Secondary Schizophrenia (157 page)

by these medications are risk of movement disorder,
Sustained psychosis may arise in a variety of con-sedation, anticholinergic effects, hypotension, weight
texts, all of which are manifest as delusions, halluci-gain, metabolic dysregulation, and seizure. As these
nations, disorganization, and functional deterioration.

may adversely affect the patient’s underlying disorder,
Antipsychotic medications are the mainstay of treat-they should generally be considered first in treatment
ment for these symptoms in primary schizophrenia,
selection. A comparison of risk for these side effects is
the pathophysiology of which is poorly understood
given in
Table 32.1
as a guide to the clinician in treat-and not remediable with current therapies. These
ment selection.

drugs also have a place in the treatment of secondary
Abnormal movements are common in neurolog-schizophrenia, although in conjunction with therapies
ical disorders and must be a principal consideration
addressing the primary condition, if it is known and
in drug selection among these patients. The antipsy-treatable. Antipsychotics have generally been shown to
chotics with the most benign EPS profiles are quetiap-be effective in both primary and secondary conditions
ine and clozapine. Because clozapine carries additional
for control of active psychosis and behavioral difficul-side effects and mortality risks, quetiapine will be the
ties. The current state of knowledge supports the use
drug of choice in most of these cases. In contrast, con-of antipsychotics for symptom control, but not to the
ventional agents will generally be avoided.

exclusion of more definitive treatment of underlying
A similar review of side effects will drive treat-conditions, and always with caution regarding their
ment choices in other cases as well. Aripiprazole and
complicating side effects. There are more substantive
ziprasidone are most favorable when somnolence is
differences among the side effects of the antipsychotic
a problem, but quetiapine or a low-potency conven-medications than their efficacy; hence, side-effect pro-tional agent may be preferred when sedation is desir-files will generally guide treatment choices. More care-able. Weight gain and metabolic dysregulation are least
fully conducted efficacy studies involving this treat-problematic with aripiprazole and ziprasidone, but
ment population would be a welcome addition to the
400

olanzapine or clozapine may be indicated to assist a
medical literature.

Chapter 32 – Drug treatment of secondary schizophrenia

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