Module 4 - Schizophrenia and Other Psychoses

What happens to people who have schizophrenia?

With appropriate treatment most people recover from their first psychotic episode although this usually takes several months or longer as most acute episodes last 3 to 6 months. However some people will never recover and over 80% will have further episodes. In the longer term 30% of people may have persistent symptoms that are largely resistant to treatment and have significant problems in looking after themselves. About 10% recover and have no further problems and the rest fall in the middle of these 2 extremes. Medication is the mainstay of treatment for positive symptoms and is usually effective to a greater or lesser degree. Negative symptoms are more difficult to shift and often mean that the person needs a lot of support to engage in activities and may need help to attend to basic functions such as self- care.

Reviewing Medication

People with intellectual disability may not know that they can request that their medication be changed, reduced or discontinued and may continue to take medication for many years. Medication may have been commenced many years before for reasons that are no longer apparent. The GP may have continued to prescribe medication and if the person does not see a psychiatrist regularly the need for ongoing medication may not be reviewed. Many people with intellectual disability receive treatment and have never had a mental illness. On the other hand there may have been a clear episode of illness in the past but this is not clear because the records from that time are incomplete or unavailable and the treating clinician is no longer involved.

Discontinuing Medicaion

The decision to discontinue medication should not be made without careful consideration and if medication is to be reduced this should be done gradually and with regular review. It is important to keep an open mind, particularly if there are limited case records available, and a tapered reduction of medication over several months is the usual approach. On discontinuation of medication there is the potential for the person to develop an acute psychotic episode and only at that point will it be possible to distinguish between a person receiving effective treatment with antipsychotic medication and a person receiving medication inappropriately when they do not have a mental illness. Studies of antipsychotic medication withdrawal in people with intellectual disability have shown that stopping medication can lead to high levels of physical and mental ill health. Furthermore, recommencing treatment may be only partially successful in restoring the person’s mental health. General practitioners may not believe they have the experience necessary to discontinue long term medication and specialist psychiatric review and monitoring with education of the person, their carers and other medical practitioners may be required.  
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