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Methods of treatment of schizophrenia in men

, medical expert
Last reviewed: 06.05.2022
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The treatment of schizophrenia in men does not differ from the treatment of women, it is just that men are more likely to get sick more severely, and, accordingly, more powerful antipsychotics in higher doses are required for their treatment. In any case, the main therapy with antipsychotics is used, the choice of the drug is based on an analysis of the features of the manifestation of productive symptoms and the form of the course of the disease. Other methods are used, for example, insulin coma and electroconvulsive therapy. [1]

In the acute period, active drug therapy is used, after reaching the therapeutic effect, the patient is transferred to maintenance therapy with the appointment of the minimum effective dose of the drug in order to prevent exacerbations and increase the stabilization interval. [2]

The most severe form of the disease - juvenile malignant continuous schizophrenia is treated with the use of powerful antipsychotic drugs that can weaken and nullify severe catatonic, hebephrenic, paranoid and mixed symptoms. In such cases, high dosages of neuroleptics are prescribed, exceeding the standard ones by two or even five times. This contributes, in most cases, to a significant weakening of the manifestations of psychosis.

Aminazine remains the drug of choice. It is prescribed at 0.6-0.8 g per day. Azaleptin is also used (at a daily dose of 0.3-0.4 g), Propazine (0.35 g), Tizercin 0.2-0.3 g), Haloperidol or Mazeptil (0.03-0.04 g), Trisedil (0. 01-0.015g). The choice of the drug is based on its effectiveness and sensitization to it in the patient.

The action of classical antipsychotics is based on the influence on the dopamine system, due to which they effectively cope with delusional hallucinatory symptoms, eliminate paranoid and manic thoughts, stop psychomotor agitation, and calm aggressive impulses.

However, these drugs have many side effects on the part of almost all organs and systems. In addition to the fact that they cause relatively "harmless" symptoms such as dry mouth, heartburn, diarrhea, nausea, drowsiness, allergic rashes, they disrupt the heart, cause dysuric disorders and inflammation of the liver, and can cause anaphylaxis, in principle, like others. Drugs. Drugs with antipsychotic action also cause neuroleptic syndrome associated with their effect on the brain, the leading symptom of which is hyper- or hypokinesia, additional ones are anxiety, agitation, convulsions and other disorders of the central nervous system, essentially changing one mental disorder to another. [3]

To neutralize severe complications that often develop during treatment with neuroleptics, patients are prescribed corrective drugs (antiparkinsonian): an anticholinergic of central and peripheral action with a muscle relaxant effect Cyclodol in a daily dose of 0.012-0.014 g; central anticholinergic Akineton; nootropics.

Long-term antipsychotic therapy is addictive, which reduces its effectiveness. To intensify treatment, resort to a variety of techniques. For example, sudden interruption of antipsychotic therapy followed by resumption of treatment is practiced.

A positive response to the action of neuroleptics enhances the use of immunostimulants. In the hospital, twice a week, the patient is prescribed Decaris injections (0.15 g each). Orally, Dimephosphone can be prescribed three times a day at the rate of 0.03 g per kilogram of the patient's weight.

In addition to antipsychotics, forced insulin-coma therapy is used - a drip of insulin before the onset of insulin coma. The course of treatment is from 25 to 30 procedures. [4]

Simple juvenile schizophrenia is treated with classical antipsychotics that have a psychostimulating effect. Triftazin is prescribed in a daily dose of 0.02-0.025 g, Etaperazin (not more than 0.03 g), Mazheptil (not more than 0.015 g) and others.

Atypical antipsychotics are also used, which are considered less dangerous in terms of complications from their action: Risperidone in a daily dose of up to 0.004 g; [5]Olanzapine (up to 0.015 g); Seroquel (up to 0.9g). New generation drugs act not only on the dopaminergic system of the brain, but also on the serotonergic system, which reduces the likelihood of developing neuroleptic syndrome, however, does not completely exclude it. In addition, side effects such as obesity and diabetes mellitus, as well as stroke, develop after taking atypical antipsychotics much more often than classical ones. [6].  [7]. [8]

Typical antipsychotics are also chosen for the treatment of paranoid continuous schizophrenia, the leading symptom of which is delusions and hallucinations. Schizophrenics with a predominance of the delusional component are prescribed Etaperzine in a daily dose of 0.06 g to 0.09 g, Triftazin - approximately 0.04-0.05 g each, Haloperidol (0.02-0.03 g), hallucinatory - lower doses of Etaperazine (0.035 -0.04 g) or Triftazin (0.03-0.035 g). Of the atypical antipsychotics, Azaleptin is preferred. It is prescribed in a daily dose of up to 0.3 g. In general, drugs are selected individually, as well as dosages. It is necessary to cause a satisfactory therapeutic effect and to avoid serious side effects as much as possible, for which the doctor needs constant contact with the patient. [9]

In the later stages of paranoid schizophrenia, when the patient's body no longer responds properly to classical antipsychotic therapy, injectable forms are resorted to, for example, the long-acting drug Fluphenazine (Moditen-Depot). One intramuscular injection (0.025-0.075 g) is given at intervals of a week to a month (individually, empirically, depending on the release rate of the active substance). The drug has a strong antipsychotic effect, exceeding the action of Aminazine (standard), and has a lower likelihood of developing neuroleptic syndrome and somatic complications. It is also successfully used to treat forms of juvenile malignant schizophrenia.

