Editing Schizophrenia (section)

===Medication===
[[File:Risperdal tablets.jpg|thumb|left|upright|[[Risperidone]] (trade name Risperdal) is a common [[atypical antipsychotic]] medication.]]

The first-line treatment for schizophrenia is an antipsychotic. The first-generation antipsychotics, now called [[typical antipsychotics]], like [[haloperidol]], are [[dopamine antagonist]]s that block D<sub>2</sub> receptors, and affect the [[neurotransmitter|neurotransmission]] of [[dopamine]]. Those brought out later, the second-generation antipsychotics known as [[atypical antipsychotics]], including [[olanzapine]] and [[risperidone]], can also have an effect on another neurotransmitter, [[serotonin]]. Antipsychotics can reduce the symptoms of anxiety within hours of their use, but, for other symptoms, they may take several days or weeks to reach their full effect.<ref name=RAISE/><ref name=nhsTreatment/> They have little effect on negative and cognitive symptoms, which may be helped by additional psychotherapies and medications.<ref>{{cite journal | vauthors = Ortiz-Orendain J, Covarrubias-Castillo SA, Vazquez-Alvarez AO, Castiello-de Obeso S, Arias Quiñones GE, Seegers M, Colunga-Lozano LE | title = Modafinil for people with schizophrenia or related disorders | journal = The Cochrane Database of Systematic Reviews | volume = 12 | page = CD008661 | date = December 2019 | issue = 12 | pmid = 31828767 | pmc = 6906203 | doi = 10.1002/14651858.CD008661.pub2 }}</ref> There is no single antipsychotic suitable for first-line treatment for everyone, as responses and tolerances vary between people.<ref>{{cite journal | vauthors = Lally J, MacCabe JH | title = Antipsychotic medication in schizophrenia: a review | journal = British Medical Bulletin | volume = 114 | issue = 1 | pages = 169–179 | date = June 2015 | pmid = 25957394 | doi = 10.1093/bmb/ldv017 | doi-access =  }}</ref> Stopping medication may be considered after a single psychotic episode where there has been a full recovery with no symptoms for twelve months. Repeated relapses worsen the long-term outlook and the risk of relapse following a second episode is high, and long-term treatment is usually recommended.<ref>{{cite journal | vauthors = Keks N, Schwartz D, Hope J | title = Stopping and switching antipsychotic drugs | journal = Australian Prescriber | volume = 42 | issue = 5 | pages = 152–157 | date = October 2019 | pmid = 31631928 | pmc = 6787301 | doi = 10.18773/austprescr.2019.052 }}</ref><ref name=Harrow2013>{{cite journal | vauthors = Harrow M, Jobe TH | title = Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? | journal = Schizophrenia Bulletin | volume = 39 | issue = 5 | pages = 962–5 | date = September 2013 | pmid = 23512950 | pmc = 3756791 | doi = 10.1093/schbul/sbt034 }}</ref>

About half of those with schizophrenia will respond favourably to antipsychotics, and have a good return of functioning.<ref>{{cite journal |vauthors=Elkis H, Buckley PF |title=Treatment-Resistant Schizophrenia |journal=The Psychiatric Clinics of North America |volume=39 |issue=2 |pages=239–65 |date=June 2016 |pmid=27216902|doi=10.1016/j.psc.2016.01.006}}</ref> However, positive symptoms persist in up to a third of people. Following two trials of different antipsychotics over six weeks, that also prove ineffective, they will be classed as having treatment-resistant schizophrenia (TRS), and [[clozapine]] will be offered.<ref>{{cite journal |vauthors=Gillespie AL, Samanaite R, Mill J, Egerton A, MacCabe JH |title=Is treatment-resistant schizophrenia categorically distinct from treatment-responsive schizophrenia? a systematic review |journal=BMC Psychiatry |volume=17 |issue=1 |page=12 |date=13 January 2017 |pmid=28086761 |doi=10.1186/s12888-016-1177-y|pmc=5237235 |doi-access=free }}</ref><ref name=Siskind2017/> Clozapine is of benefit to around half of this group although it has the potentially serious side effect of [[agranulocytosis]] (lowered [[white blood cell]] count) in less than 4% of people.<ref name=Lancet2009/><ref name=BMJ07/><ref>{{cite journal | vauthors = Essali A, Al-Haj Haasan N, Li C, Rathbone J | title = Clozapine versus typical neuroleptic medication for schizophrenia | journal = The Cochrane Database of Systematic Reviews | issue = 1 | page = CD000059 | date = January 2009 | volume = 2009 | pmid = 19160174 | doi = 10.1002/14651858.CD000059.pub2 | pmc = 7065592 }}</ref>

About 30 to 50 percent of people with schizophrenia do not accept that they have an illness or comply with their recommended treatment.<ref>{{cite journal | vauthors = Baier M | title = Insight in schizophrenia: a review | journal = Current Psychiatry Reports | volume = 12 | issue = 4 | pages = 356–361 | date = August 2010 | pmid = 20526897 | doi = 10.1007/s11920-010-0125-7 | s2cid = 29323212 }}</ref> For those who are unwilling or unable to take medication regularly, [[Injection (medicine)#Depot|long-acting injections]] of antipsychotics may be used,<ref>{{cite journal | vauthors = Peters L, Krogmann A, von Hardenberg L, Bödeker K, Nöhles VB, Correll CU | title = Long-Acting Injections in Schizophrenia: a 3-Year Update on Randomized Controlled Trials Published January 2016 – March 2019 | journal = Current Psychiatry Reports | volume = 21 | issue = 12 | pages = 124 | date = November 2019 | pmid = 31745659 | doi = 10.1007/s11920-019-1114-0 | s2cid = 208144438 }}</ref> which reduce the risk of relapse to a greater degree than oral medications.<ref>{{cite journal | vauthors = Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G, Davis JM | title = Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis | journal = Lancet | volume = 379 | issue = 9831 | pages = 2063–2071 | date = June 2012 | pmid = 22560607 | doi = 10.1016/S0140-6736(12)60239-6 | s2cid = 2018124 }}</ref> When used in combination with psychosocial interventions, they may improve long-term [[Adherence (medicine)|adherence]] to treatment.<ref name=Depo06>{{cite journal | vauthors = McEvoy JP | title = Risks versus benefits of different types of long-acting injectable antipsychotics | journal = The Journal of Clinical Psychiatry | volume = 67 | issue = Suppl 5 | pages = 15–18 | year = 2006 | pmid = 16822092 }}</ref>

