These are the most commonly used drugs for schizophrenia.

Although they have several drawbacks and side effects, their use can be very useful.

Schizophrenia is one of the most well-known mental disorders in history, and even today it receives a lot of attention. and even today it receives a lot of attention. The presence of hallucinations, delusions and disorganized behaviors, together with a possible negative symptomatology such as alogia, has generated through the ages a deep suffering to those who suffer from it, being often stigmatized and institutionalized.

It would not be until the appearance of the first psychotropic drugs that its symptoms would not begin to be controlled effectively. Since then, a large number of substances have been researched and synthesized whose main objective is to control the symptoms of schizophrenia. In fact, even today, pharmacological treatment is still a fundamental element. In this article we are going to make a small review of the most used drugs against schizophrenia. the most commonly used drugs against schizophreniaas well as their disadvantages and limitations.

Antipsychotics: basic operation

Antipsychotics or neuroleptics are a group of drugs that have as their main objective the treatment of psychotic symptomatology by means of chemical changes in the brain.. Their mechanism of action is based on the regulation of dopamine levels in the brain.

The main one is the mesolimbic pathway, which in patients with schizophrenia presents an excess of dopamine that would end up generating the experience of positive symptoms such as hallucinations. At this point, all existing antipsychotics aim to reduce the amount of dopamine in this area in order to reduce psychotic symptoms, acting specifically on D2 receptors, which it blocks.receptors, which it blocks.

The first antipsychotics discovered worked very well in this regard, causing a great decrease in positive psychotic symptoms. However, there is another pathway that is also of great importance: the mesocortical pathway. This pathway has in subjects with schizophrenia a decrease of dopamine that causes the subject to manifest negative symptoms such as alogia or alopecia. negative symptoms such as alogia or poverty of thought and other alterations and other alterations such as withdrawal and loss of abilities.

Although typical antipsychotics have the function of reducing the level of dopamine in the mesolimbic pathway, the fact is that they exert their action in a non-specific way, causing this reduction to occur in other nervous pathways and even in other parts of the organism. Among the affected pathways would be the mesocortical.

Considering that the negative symptoms are caused by an absence or deficit of dopamine in it, the use of typical neuroleptics will not only have no effect but may actually impair and increase the negative symptoms. and increase the negative symptoms. In addition, other pathways that act in a normative way are also negatively affected, which can generate very annoying secondary symptoms that can interfere with daily life. For this reason, research was directed towards the search for alternatives, and over time the so-called atypical neuroleptics were developed.

These are known to act also as dopamine D2 receptor agonists, like the typical ones, but also acting on the serotonin level. but also acting on the level of serotonin in the brain.. Taking into account that serotonin has an inhibitory effect on dopamine secretion and that in the cortex there is a much higher level of serotonergic receptors than dopaminergic receptors, reducing serotonin will mean that although the drug lowers dopamine in the cortex, the inhibition of an inhibitor will eventually cause the levels to be maintained. Thus, the level of dopamine in the mesolimbic pathway is reduced but not in the mesocortical pathway, while secondary symptoms from other pathways are also reduced.

The most commonly used psychotropic drugs for schizophrenia

Although historically typical antipsychotics have been more widely used, the fact is that nowadays, due to the lower number of secondary symptoms and their greater effect on negative symptomatology, the most common antipsychotic drugs in clinical practice are those that have been used to treat schizophrenia, in clinical practice it is more common to find typical antipsychotics in clinical practice.. Despite this, the typical ones are still used with some frequency. Below are some of the most commonly used drugs for schizophrenia, both atypical and typical.

The most widely used at present: atypical antipsychotic drugs.

Although their level of control of positive symptomatology is comparable to that of typical antipsychotics, atypical antipsychotics have a number of major advantages over the latter. These include the existence of a certain effect on negative symptoms and the lower risk and frequency of undesirable side symptoms. However, they can generate sexual effects, arrhythmias, extrapyramidal effects linked to movement such as akinesia or tardive dyskinesia, hyperglycemia, eating and weight alterations and other problems.

The drugs most commonly marketed and used in Spain for schizophrenia are the following, although there are quite a number of others. are the following, although there are many more:

Clozapine

One of the best known atypical neuroleptics. Clozapine has a good effect even in subjects who do not respond to other neuroleptics. Also in those who with other drugs suffer from extrapyramidal symptoms due to dopaminergic alteration in the nigrostriatal pathway (in fact it is considered the neuroleptic with the least extrapyramidal effects).

Apart from acting on dopamine and serotonin, it acts on adrenaline, histamine and acetylcholine.. However, it also generates metabolic changes, overweight and there is also a risk of agranulocytosis, so its use is more limited than that of the other atypicals and it tends to be used as a second option.

Risperidone

In addition to schizophrenia, risperidone is also used in the treatment of aggressive behavior in children with severe behavioral disorders. in children with severe conduct disorders. It is also used in bipolar disorder and autism.

