant schizophrenia but carries a risk of agranulocytosis, a life-threatening reduction in white blood cells (Galletly et al., 2016). Other atypicals like olanzapine and risperidone are associated with increased appetite, metabolic syndrome, and sedation.

3. Monitoring Treatment and Side Effects

Given the risk of significant side effects, careful monitoring of patients on antipsychotic medication is critical. Clinical guidelines emphasize the importance of both physical and psychiatric monitoring to ensure medication efficacy and minimize harm.

3.1 Physical Health Monitoring Patients on antipsychotic medications, especially atypical ones, should undergo regular monitoring for metabolic side effects. This includes measuring body weight, body mass index (BMI), fasting blood glucose, and lipid profiles at baseline and during treatment (Royal Australian and New Zealand College of Psychiatrists [RANZCP], 2016). Clozapine requires regular blood tests to monitor white blood cell counts due to the risk of agranulocytosis (Siskind et al., 2017).

3.2 Monitoring for Extrapyramidal Symptoms For patients taking typical antipsychotics, it is essential to monitor for signs of EPS. Regular assessments using tools such as the Abnormal Involuntary Movement Scale (AIMS) or Simpson-Angus Scale (SAS) can help clinicians detect early signs of tardive dyskinesia or other motor disturbances (Leucht et al., 2013).

3.3 Psychiatric and Cognitive Monitoring The impact of antipsychotic medications on a patient’s psychiatric symptoms and cognitive function should also be regularly evaluated. Cognitive assessments and monitoring for changes in social functioning and emotional responsiveness can help in tailoring treatment plans. Additionally, patients should be routinely screened for suicidal ideation, as individuals with schizophrenia have an elevated risk of suicide, especially during the early stages of treatment (Galletly et al., 2016).

Conclusion

In Australia, antipsychotic medications are essential in the management of schizophrenia, with both typical and atypical antipsychotics being widely used. While these medications can significantly reduce symptoms, they come with potential side effects that necessitate ongoing monitoring. Effective management requires a holistic approach, including regular physical health checks, psychiatric assessments, and cognitive monitoring. By understanding the risks associated with these medications and implementing robust monitoring protocols, healthcare providers can optimise outcomes for individuals living with schizophrenia.

References

Citrome, L. (2020). New treatments for schizophrenia: Potential uses and side effects. Journal of Clinical Psychiatry.

Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., Kulkarni, J., McGorry, P., Nielssen, O., & Tran, N. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian & New Zealand Journal of Psychiatry, 50(5), 410-472.

Leucht, S., Tardy, M., Komossa, K., Heres, S., Kissling, W., Salanti, G., & Davis, J. M. (2012). Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: A systematic review and meta-analysis. The Lancet, 382(9905), 1203-1211.

Royal Australian and New Zealand College of Psychiatrists. (2016). RANZCP clinical practice guidelines: Schizophrenia and related disorders. Retrieved from https://www.ranzcp.org

Siskind, D., McCartney, L., Goldschlager, R., & Kisely, S. (2017). Clozapine v. first- and second-generation antipsychotics in treatment-refractory schizophrenia: Systematic review and meta-analysis. The British Journal of Psychiatry, 209(5), 385-392.