The [[fixed-dose combination]] medication [[xanomeline/trospium chloride]] (Cobenfy) was approved for medical use in the United States in September 2024.<ref name="FDA PR 20240926">{{cite press release | title=FDA Approves Drug with New Mechanism of Action for Treatment of Schizophrenia | website=U.S. [[Food and Drug Administration]] (FDA) | date=26 September 2024 | url=https://www.fda.gov/news-events/press-announcements/fda-approves-drug-new-mechanism-action-treatment-schizophrenia | access-date=27 September 2024 | archive-date=27 September 2024 | archive-url=https://web.archive.org/web/20240927004824/https://www.fda.gov/news-events/press-announcements/fda-approves-drug-new-mechanism-action-treatment-schizophrenia | url-status=live }} {{PD-notice}}</ref><ref>{{cite press release | title=U.S. Food and Drug Administration Approves Bristol Myers Squibb's Cobenfy (xanomeline and trospium chloride), a First-In-Class Muscarinic Agonist for the Treatment of Schizophrenia in Adults | publisher=Bristol Myers Squibb | via=Business Wire | date=27 September 2024 | url=https://www.businesswire.com/news/home/20240925382351/en/U.S.-Food-and-Drug-Administration-Approves-Bristol-Myers-Squibb%E2%80%99s-COBENFY%E2%84%A2-xanomeline-and-trospium-chloride-a-First-In-Class-Muscarinic-Agonist-for-the-Treatment-of-Schizophrenia-in-Adults | access-date=27 September 2024}}</ref> It is the first [[cholinergic agonist]] approved by the US [[Food and Drug Administration]] (FDA) to treat schizophrenia.<ref name="FDA PR 20240926" />

Negative and cognitive symptoms are an unmet clinical need in antipsychotic-based treatment approaches. Psychostimulant drugs have been found effective in the treatment of negative symptoms, but are rarely prescribed due to concerns about the excacerbation of positive symptoms.<ref name="sciencedirect.com"/> It is possible that low-dose psychedelic therapies could be of benefit in schizophrenia through their prosocial and procognitive effects, although there is a serious risk that high dose psychedelic therapies could lead to worsening of positive symptoms.<ref>{{Cite journal |last1=Sapienza |first1=Jacopo |last2=Martini |first2=Francesca |last3=Comai |first3=Stefano |last4=Cavallaro |first4=Roberto |last5=Spangaro |first5=Marco |last6=De Gregorio |first6=Danilo |last7=Bosia |first7=Marta |date=2024-09-18 |title=Psychedelics and schizophrenia: a double-edged sword |url=https://www.nature.com/articles/s41380-024-02743-x |journal=Molecular Psychiatry |volume=30 |issue=2 |language=en |pages=679–692 |doi=10.1038/s41380-024-02743-x |pmid=39294303 |issn=1476-5578}}</ref>

====Adverse effects====
{{Further information|Antipsychotic#Adverse effects}}

[[Extrapyramidal symptoms]], including [[akathisia#Drug-induced|akathisia]], are associated with all commercially available [[antipsychotic]] to varying degrees.<ref name=Chow2020>{{cite journal |vauthors=Chow CL, Kadouh NK, Bostwick JR, VandenBerg AM |date=June 2020 |title=Akathisia and Newer Second-Generation Antipsychotic Drugs: A Review of Current Evidence |url= |journal=Pharmacotherapy |volume=40 |issue=6 |pages=565–574 |doi=10.1002/phar.2404 |pmid=32342999|hdl=2027.42/155998 |s2cid=216596357 |hdl-access=free }}</ref>{{Rp|page=566|quote=However, EPS, particularly akathisia, occurs, to some degree, with all commercially available SGAs.}} There is little evidence that second generation antipsychotics have reduced levels of extrapyramidical symptoms compared to typical antipsychotics.<ref name=Chow2020/>{{Rp|page=566|quote=Furthermore, previous meta-analyses and systematic reviews comparing the safety and tolerability of FGAs and SGAs have found little evidence to support the notion that as a class, SGAs pose a reduced risk for EPS com- pared with FGAs. However, high-potency FGAs do tend to pose the greatest risk for EPS.}} [[Tardive dyskinesia]] can occur due to long-term use of antipsychotics, developing after months or years of use.<ref>{{cite journal |vauthors=Carbon M, Kane JM, Leucht S, Correll CU |date=October 2018 |title=Tardive dyskinesia risk with first- and second-generation antipsychotics in comparative randomized controlled trials: a meta-analysis |journal=World Psychiatry |volume=17 |issue=3 |pages=330–340 |doi=10.1002/wps.20579 |pmc=6127753 |pmid=30192088}}</ref> The antipsychotic [[clozapine]] is also associated with [[thromboembolism]] (including [[pulmonary embolism]]), [[myocarditis]], and [[cardiomyopathy]].