Olanzapine

Another of the best known drugs against schizophrenia, olanzapine is used especially to combat both positive and negative psychotic symptoms. Like some of the previous ones, it has also been used for the treatment of bipolar disorder, and in some cases for borderline personality disorder. It is one of the most effective antipsychotics, similar to clozapine but with greater serotonergic affinity (which will have a greater effect on negative symptoms).

As with the rest, secondary symptoms include appetite and weight alterations, sexual problems (decreased libido and possible (decrease of libido and possible galactorrhea and gynecomastia), tachycardia and hypotension among many others.

Aripiprazole

This type of atypical antipsychotic has been used for schizophrenia, but also for other disorders in which there is great agitation such as in some cases of autism and for major depressive disorder. It is a relatively new drug, synthesized in 2002.. It stands out for being a partial agonist of D2 receptors (acting only depending on the dopamine levels of the pathway in question). It is effective in the treatment of positive, negative and affective symptoms. It does not cause sexual problems.

Most common typical neuroleptics

Although they are currently much less commonly used than atypical neuroleptics because they tend to generate more and more potent effects than atypical neuroleptics. they tend to generate more and more potent side effectsIn some cases, some classical neuroleptics are still used in drug-resistant cases in which atypical neuroleptics do not work or under certain conditions. In this regard, although there are many more, two stand out as the best known and most frequent.

Haloperidol

The best known of all antipsychotics, it has been the most widely used until the birth of atypical neuroleptics and in fact it is still used as a treatment for schizophrenia. It is frequently used in injection to treat acute crises and stabilize the patient, even if he/she is later switched to another antipsychotic.It is often used in injection to treat acute crises and stabilize the patient, even if he or she is subsequently switched to another type of medication.

In addition to schizophrenia, it is used in other psychotic disorders (being very effective in the treatment of positive symptoms), or other disorders that generate psychomotor agitation: tic disorders and Tourette's syndrome, manic episodes or delirium tremens among others. Occasionally it has been used as an analgesic and antiemetic.

Chlorpromazine

Another of the most common and well-known antipsychotics, is in fact the first antipsychotic that was found to be. Its effects and indications are similar to haloperidol. Occasionally it has also been used for the treatment of tetanus and porphyria, or as a last option in the case of OCD.

Antiparkinsonians

Due to the likelihood of extrapyramidal effects characteristic of neuroleptics (especially typical ones), antiparkinsonian drugs are often used as an alternative to antipsychotic medication, antiparkinsonian medication is often added to antipsychotic medication.. In this sense, the use of elements such as Levodopa is frequent.

Reflection on its disadvantages and limitations

Pharmacological treatment of schizophrenia is essential and should be given continuously throughout the life cycle in order to prevent the presence of outbreaks. However, it is relatively common to find cases in which patients have suffered an outbreak after having decided to quit.

The truth is that continuous use of psychotropic drugs has a number of disadvantages and limitations.. In the first place, the continued consumption of a given substance will cause the body to acquire a certain degree of tolerance to it, so that the effects may become less pronounced. This is one of the reasons why it is not uncommon to change doses or directly change medication (using other active ingredients).

Another major limitation of neuroleptics is that although they have a great effect on positive symptomatology (hallucinations, delusions, agitation and disorganized speech and behavior), their effectiveness on negative symptoms (poor speech and thinking) is still to be desired. In fact, typical antipsychotics do not have an effect on the latter and may even worsen them. and may even worsen them. Fortunately, atypical antipsychotics do have an effect on this symptomatology, although they still have a wide margin for improvement.

In addition, there is the great disadvantage of the presence of possible secondary symptoms. The most common (it is not for nothing that another name for the first antipsychotics was that of major tranquilizers) is excessive drowsiness and sedation, which can limit the subject's creativity and cognitive capacity. This can affect, for example, their work or academic performance.. Motor disturbances may also appear, some of them affecting the extrapyramidal pathways (although this is more frequent in the typical ones), and in some cases they also have an effect on the sexual sphere. In addition, weight gain, hypercholesterolemia and hyperglycemia are also favored.

They can be a risk factor for some diseases, and could be a risk for patients with some metabolic problems such as Diabetes (their use is contraindicated in diabetic patients, with liver and heart problems). They are also not recommended during pregnancy and lactation or in subjects with dementia.

Finally, a limitation of the use of psychotropic drugs is the fact that in acute phases or in people who do not accept their diagnosis, there may be a high resistance or even forgetfulness of their use. Fortunately, in this regard some drugs have depot presentations, which are injected intramuscularly and are slowly and are gradually released into the bloodstream over time.

Thus, although the use of antipsychotics is essential to prevent outbreaks and keep symptomatology under control, we must bear in mind that it has its limitations and can generate some problems. This should lead to further research to find and synthesize new drugs that allow a much more specific action and produce fewer adverse effects, as well as to assess and measure with great precision the type of drug and the doses we use in each case in order to produce the greatest possible well-being of the patient.