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Schizophrenia, Olanzapine (Zyprexa) and Risperidone (Resperdal)

What is Schizophrenia? (Text Below: Credit of AMI/FAMI)

Schizophrenia, a disease of the brain, is one of the most disabling and emotionally devastating illnesses known to man. But because it has been misunderstood for so long, it has received relatively little attention and its victims have been undeservingly stigmatized. Schizophrenia is not a split personality, a rare and very different disorder. Like cancer and diabetes, schizophrenia has a biological basis; it is not caused by bad parenting or personal weakness. Schizophrenia is, in fact, a relatively common disease, with an estimated one percent to one and a half percent of the U.S. population being diagnosed with it over the course of their lives. While there is no known cure for schizophrenia, it is a very treatable disease. Most of those afflicted by schizophrenia respond to drug therapy, and many are able to lead productive and fulfilling lives.

What are its symptoms?

Schizophrenia is characterized by a constellation of distinctive and predictable symptoms. The symptoms that are most commonly associated with the disease are called positive symptoms, that denote the presence of grossly abnormal behavior. These include thought disorder, delusions, and hallucinations. Thought disorder is the diminished ability to think clearly and logically. Often it is manifested by disconnected and nonsensical language that renders the person with schizophrenia incapable of participating in conversation, contributing to his alienation from his family, friends, and society. Delusions are common among individuals with schizophrenia. An affected person may believe that he is being conspired against (called "paranoid delusion"). "Broadcasting" describes a type of delusion in which the individual with this illness believes that his thoughts can be heard by others. Hallucinations can be heard, seen, or even felt; most often they take the form of voices heard only by the afflicted person. Such voices may describe the person's actions, warn him of danger or tell him what to do. At times the individual may hear several voices carrying on a conversation. Less obvious than the "positive symptoms" but equally serious are the deficit or negative symptoms that represent the absence of normal behavior. These include flat or blunted affect (i.e. lack of emotional expression), apathy, and social withdrawal).

Who gets it?

While schizophrenia can affect anyone at any point in life, it is somewhat more common in those persons who are genetically predisposed to the disease. The first psychotic episode generally occurs in late adolescence or early adulthood.

Genetic Link -- The probability of developing schizophrenia as the offspring of two parents, neither of whom has the disease, is 1 percent. -- The probability of developing schizophrenia as the offspring of one parent with the disease is approximately 13 percent. -- The probability of developing schizophrenia as the offspring of both parents with the disease is approximately 35 percent.

Onset by Age -- Three-quarters of persons with schizophrenia develop the disease between 16 and 25 years of age. -- Onset is uncommon after age 30, and rare after age 40.

Onset by Sex -- In the 16-25 year old age group, schizophrenia affects more men than women. -- In the 25-30 year old group, the incidence is higher in women than in men.

What is the course of the disease?

Studies have shown that some persons with schizophrenia recover completely, and many others improve to the point where they can live independently, often with the maintenance of drug therapy. Fortunately, this accounts for the majority of cases. However, approximately 15 percent of people with schizophrenia respond only moderately to medication and require extensive support throughout their lives, while another 15 percent simply do not respond to existing treatment. New therapies may offer hope for the treatment of these most seriously affected sufferers.

How is it treated?

Hospitalization is often necessary in cases of acute schizophrenia. This ensures the safety of the affected person, while allowing for observation by trained mental health professionals to determine whether schizophrenia is the appropriate diagnosis. Hospitalization also allows for the initiation of medication under close supervision. Antipsychotic drugs (also called neuroleptics), available since the 1950s, can dramatically improve the functioning of people with schizophrenia. Once the most troubling symptoms are controlled by medication, the person often does not require hospitalization. Depending on the seriousness of the disease, the person may utilize day programs, rehabilitation facilities, and be treated in an outpatient setting. This allows the psychiatrist to adjust medication dosages as necessary over the course of the disease. The person may also need assistance in readjusting to society once his or her symptoms are controlled. Supportive counseling or psychotherapy may be appropriate for these individuals as a source of friendship, encouragement, and practical advice during this process. Relatives and friends can also assist in rebuilding the person's social skills. Such support is very important.

