As is it, the prognosis (future outcome) of schizophrenia and other psychotic disorders can follow one of three paths.

  1. 33% will live very normal lives, gaining great control over their symptoms
  2. 33% will have a decent existence, but will still be battling symptoms to a significant extent
  3. 33% will be very symptomatic, and live have difficult lives.

In order to ensure the best possible outcome, medication must be taken. If someone with schizophrenia or schizoaffective disorder does not take medication for it, the risk of relapse within two years more than triples compared to someone who takes their medicine. If you absolutely must stop taking your medication, notify your doctor, so that it can be done somewhat safely. If you take your medication by pill form, perhaps pack your medication in a pill box to remember taking it.

Schizophrenia is not known for being curable. Medications treat the symptoms of the disease, they don’t make it go away. Many people who battle a mental illness that has a psychotic component may need to take medication for life. But at the cost of not being lorded over around every turn, it’s worth it.

Antipsychotic medication can be hard to tolerate. That said, the newer options have a better reputation fro being more tolerable, and treating some of the negative and cognitive symptoms, not just the positive ones. Also, there are well over 10 different antipsychotic medications.

These medications work to decrease the activity of a neurotransmitter called dopamine. They stop it binding to a sub-type of the dopamine receptor (D2) in selected parts of the brain. In order to be effective, an antipsychotic must inhibit D2 binding by 65%-78% in the striatum region of the human brain.

Drugs used to treat psychotic disorders are either “typical” or “atypical”. Both typical and atypical antipsychotics treat positive symptoms and agitation.

The older “typical” neuroleptics (antipsychotics) work only weakly, or not at all, on negative, cognitive, and affective aspects. Theory suggests that because atypical antipsychotics also bind strongly to the 5-HT2a subtype of the serotonin receptor, in addition to D2, they treat more symptoms. Atypical antipsychotics are also useful for bipolar disorder.

Invega is the only antipsychotic officially approved for schizoaffective disorder, yet other antipyschotics are effective against it too.

There are about ten atypical antipsychotics on the market, and a few more than ten atypicals available.

Unfortunately, it may take a while for antipsychotics to start working fully.

  • After one or two days of treatment, hyperactivity, hostility, and combativeness resolves
  • It may take one to two weeks for social skills, delusions, hallucinations, sleep problems, appetite, and hygiene to improve
  • At one to two months of treatment, insight and sound judgement is usually gained
  • If one is treated with an atypical antipsychotic, they can additionally expect that negative, cognitive, and affective symptoms will become less severe
    • This can take six months to a year

Many antipsychotics are now available in long-acting shots (every two to four weeks)

  • Typicals
    • Prolixin
    • Haldol
  • Atypicals
    • Risperdal
      • Also approved for Bipolar Type I
    • Invega
    • Abilify
    • Zyprexa

Additionally, a recently approved form of ths Invega injection lasts for three months.

As makes sense, treatment with injections greatly increases compliance. The patient only has to make the decision to take their medicine twice per month at most, instead of every day.

A few new antipsychotics, Vraylar and Rexulti, were approved just a few months ago. They act in a similar manner as Abilify, keeping levels of dopamine low enough to be effective against psychosis, but high enough to promote a good mood (partial agonism). Regarding the latter, it makes them easier to tolerate. Both Abilify and another antipsychotic, Seroquel, are officially approved as adjuncts in treating depression, usually at lower doses.

Clozapine deserves special mention. It was the first atypical antipsychotic discovered, and remains the sole medication licensed for treatment-resistant schizophrenia. This is largely in part because it’s well-known for reducing suicidal behavior.

But there are downsides. Unfortunately, clozapine produces a serious side effect in .38%-.73% of those who take it, requiring frequent blood tests. Also, smokers, which between 70% and 97% of all schizophrenics are, will require a greater dosage, as smoking clears clozapine from one’s system faster. Finally, it isn’t available as a monthly or bimonthly injection, either.

Despite this, clozapine is unmatched. It has had an enormous role in giving me back my life, along with those of countless others. Please refer to My Analysis of Clozapine for more information on the compound.

If so inclined, the guide to neurotransmitters and receptors will help understand the table below. The smaller the number, the more tightly a given antipyschotic binds to a given receptor subtype.

Current Psychiatry is perhaps the best resource for learning about new treatment. Though relatively outdated, this source details many medications in development for psychotic disorders. Schizophrenia.com is a decent, wholesome resource, though much of their information isn’t current.

Sometimes schizophrenia and schizoaffective disorder require more than one medication to adequately control symptoms. Usually, this involves treatment with mood stabilizers and/or antidepressants.

Sources: Condensed Psychopharmacology 2013: A Pocket Reference for Psychiatry and Psychotropic Medications, WedMD.com, Schizophrenia.com, Stahl’s Essential Psychopharmacology, http://annals.org/article.aspx?articleid=1363530, https://www.gatewaypsychiatric.com, The Jenkins Center