Paranoid schizophrenia also responds well to injectable therapy with Clopixol, one of the relatively new neuroleptics. It is injected deep into the muscle in a daily dose of 0.1 g. It is effective both in the debut of a paranoid attack and in the treatment of relapse. Olanzapine is also used. These drugs, in addition to stopping productive symptoms, also alleviate negative manifestations.

Sometimes combinations of antipsychotics are used to stabilize the condition and form a long period of remission, for example, Klopiksol-depot and Piportil L4.

In the treatment of fur-like schizophrenia, the goal is to stop acute attacks of affective-delusional psychosis. To do this, they resort to insulin-comatose therapy (with the manifestation of the disease) or combined (especially with relapses): antipsychotic therapy with the use of Leponex (0.3 g per day), Propazine (0.35 g), Tizercin (0.2 g) in combination with taking antidepressants - the classic tricyclic Amitriptyline in a daily dose of up to 0.3 g, Anafranil (up to 0.3 g) or Ludiomil (up to 0.2 g). The choice of drug depends on the structure of the affect. With the predominance of the manic component, antipsychotics are combined with lithium preparations.

Schizotypal disorder (sluggish schizophrenia) usually requires lower doses of antipsychotics, both typical and atypical, in combination with tranquilizers. It is recommended to include in the treatment regimen biotic preparations that improve metabolic processes in the brain, increase stress resistance and performance, glycine or biotredin in a daily dose of up to 0.8 g. In mild forms of schizophrenia, cognitive-behavioral therapy may help in some cases even without the use of antipsychotics.

Nutrition for schizophrenia in men

In principle, schizophrenics can eat any food, the disease does not oblige them to any diets. However, there is an opinion that a certain style of eating can contribute to the appearance of schizophreniform symptoms. This opinion is shared by many physicians. In general, nutrition for schizophrenia should be completely complete, varied, healthy and tasty. You just need to follow some restrictions.

It is doubtful that true schizophrenia can be cured only by nutritional correction, but in any case there should be an undoubted benefit.

In schizophrenia, the biochemical processes that take place in the brain change, and there are foods that can affect metabolism. Therefore, if you adhere to certain principles of nutrition, then it will definitely not be worse.

The anti-schizophrenic diet recommends practically not eating foods that contain casein and gluten. The largest amount of casein is found in milk, goat and cow, a lot of it in cheeses and other dairy products. This is an easily digestible protein necessary for people to grow muscle and bone tissue. However, in schizophrenics, especially if there is lactose intolerance acquired with age, these products will provoke not only digestive disorders, but also attacks of schizophrenia. A patient with an excess of casein may complain of blurred vision, dizziness, he will often have anxiety and dysphoric disorders. Schizophrenics should not completely abandon dairy products, but it is better to use them in a fermented form (kefir, fermented baked milk, curdled milk, natural yogurt) and no more than one glass per day, the use of cheeses (cottage cheese) is limited to 30-gram servings three times a week.

Schizophrenics and persons predisposed to the disease should monitor the consumption of sweets, that is, foods high in sugar, and control blood glucose levels, keeping it normal. Do not completely eliminate sweets, and do not overeat. For example, sweet carbonated drinks should be completely removed from the diet, store-bought juices in cardboard boxes can be dispensed with, cakes, pastries, sweets also do not belong to healthy food. You can not eat honey and jam in tablespoons, fruits and berries with a high sugar content - in kilograms. In our area - these are grapes, cherries, sweet apples, exotic - figs, lychee, mango, pineapple. At the same time, it is better to replace sugar with a small amount of honey, dried fruits, berries. You do not need to completely give up sweets, just control its consumption.

Gluten is found in cereals. These are cereals and all kinds of pastries. If you exclude gluten-containing foods from the diet, then there is an improvement in the condition of patients, attacks disappear with milder symptoms, and remission occurs faster.

Changing the diet should also be done in the direction of greater consumption of mono- and polyunsaturated fatty acids, which are involved in the renewal of all cell membranes, including brain neurons. These are vegetable oils: sunflower, corn, olive, linseed, rapeseed, seafood and shellfish, fish and fish oil, nuts, flax seeds, pumpkin, sesame seeds, germinated cereals, green vegetables. There are many such products.

Saturated fatty acids are found in meat, offal, butter. These foods can and should be consumed, but do not overeat. For example, lean red meat - once a week, with a side dish of vegetables (but not with potatoes), butter - about five grams per day.

Foods with antidepressant properties - fish (salmon), seaweed, almonds, turkey and rabbit meat, bananas, blueberries, strawberries will help improve mood and reduce anxiety.

The diet should contain vitamins, ascorbic acid (onions, fresh vegetables, berries and fruits), B vitamins (eggs, meat, liver, legumes, green vegetables, fish, potatoes, tomatoes), vitamin E (vegetable oils, olives, seeds, nuts, dried apricots).

In addition, whenever possible, you need to use natural organic products. The diet should contain more vegetables and fruits, fresh, in winter - freshly frozen. Bread is preferred whole grain or rye and in limited quantities. No alcohol, coffee and strong tea, the same goes for sausages, smoked meats and pickles. From cereals, preference is given to oatmeal, buckwheat, and millet. It is recommended to use bran and germinated grains of wheat. Every day there are nuts and seeds from 20 to 50g.

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