What can/should I do if a loved one is sick?

Because an individual with schizophrenia may not be aware that he is ill, it is often necessary for a friend or relative to make certain that proper treatment is sought. A good doctor is critical; it helps to find one through the recommendation of other families or healthcare professionals. Once the person is released from the hospital, families are often left with the responsibility of ensuring that the person is taking medication and is continuing to receive whatever other treatment is necessary. The best way to treat a friend or relative with schizophrenia is with compassion, understanding, and support. The person should not be made to feel as if the disease is his or anybody's fault. As Dr. E. Fuller Torrey has stated, "People do not cause schizophrenia; they merely blame each other for doing so." Learning about the disease and its treatment will help to avoid the temptation to blame. In addition to seeking help for the person afflicted with the disease, loved ones often find mutual support to be invaluable. AMI/FAMI is a grassroots, self-help organization of families and friends of people with serious mental illnesses. Members meet regularly to share practical information and common experiences.

Glossary of Mental Illness Terminology

 

What is Olanzapine (Zyprexa)? (RXlist Database) 

Description

Olanzapine is an antipsychotic agent that belongs to the thienobenzodiazepine class. The chemical designation is 2-methyl-4-(4-methyl-1-piperazinyl)-l OH-thieno[2,3-b] [1,5] benzodiazepine. The molecular formula is C17H20N4S, which corresponds to a molecular weight of 312.44.

Olanzapine is a yellow crystalline solid, which is practically insoluble in water.

Olanzapine tablets are intended for oral administration only.

Each Zyprexa tablet contains olanzapine equivalent to 2.5 mg (8 Ámol), 5 mg (16 Ámol), 7.5 mg (24 Ámol), or 10 mg (32 Ámol). Inactive ingredients are carnuba wax, color mixture white, crospovidone, FD&C Blue No. 2 Aluminum Lake, hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose, magnesium stearate, microcrystalline cellulose, and other inactive ingredients.

What is Risperidone (Resperdal)? (NAMI www.nami.org)

What is Risperdal?

Risperdal, or risperidone, is the newest medication for treating schizophrenia and psychotic disorders. It helps manage schizophrenia's "positive symptoms" such as visual and auditory hallucinations, delusions, and thought disturbances. Risperdal may also help in treating so-called "negative symptoms" such as social withdrawal, apathy, lack of motivation, and inability to experience pleasure. Side effects are usually relatively minor, and blood monitoring is not necessary. Risperdal is the first new front-line treatment option in twenty years.

How is Risperdal different from other antipsychotic medications?

Conventional antipsychotics such as Haldol, Stelazine, and Prolixin have treated positive symptoms in many patients for several years. However, they do not satisfactorily affect the negative symptoms, and they often cause uncomfortable or intolerable side effects. Risperdal is as effective as the conventional medications in treating positive symptoms. It also offers the advantages of helping to treat some of the negative symptoms somewhat and causing fewer extrapyramidal side effects (EPS) such as restlessness, muscle rigidity, and tremor when taken at the manufacturer's recommended dose of 6 mg per day.

Why is Risperdal called a new "front-line option?"

It means that Risperdal could be the first medication prescribed for a person who is newly diagnosed with a psychotic disorder. Some medications, such as clozapine, have side effects that may be inconvenient or difficult to manage. Such medications may be reserved until after other medications have been tried unsuccessfully. Because Risperdal is effective and has relatively few side effects, doctors may consider it one of the first medications to try for patients with schizophrenia. It's important to remember that no medication will work for everyone, and some patients will have greater success with Risperdal than others.

How does Risperdal work?

