Medication

Medication

People who experience the symptoms of psychosis are treated with antipsychotic drugs.

Someone who has been given a diagnosis of schizophrenia or schizoaffective disorder may be prescribed antipsychotic medication for a number of years to prevent relapse.

Antidepressants and/or drugs that tackle anxiety may also be prescribed if someone experiences depression and/or other 'negative' symptoms of schizophrenia after an episode of psychosis – apathy, difficulty concentrating and lack of motivation, for example.

People who have been given a diagnosis of bipolar disorder will often be prescribed a cocktail of medication. This may include an antipsychotic, mood stabilising drugs and antidepressants. The different types of drugs may be prescribed at different times, depending on the symptoms. People may also be prescribed antipsychotics and/or mood stabilisers in the longer term to prevent another episode.

Your relative should be given information about all the drugs they are prescribed, including potential side effects and any health risks, and they should be involved in discussions and decisions about medication. Family members and other carers should also be included in these discussions, unless the person who is unwell does not want them to be. It's important to ask for information and clarification: the 2012 National Audit of Schizophrenia (carried out by the Royal College of Psychiatrists in collaboration with various other organisations) showed that many people did not understand information they had been given about drugs and did not always feel involved in decisions about their medication.

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Searching for new drugs

Researchers around the world continue to search for different sorts of drugs to treat the symptoms of psychosis and serious mental illness. Not everyone responds to existing antipsychotic medication and researchers are particularly keen to find effective drugs to treat the 'negative' symptoms of schizophrenia (apathy, difficulty concentrating and lack of motivation, for example) that may continue between episodes of psychosis. A lot of work still needs to be carried out however, before new drugs are routinely available.

Antipsychotics work by changing the effect of chemicals (called neurotransmitters) in the brain. Most existing antipsychotics 'dampen down' the effect of the neurotransmitter dopamine and target the system that dopamine uses to travel around the brain. Research has shown that the abnormal production of too much dopamine can lead to hallucinations, delusions and confused thinking. People who may be at risk of developing the symptoms of psychosis also have increased levels of dopamine in their brain.

Researchers are interested in testing drugs that affect other neurotransmitters that may somehow be involved in the development of the symptoms of psychosis and serious mental illness. These include glutamate (that stimulates the brain) and scientists are investigating the effects of drugs that might target the system that helps glutamate travel around the brain.

Trials have shown that the antibiotic minocycline can help improve negative symptoms experienced by people who have a diagnosis of schizophrenia. Researchers continue to test the drug to try to work out why minocycline makes a difference – whether it works within the system that supports glutamate in the brain, or whether the drug's anti-inflammatory properties are important.

There are also trials testing the effectiveness of other anti-inflammatory agents such as aspirin and statins. This is because some scientists think inflammation might play a role in the development of schizophrenia.

There are studies examining many other substances and compounds – whether adding folic acid to someone's prescription might be worthwhile, for example, and what difference the hormone oxytocin might make. Because oxytocin has been shown to boost trust and empathy, some researchers think it might help make social interaction easier for people who are experiencing the negative symptoms of schizophrenia.

Several drugs licensed to treat other illnesses and conditions have been/continue to be tested in trials to see if they can help people with schizophrenia concentrate better and improve their thinking skills and memory.

Modafanil is a stimulant sometimes prescribed off licence to people with schizophrenia who are experiencing fatigue as a result of the antipsychotics they are taking. Some researchers think this drug may improve people's attention and concentration skills, though there hasn't been enough research to prove whether that is the case. One study is investigating the use of modafinil together with brain training exercises.

Other researchers are testing drugs used to treat Alzheimer's disease (acetylcholinesterase inhibitors) to see if they can improve memory in people with schizophrenia.

Visit the NHS Choices website to find out more about different clinical trials testing medication for schizophrenia and bipolar disorder.

Or visit the UK Clinical Research Network Portfolio Database where clinical trials being carried out within NHS organisations in England, Wales, Scotland and Northern Ireland are listed.

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Rapid tranquilisation

When people are in hospital and very unwell, they may be sedated with drugs if they behaved in a violent or disturbed way. Guidance from the National Institute for Health and Care Excellence (NICE) details when and how this should happen.

‘Rapid tranquilisation’ can be achieved using different medications, including benzodiazepines, antipsychotic medication or antihistamines. If people are experiencing the symptoms of psychosis, doctors will normally use antipsychotic medication and a benzodiazepine. The medication will by given orally or injected.

If rapid tranquilisation is used, there should be a review afterwards to find out what happened leading up to the sedation, and during the tranquilisation. Family members and other carers should be involved in this review, unless the individual who was sedated does not want that to happen.

For more information, read what the NICE guideline says, Violence: managing disturbed/violent behaviour. Information for the public.

 

 


This page was last updated 5 April 2013.
There are no plans to update the page because funding for mentalhealthcare.org.uk ended in April 2013.

We will, however, continue to regularly check that all links are working.
Links on this page last checked: 2 December 2013
Next links check due: April 2014


Other useful websites

Medicines and Healthcare products Regulatory Agency (MHRA)

All medicines available in the UK (over the counter or on prescription) are checked for safety and licensed by the MHRA.


Yellow Card: Helping to make medicines safer

Use this site to report suspected side effects to any medication. The Yellow Card scheme helps the Medicines and Healthcare products Regulatory Agency monitor the safety of medicines.


Other useful websites

The British National Formulary

The BNF is a joint publication of the British Medical Association and the Royal Pharmaceutical Society. It aims to provide prescribers, pharmacists and other healthcare professionals with sound up-to-date information about the use of medicines. Anyone can access the information via the website after registering with an email and password.


NHS Choices Medicines A-Z

Information about individual medicines and medicines prescribed for different conditions.


Resources

The Maudsley Prescribing Guidelines in Psychiatry
11th edition
David Taylor, Carol Paton and Shitij Kapur,
published by Wiley-Blackwell, March 2012.
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