Rational drug use in schizophrenia

Schizophrenia is a psychiatric disorder that is chronic course and has inşuence on thought, behavior, and affect in various forms. It is a heterogeneous clinical picture from the point of view of onset, course, and clinical aspect. Its clinical picture and course were determined with positive, negative, cognitive, depressive, anxiety, and agitation-aggression symptoms. The psychopharmacology of schizophrenia is a developing field rapidly. Many researches have been done in this field and the novel drugs have been gone in using to the treatment. But schizophrenia keeps on still being a psychiatric disorder has not successful medical treatment in spite of these developments, and an expectation of ideal drug (antipsychotic) has been continued. At present, the classical (typical) and new generation (atypical) antipsychotic drugs have been used in treatment of schizophrenia. STEPS rules must be used in which drug will choose for treatment. Safety (S) includes the therapeutic index of drug, drug-drug interaction, pharmacodynamics and pharmacokinetic characteristics of drug. Tolerability (T) is concerned with side effects of the drug. Efficacy (E) shows the effect fields, response ratio to treatment, the usable of maintenance and prophylactic treatment of drug. Payment (P) includes the direct and indirect effects to expenses of the drug. Simplicity (S) means in single dose the application of the drug, being various forms of the drug, such as oral, parenteral, long action. The main rule of drug choosing is minimum side effects and maximum efficacy. In drug choosing, the response to former drug, the sensitivity to the side effects of drug, and clinical picture of disorder must be taken into consideration. It is suggested that the members of family also participated in drug choosing. There is no enough evidence to give preference to new generation antipsychotic drugs. There are some main principles in related to the antipsychotics used in schizophrenia treatment: a) identifying target symptoms, b) to use antipsychotic drug, c) observation the first reaction, and d) to continue the using antipsychotic drug in sufficient dose and period of time. If this trial is useless,an antipsychotic from different class must be chosen, at the sometimes it is favorable that to look for comorbid disorders. In the treatment process of patients with schizophrenia, the maintenance treatment is one of the most important difficulties. Fifty and eighty percent of patients with schizophrenia do not believe that they are ill. There is the lack of insight in them, and they reject to take medicine, especially oral. As a result, they are not adherence to treatment. Depot or long action antipsychotic drugs can be a starting point to take medicine as oral. Depot or long action antipsychotic drugs have some advantages, such as a) non-adherence is noticed easily, b) what cause is related to relapse that is realized, c) relapse risk is decreased, d) using simple, e) regularly interview with patient and his family, f) gives opportunity for psycho-education, g) more stable plasma concentration than fast action forms, h) more efficacy for a long time. Although non-pharmacological approaches have positive effects to provide adherence, but only it is not sufficient. In schizophrenia treatment, the characteristics of chosen drug and the guarantee to be found the drug in plasma are an important issue in patient adherence and it’s continue.