Risperdal, like other new antipsychotic drugs currently under development, is designed as a serotonin/dopamine antagonist. While its exact mechanism of action is not yet understood, Risperdal seems to block the action of serotonin and dopamine, two neurotransmitter chemicals in the brain. Conventional antipsychotics seem to primarily affect only dopamine.

How quickly does Risperdal relieve symptoms of schizophrenia?

The recommended dose is usually reached within three to four weeks, and improvement of symptoms may be noticed in some patients relatively quickly. Some adjustments may be necessary to reach the optimal dose for each patient. It is normally advisable to give the medication a trial period of at least four to six weeks at the optimal dose (6 mg/day) before evaluating its effectiveness, although experience with clozapine suggests that improvements may take months to fully emerge.

What are the side effects of Risperdal?

When taken at the manufacturer's recommended dose of 6 mg a day (3 mg twice a day), the incidence of many side effects is not significantly greater than for placebo. These side effects include extrapyramidal symptoms (muscle stiffness, tremors, and body shakes). At higher doses, extrapyramidal side effects often increase. Benztropine (Cogentin) can be prescribed to reduce or eliminate stiffness and tremors, but its use beyond three months should be re-evaluated.

More significant possible side effects, affecting some patients but not all, include low blood pressure, dizziness, especially when standing up suddenly; heart palpitations; sleepiness; constipation; weight gain; sexual dysfunction; and fatigue. Some of these problems can be minimized by following recommended guidelines for dosage at the beginning of treatment (gradual increase of dose over a period of several weeks). Patients who already have low blood pressure, who have kidney or liver impairment, are elderly, or in a weakened condition may require close monitoring and even more gradual dose adjustment.

Does Risperdal cause tardive dyskinesia?

Tardive dyskinesia (TD), a disfiguring side effect that occurs in some patients taking antipsychotic drugs, may not be a major risk associated with Risperdal use, although it may take years before researchers can fully assess the risk. It is prudent to minimize the risk by using the lowest dose necessary to relive psychotic symptoms. Should symptoms of TD develop, such as grimacing, sucking and smacking of lips and other spasmodic movements, discontinuation of Risperdal should be considered.

What else should be kept in mind when taking Risperdal?

Risperdal is usually taken twice a day. It can be take before, during, or after meals. Because of its long half-life (similar to haloperidol), however, once daily dosing should be considered. Patients should be cautious about operating hazardous machinery, including driving, until they are certain they are not adversely affected. Women should let their doctor know if they become pregnant or intend to become pregnant. Breast feeding is not recommended while taking Risperdal. Because some medications can affect the effectiveness of Risperdal when taken at the same time, patients should be sure their doctor is aware of all medications they are taking.

How much does Risperdal cost?

At the recommended dose of 4-6 mg a day, Risperdal is expected to cost the patient less than $3,000 a year. Some insurance policies will cover the cost. Uninsured outpatients who meet income eligibility standards may qualify for low cost or free Risperdal through the manufacturer. Janssen Pharmaceutica also answers questions about insurance coverage, and offers assistance in filing claim forms and resolving claims that have been denied. For information on the Risperdal Patient Assistance Program and the Risperdal Reimbursement Support Program, call 1-800-652-6227.

Reviewed by David Pickar, M.D., Chief, Experimental Therapeutics Branch, National Institute of Health, (5/94) and Dale R. Grothe, Pharm.D., Mental Health Clinical Pharmacy specialist, NIH/NIMH Pharmacy Dept. (12/95) 

Compiled by MWSearch Staff and Conclusions

The above information is compiled for MWSearch membership. Recently, there is a news report concerning serious side effects such as diabetes (Wall Street Journal April, 11, 2003) caused by Zyprexa and other rival drugs. We compile the above background information for our members and urge you to use the MWSearch intelligent medical search engine to get into deeper knowledge if you are interested. Drug manufacturers maintain web sites for their drugs. Caution should be taken in interpreting their reporting. For instance, Dr. Pickar's review on Risperidal although informative but it does not contain comparative analysis nor detailed case report. One can get more facts by searching through the Internet.   


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