Taking Charge of Your Health

– [Voiceover] So, managing Schizophrenia is a tricky business. Typically, the main problem
that we want to try to manage are psychotic symptoms, like
hallucinations and delusions using medications that are
called anti-psychotics. Now, anti-psychotics can be
broken up into older drugs, sometimes called first
generation anti-psychotics, or we can shorten that to FGA. And these guys are also
called typical and then the newer drugs are called second generation
anti-psychotics, or SGAs, and these ones can also
be called atypical. Now, most of these work by
blocking a specific type of receptor called dopamine receptor D2. Were not exactly sure why
blocking these receptors has been shown to help with
psychotic symptoms, we just known that they’re helpful for most of the people that take them. Now, SGAs are actually usually
preferred over FGAs because they usually have less side effects that induce movement disorders,
like, Parkinsonism. These movement type side effects are also called extrapyramidal side effects. And the main difference
between FGAs and SGAs is thought to be that SGAs
have this tendency to block serotonin receptor 5HT2 with a higher potency than FGAs and block dopamine receptors less than FGAs. This has been shown to lead to less extrapyramidal side effects. That’s not to say that there are no side effects at all, though. The SGA side effects will
depend on their type. Okay. So, depending on
what stage the person’s in, we’ll try to focus on
different treatments. So, let’s say that someone has their first episode of psychosis, and we want to treat it . We would say that they’re
in the acute phase and the acute phase is the
very early stages where the person is having their
first episodes of psychosis, or this also includes when
they’re relapsing after not having episodes of
psychosis for a while. And our goal here is to
reduce the severity of psychotic thoughts and behaviors. In patients that are having
their first episodes often respond better than those
that are relapsing, and so they might be able
to take lower doses of their medication. But because everybody
responds so differently to anti-psychotic medications,
they’ll often be “trialed” to find the right anti-psychotic
for each person. So, let’s say that we give
our patient one of our FGAs, this seems to help with
their psychotic symptoms, meaning things like
delusions and hallucinations, tend to be down, but they’re
experiencing spasms and movements as a side effect. Knowing this, we might switch to SGAs that tend to produce less movement
related side effects. And after these trials
of different medications, we eventually find the
ones that are right for this patient and their symptoms
are reasonably controlled. At this point, there are
essentially recovered from the acute phase and enter
the stable/maintenance phase. And our goal in this phase
is to prevent a relapse. So, we’re minimizing
symptoms and we’re trying to improve any areas of life
that have been impaired, like relationships or work capabilities. At this point, therapy might be added into the treatment plan to help. And we might focus on things
like stress reduction, as well as creating support
networks of family and friends. And finally, emphasizing the importance of minimizing the use of drugs and alcohol. Now, in this phase of treatment, even though psychotic symptoms
might be under control, managing side effects of
the medications, themselves, is a really important part
of managing Schizophrenia and improving quality of life. Now, one helpful mnemonic
that might help us look for side effects is SHE WAS ME,
which stands for the following: Sedation, which is a state
of being calm or sleeping, hypotension, which is low blood pressure, extrapyramidal, movement related, wieght, as in weight gain, anticholinergic, things like dry mouth, blurred vision, constipation, sexual dysfuntion, metabolic,
or glucose tolerance, and endocrine, like
hyperprolactinemia, which is high levels of prolactine in the blood. And a lot of times,
Schizophrenia also comes with other symptoms, besides psychosis, right? Like Depression and Manic Depression. And Depression will
usually be treated with Anti-Depressants, where
Manic-Depressive episodes can be treated with mood stablizers. So, with all this known, what’s usually the prognosis for patients? Well, unfortunately, relapse
are relatively common. Even those that are on
anti-psychotic medications, see relapses about 20% of the time. Those not being treated with
anti-psychotics, though, are significantly higher and have about a 75% chance of relapse. Additionally, after each
relapse, the stable baseline of functioning usually gets worse. So, if you are currently
stable and being treated, but still have some side effects and symptoms, after an episode of psychosis in relapse, you might come back to a baseline that’s worse than before. And there are a couple of
factors that seems to be associated with a worse prognosis, and simply being male is one of them, but we’re not quite sure why. An early onset seems to also be associated with worse prognosis. And, finally, a strong family
history of Schizophrenia, meaning the more family members
that have Schizophrenia, the worse the outlook
on your prognosis is. With that said, though, positive symptoms, like delusions, hallucinations, and disorganized thinking and behavior typically improve over
time and with treatment. Unfortunately, though,
negative symptoms that tend to be socially
debilitating, like apathy or flat affect, tend to get worse over time. And it’s also unclear at this
point why this is the case. And, finally, another difficulty
with treating Schizophrenia is non-compliance with
medications and treatments. This is a huge, huge issue. In about 50% of patients within
the first one to two years will be non-compliant in some way, which tends to make the
prognosis even worse.

18 thoughts on “Schizophrenia treatment | Mental health | NCLEX-RN | Khan Academy

  1. as a medical student who has watched a lot of videos, I can't emphasize enough on how well this topic was presented. THANK YOU. The writing was in sync with the verbal explanations and everything was neatly organised. The pacing of speech was just at the right speed with proper articulation. The information is what I needed too. Thank you khan academy and thank you presenter.

  2. Thank you so much for posting your psych videos! They are very helpful and will hopefully help me pass my nursing psych test!!

  3. Why didn't you mention the link between schizophrenia and gluten?

    Jackson J, Eaton W, Cascella N, Fasano A, Kelly D (2006) Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity []

  4. Hello, does FGA blocks dopamine receptor more (written) or less (verbally) than SGA at 1.18 ? Thank you 🙂

  5. you just lost a subscriber. deleting a comment, that contains no profanity, and held a lot of truth, makes this channel a censored truth, and one that can not be fully trusted. Look for the truth, the lies will line your way my friends

  6. The cure is Jesus, this is a demonic spirit that can only be cast out in the name of Jesus, repent from your sins and ask Jesus into your life is all you need. These drugs were created specifically just to addict and not cure. John 13:16 I'am the truth the way and the life.

  7. I'm so used to hearing the Osmosis guy's voice that I didn't realize that this was Khan Academy and not Osmosis when he started speaking. My nursing school education is 90% Osmosis, I swear.

  8. I remember I used to watch khan academy in high school about calculus. I didn't realize they did nursing as well!

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