Treatment & other helpful information

Treatment

Medical Care

* If patients are suicidal, homicidal, or gravely disabled, admit them to an inpatient psychiatric unit. Inpatient treatment is mandatory for patients who are dangerous to themselves or others and for patients who cannot take care of themselves.
* Patients who have schizoaffective disorder can greatly benefit from psychotherapy and well as psychoeducational programs.
o They should receive therapy that involves their families, develops their social skills, and focuses on cognitive rehabilitation.
o Psychotherapies should include supportive therapy and assertive community therapy in addition to individual and group forms of therapy and rehabilitation programs.
* Family involvement is needed in the treatment of this particular disorder.
* Treatment includes education about the disorder and its treatment, family assistance in compliance with medications and appointments, and maintenance of structured daily activities (ie, schedule of daily events) for the patient.

Consultations

* Consult a neurologist to rule out neurological disease.

Diet

* No specific diet is recommended for patients with schizoaffective disorder.

Activity

* Restrict activity if patients represent a danger to themselves or to others or if they are gravely disabled. Otherwise, encourage patients who are schizoaffective to continue their normal routines and strengthen their social skills whenever possible.

Medication

Several medications are used to treat schizoaffective disorder. Agent selection depends on whether the depressive or manic subtype is present. Early treatment with medication along with good premorbid function often improves outcomes. In the depressive subtype, combinations of antidepressants (eg, sertraline, fluoxetine) plus an antipsychotic (eg, haloperidol, risperidone, olanzapine) are used. In refractory cases, clozapine has been used as an antipsychotic agent. In the manic subtype, combinations of mood stabilizers (eg, lithium, carbamazepine, divalproex) plus an antipsychotic are used. Of the many medications and combinations available to treat schizoaffective disorder, a few are reviewed below.
Antipsychotics

These agents ameliorate psychosis and aggressive behavior.

Haloperidol (Haldol)

For management of psychosis. Also for motor and vocal tics in children and adults. Mechanism of action not clearly established, but has selective effect on CNS by competitively blocking postsynaptic dopamine (D2) receptors in mesolimbic dopaminergic system; increases in dopamine turnover responsible for tranquilizing effect. With subchronic therapy, depolarization blockade and D2 postsynaptic blockade responsible for antipsychotic action.

Risperidone (Risperdal)

Selective monoaminergic antagonist binds to dopamine D2 receptor with 20 times lower affinity than to 5-HT2 receptors. Also binds to alpha1-adrenergic receptors with lower affinity to H1-histaminergic and alpha2-adrenergic receptors. Improves negative symptoms of psychosis and decreases occurrence of extrapyramidal effects.
Also available in long-acting IM formulation (Risperdal Consta).

Olanzapine (Zyprexa)

Atypical antipsychotic with broad pharmacologic profile across receptor systems (eg, serotonin, dopamine, cholinergic muscarinic, alpha adrenergic, histamine). Antipsychotic effect from antagonism of dopamine and serotonin type 2 receptors. Indicated for treatment of psychosis and bipolar disorder.

Clozapine (Clozaril)

Weak D2-receptor and D1-receptor blocking activity, but noradrenolytic, anticholinergic, antihistaminic, and arousal reaction inhibiting effects are significant. Antiserotonergic properties. Risk of agranulocytosis limits use to patients nonresponsive to or intolerant of classic neuroleptic agents.

Quetiapine (Seroquel)

Newer antipsychotic for long-term management. May antagonize dopamine and serotonin effects. Improvements over earlier antipsychotics include fewer anticholinergic effects and less dystonia, parkinsonism, and tardive dyskinesia.

Ziprasidone (Geodon)

Antagonizes dopamine D2, D3, 5-HT2A, 5-HT2C, 5-HT1A, 5-HT1D, alpha1-adrenergic. Has moderate antagonistic effect for histamine H1. Moderately inhibits reuptake of serotonin and norepinephrine.

Aripiprazole (Abilify)

Improves positive and negative schizophrenic symptoms. Mechanism of action unknown, but hypothesized to differ from that of other antipsychotics. Aripiprazole thought to be partial dopamine (D2) and serotonin (5HT1A) agonist, and antagonizes serotonin (5HT2A). No QTc-interval prolongation noted in clinical trials.

Antidepressants

These agents decrease aggression and treat the underlying illness.

Selective serotonin reuptake inhibitors (SSRIs) are greatly preferred over the other classes of antidepressants. Because the adverse-effect profile of SSRIs is less prominent than the profiles of other drugs, improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with tricyclic antidepressants. Arrhythmia risk is especially pertinent in overdose, and suicide risk must always be considered when one treats a child or adolescent with a mood disorder.

Physicians are advised to be aware of the following information and to use appropriate caution when they consider treatment with SSRIs in the pediatric population.

