Since its opening in the 50-ies of XX century firstpsychotropic drug chlorpromazine there was a revolution in the treatment of mental disorders, particularly schizophrenia. Until that time, the most popular methods of treating schizophrenia were insulin therapy, electroconvulsive therapy and lobotomy. Drug treatment has been largely directed at eliminating certain symptoms and usually included a soothing medicaments.
With the advent of antipsychotic drugs have an opportunitychemically influence and eliminate the symptoms, whereas previously these patients had to be isolated from society in anticipation of short-term spontaneous remission.
Modern pharmacology much progressforward and today there is a fairly extensive range of products, in varying degrees affect the symptoms of schizophrenia. These drugs are called "neuroleptics" or "antipsychotics". They have in common one thing - they are primarily eliminate symptoms of psychosis: delusions, hallucinations, agitation.
The mechanism of their action is the blockadereceptor a biologically active substance brain dopamine, and due to this effect arises antipsychotic drugs. In addition, they have an affinity for other receptors (for acetylcholine, adrenaline, serotonin, histamine), which explains the fairly wide range of their activities and the occurrence of certain side effects.
There are many classes of neuroleptics, whichThey differ in chemical structure, and therefore they have different effects on the body, to a greater or lesser extent affecting various manifestations of schizophrenia.
There are proper antipsychotic actionneuroleptics: General - impact on all manifestations of psychosis and prevent further progression of the disease, and selective - sighting effect on delirium, hallucinations, obsessive-compulsive disorder, catatonia. Thanks to the sedative (inhibits) the action of antipsychotics are effective in various types of psychomotor agitation and insomnia. Some antipsychotics contrary is inherent in activating effect, it is used in the treatment of apathy, catatonic stupor, autism.
Kognitotropnoe action - this is the effect of the higherthe function of the cerebral cortex (memory, attention, thinking, perception). Antipsychotics also have neurological effects - associated with the dopamine receptors, which are located in the center of the movement regulation, which causes side effects such as muscle stiffness, restlessness, trembling of the limbs. These adverse effects are eliminated appointment of correctors, such as tsiklodol or akineton.
Antipsychotics also have an impact onthe autonomic nervous system and the endocrine system, which can manifest dry mouth, urinary retention, low blood pressure, decreased libido, menstrual irregularities, weight gain. Different groups of neuroleptics these effects are expressed in varying degrees, and the use of a class of drugs depends on the form of schizophrenia and its flow characteristics.
Last time preferencemodern class of neuroleptics, which appeared in the 90-ies of XX century, the so-called "atypical" antipsychotics. They are atypical, because unlike the earlier generations of drugs, have virtually no neurological effect, i.e. do not cause side effects associated with movement disorders. This is a very valuable asset, as movement disorders usually deliver great discomfort to patients and require the appointment of additional drugs-correctors.
Thus the same advanced antipsychoticseffective in eliminating the symptoms of schizophrenia, as well as older drugs. Another advantage of the atypical antipsychotics is their positive effect on cognitive function (kognitotropnoe action), which did not have drugs in previous years. Furthermore, by binding to brain serotonin receptors, atypical antipsychotics still have antidepressant effect.
Modern drugs are easy to use -their distribution in the body such that they can be taken only once a day. With regular use of the drug begins to act fully in 2-3 weeks, so they need to continue to take, even if at first sight there is no expected effect. However, at the peak effect of the drug, not all symptoms of the disease can be eliminated immediately - for the complete disappearance of the symptoms and to prevent a recurrence of the disease medication should drink an average of two years.
For the convenience of long-term use of drugs produced forms of long-acting antipsychotics in the form of injection (Consta-rispolept) - one such injection lasts for 2-4 weeks.
In addition to addressing the specific schizophrenicsymptoms, it is useful to carry out restorative treatment, as the disease is usually accompanied by general disorders of the nervous system. For this purpose, used drugs that enhance metabolism in nervous tissue: pikamilon, mexidol cerebrolysin milgama, mildranat, gliatillin, nootropil.
The main problem that may arise whentreatment of schizophrenia - a resistance to drugs. This phenomenon is very rare, but can occur in certain forms of schizophrenia, metabolic features of a patient or prolonged inadequate treatment and psychotropic drugs. In such cases, as well as for termination of acute episodes of schizophrenia with delusions and catatonia, using electroconvulsive therapy (ECT), insulin shock therapy, hemosorption and plasmapheresis, laser irradiation of blood.
Sessions are held in electroconvulsive therapyconditions of the intensive care unit under general anesthesia, to minimize the risk of complications. On the patient's head superimposed electrodes and artificially induce a seizure. The course of treatment consists of 4-8 sessions of ECT, patients forget completely fits, and the effectiveness of this method can be quite significant.
Another way to shock therapy for schizophreniaIt is insulin shock therapy. This technique is based on the administration of insulin doses to achieve hypoglycemic coma (loss of consciousness due to a decrease in blood sugar). After 10-20 minutes after the patient is removed from her coma by intravenous glucose solution. In order to break the attack of psychosis requires 10-20 sessions.
Sometimes it is an effective use of detoxification(Cleansing of toxins) the body through hemosorption or plasmapheresis. the patient's blood is passed through a special device, where it is cleaned of toxins, immune complexes, in the case of long-term treatment drugs - from drugs. This may contribute to a reduction of schizophrenic symptoms and overcoming drug resistance as a result of "cleaning" receptors. Blood has similar effects by laser irradiation.
These methods are so-called"Non-drug therapy" are used in extreme cases of intolerance, drug resistance to breakage or acute psychosis. In all other cases, a drug therapy. Also, for greater efficiency, the combination drug therapy with non-drug therapies.
In modern psychiatry development whenpossible to carry out treatment with modern drugs, with timely treatment to the doctor (not later than 2 years after the first signs of the disease), the appointment of adequate drug therapy and adherence supplementation can conduct an effective treatment with minimal side effects, with the elimination of schizophrenic symptoms and defects, that the disease has had time to cause the patient's personality.
At long current disease possibleachieve significant improvement in the condition and prevent further development of the disease process. At the same time, a biological therapy for the effective treatment of schizophrenia is not enough and require mandatory psychotherapy (individual, group, family), psychological correction of disorders of memory, attention, thinking, and aimed at human rehabilitation of the complex social activities affected by the disease .