The Whole Person Approach

MEDICATION

You may choose to:
- Find out about the latest medical treatments for severe mental illness
- Ask your doctor to prescribe the most appropriate medication for you as an individual
- Find out about the side effects and management requirements of your medication and talk to your doctor or nurse about them
- Take the right amount of medication which has the most benefit for you

Medication forms a significant part of treatment for many clients and is often not an "either/or issue". Medication must be effective and have minimal side effects.

Most people do not receive modern mental health treatment. In recent years, a number of new medicines have become available which offer more positive action in relation to both positive and negative symptoms whilst having less side-effects than older medication. Unfortunately, too often, these newer medicines are not prescribed.

Medication
Medicines are available in various forms (tablets, injections or liquids). These drugs can have side-effects for which additional medication can be prescribed.

The National Institute for Clinical Excellence has provided guidance on the use of newer (Atypical) Antipsychotic Drugs for the Treatment of Schizophrenia (Technology Appraisal Guidelines No.43) should be considered alongside the existing traditional medicines as one of the first choice options for treatment.

What does a Clinical Guideline Really Mean?

• Clinical guidelines are recommendations on the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales. They sit alongside, but do not replace, the knowledge and skills of experienced health professionals
  
• Once NICE guidance is published, health professionals are expected to take the Institute's guidance fully into account when exercising their clinical judgement. However, NICE guidance does not override the individual responsibility of health professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their guardian or carer. For example, if an individual patient was allergic to a drug recommended in the guideline, it would be appropriate for their health professional to prescribe an alternative.

NICE Clinical Guideline on Schizophrenia

• Recognises that 1:100 will experience schizophrenia
  
• Recognises that with appropriate treatment, the majority of people will improve or recover
  

This guidance recommends:

• Early treatment
  
• Holistic care in recovery
  
• Partnership working - client and services
  
• Good information
  
• Full Assessment
  
• Choice of treatment / medication and Advance Directives
  

What is the Guidance to Clients in the Use of Atypicals?

• Your doctor should discuss with you which antipsychotic drug you should take. Your doctor should explain the benefits and side effects of the drugs, and if appropriate consult your advocate or carer. Decisions about which drugs you are prescribed should be made jointly with you and your doctor, and you should understand what the side effects of the medicine might be.
• If you have been newly diagnosed with schizophrenia then your doctor should consider prescribing you one of the following atypical (newer) oral antipsychotic drugs: amisulpride, olanzapine, quetiapine, risperidone or zotepine.
• If you are currently taking typical (older) antipsychotic drugs that are controlling your symptoms of schizophrenia but are causing side effects that you and your doctor agree are unacceptable, then your doctor should consider prescribing you an oral atypical antipsychotic (amisulpride, olanzapine, quetiapine, risperidone, sertindole or zotepine).
• NICE does not recommend that you change to one of the atypical (newer) antipsychotic drugs if you are currently taking typical (older) antipsychotics that are controlling your symptoms of schizophrenia and are not causing unacceptable side effects.
• If there is evidence that you have what is known as treatment-resistant schizophrenia or TRS (where the drugs you are taking are not controlling your symptoms of schizophrenia), then your doctor should prescribe you clozapine.
• If more than one of the atypical antipsychotic drugs is suitable for you, your doctor should prescribe the least expensive drug.
• If it is not possible for you to have a full discussion with your doctor about which drug should be prescribed, for example because you are having a relapse or acute schizophrenic episode, then your doctor may prescribe an atypical antipsychotic because of the lower risk of side effects. In these circumstances, your doctor should discuss your drug treatment with your carer or advocate if possible and appropriate.
• It is recommended that "advanced directives" are developed and kept in your care programme. Advanced directives are instructions written by you and your healthcare team, that describe what you would like to happen if you are not able to be involved in a discussion with your doctor at a time you require treatment (for example during a relapse of acute schizophrenic episode).
• Treatment with antipsychotic drugs should be part of an overall package of care that addresses your medical, emotional and social needs. Your doctor and key worker should monitor, on an ongoing basis, your progress and how well the drugs you are taking are working, and any side effects you are experiencing. This is particularly important if you have just changed from one antipsychotic to another.
• A typical and typical antipsychotic drugs should not be prescribed at the same time except for short periods if you are changing drugs.
  

Side Effects
For some patients these side effects can be more isolating and socially unacceptable than the schizophrenia itself. These side effects may include shaking or trembling, muscle twitches or spasms that can be permanent or can disappear after stopping the drugs. Other side effects may be blurred vision, a dry mouth, weight gain or fits. For many people these traditional medicines control the symptoms of their schizophrenia without side effects, however for others the side effects they experience are so distressing that they may stop taking their medicine which means the symptoms of their schizophrenia can become uncontrolled to the extent that they require hospital care.

Comments from Clients

"The old drugs should be banned. Everyone should be able to get the newer, atypical drugs, regardless of how much they cost - they save lives." - Ann from Wales who spent years in a special hospital until a switch to an atypical enabled her to leave

"It's obvious that the new drugs work. People like me are working, have a social life, and just live our lives. That isn't possible on the old drugs - you feel like you're reduced to jelly." - Martin from Kent who experienced severe side effects on older medicines.

"New medication has allowed both me and my husband to have a better quality of life. In the year before I started taking atypical medication I attempted to commit suicide 12 times and was in hospital six times. Since I began taking the medication 18 months ago, I have not been in hospital and am able to do voluntary work." - Diana from Southampton.

"The modern medication has really worked for me. I've been well now for three years but before that I had a terrible time on the older medications, with symptoms like Parkinson's disease." Joe, 26, from London.

To read Hafal’s guide to atypical antipsychotics for schizophrenia, click here.