In December 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) issued an advisory that most SSRIs are not suitable for use by persons younger than 18 years for treatment of depressive illness. After review, this agency decided that the risks to pediatric patients outweigh the benefits of treatment with SSRIs, except fluoxetine (Prozac), which appears to have a positive risk-benefit ratio in the treatment of depressive illness in patients younger than 18 years.

In October 2003, the US Food and Drug Administration (FDA) issued a public health advisory regarding reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder. This advisory reported suicidality (both ideation and attempts) in clinical trials of various antidepressant drugs in pediatric patients. The FDA has asked that additional studies be performed because suicidality occurred in both treated and untreated patients with major depression and thus could not be definitively linked to drug treatment.

For more information go to the following website: http://emedicine.medscape.com/article/294763-treatment

I find it neglectful that under Medical care they write about psychotherapy and education rather than getting REAL medical care. How about being monitored for the diabetes, heart disease, artherosclerosis, eye problems, hypothyroid and so on which the medications tend to cause? What about the 100 and more illnesses that can have the symptoms of schizoaffective that should be checked? Not one item under medical care is MEDICAL!

Then under activity they don't even say EXERCISE?

Then there is diet. What about the problem with obesity? What about the potential problem we can have with gluten and casein? What about trying food elimination? What about additional nutrition we often need whether because of genetics (such as needing more B vitamins) or whatever else?

With guidelines like this, no wonder so many of us remain sick! I was very lucky to have a family with the money to get better treatment! This treatment listed is inadequate and sad. I almost think it is something promoted by the pharmaceutical industry and insurance rather than something actually caring about the PERSON with the symptoms.

Can this post be un-sticky'd? Its a poor introduction to the subject of treatment. Looks like the content was just ripped from the URL anyway.

[quote="Butterfly Faerie"]Treatment

Medical Care


Diet

* No specific diet is recommended for patients with schizoaffective disorder.

Activity/quote]


This is utter #######4. If it wasn't for my persistent research into nutrition, they would probably have drugged me by now. Instead, I found out what is really the matter. And nutrition is the answer.

Never, ever trust the lies psychiatrists keep telling.

Let's start our own research and put our own remedies that we've found for our loved ones.
That's why I'm here; to better arm myself so I can help my husband battle his struggle. I agree with the family needing to be there. I'm ready, I just need the tools!

thanks for this. i'm learning about treatment and b-100 and magnesium and fish oil seem as important to my mental health as psych meds.

the orthomolecular stuff has interested me for many years and makes sense. i can't go off meds that are working for me and try something new since i have two kids and i have to think of them. but it's something i will probably try when they are grown and gone.

thanks for this thread.

I would never discontinue my anti psychotic and anti depressant treatments. I am no longer that dumb. I've gone that route before to disastrous results. But, that does not mean I don't have other coping mechanisms up my sleeve like: mindfulness meditation twice daily, yoga daily, piano practice daily, prayer and worship constantly, pet ownership, (I have a cat), fish oil capsules three times daily, foam rolling as needed, reading every day, volunteering everyday, 9.5 hours of sleep a night or at least in a 24 hour period, good nutrition, and just a general attitude of gratitude. These practices keep me hallucination and paranoia free. I'm as near normal as can be. I do have religious delusions of reference, but, these do not bother me in the least. As a matter of fact, they help me. I keep all of my Dr. and nurse appointments and I take all of my meds religiously. All of this is what keeps me as well as I am.

Oh, I almost forgot. I also eat a handful of almonds every day. (Good for the memory). And I eat a tablespoon of white sesame seeds every day. (Tons of calcium and magnesium). And I take a 30 mg tablet of zinc a day too. (The sesame seeds and zinc are good for hair and nail growth.)

ginalovea wrote:I would never discontinue my anti psychotic and anti depressant treatments. I am no longer that dumb. I've gone that route before to disastrous results. But, that does not mean I don't have other coping mechanisms up my sleeve like: mindfulness meditation twice daily, yoga daily, piano practice daily, prayer and worship constantly, pet ownership, (I have a cat), fish oil capsules three times daily, foam rolling as needed, reading every day, volunteering everyday, 9.5 hours of sleep a night or at least in a 24 hour period, good nutrition, and just a general attitude of gratitude. These practices keep me hallucination and paranoia free. I'm as near normal as can be. I do have religious delusions of reference, but, these do not bother me in the least. As a matter of fact, they help me. I keep all of my Dr. and nurse appointments and I take all of my meds religiously. All of this is what keeps me as well as I am.

Thats some rehiment gina wow. I think i might have to borrow some of these tactics to statt dealing with my illness. Ive been mostly neglecting it up until now. How much has all this been helping? I hope a lot

I would like to add under the treatment area that there is a newer Antipsychotic agent specifically FDA approved for the treatment of Schizoaffective disorder. It is Paliperidone (Invega). It is available as a special pill that releases the agent over 24 hours and as a month injection called Invega Sustenna that lasts for about a month. I personally am on the long acting injection as it has the absolute minimum side effects. This drug is based off of risperdal.