2 antipsychotic drugs reduce the severity of and

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2. Antipsychotic drugs reduce the severity of and sometimes eliminate psychotic symptoms.a. About half of patients show significant improvement within four to six weeks; some show only mild improvement (30–40 percent); about a quarter show no improvementb. Continued maintenance medication after the acute phase may reduce relapse rate from 65–70percent to about 40 percent.c. Unfortunately, 25 percent do not improve on antipsychotic drugs.3. Motor side effectsa. Extrapyramidal symptoms (EPS)—muscular rigidity, tremors, restless agitation, involuntary postures, and motor inertia are quite common; may diminish after three to four months; other medications can minimize the severity of EPSb. Tardive dyskinesia (TD)—involuntary movements of the mouth and face, spasmodic movements of the trunk and body; sometimes it is irreversible; approximately 20 percent of patients develop TD after long-term neuroleptic useB. Second-generation antipsychotics—introduced in the U.S. in the 1990s1. As effective in treating positive symptoms as traditional antipsychotics; less likely to produce tardive dyskinesia2. Are no more effective in reducing negative symptoms than are traditional antipsychotics, although, this is contrary to early expectations and reports; also, many serious side effects are common for the second-generation antipsychotics: weight gain and risk for medical conditions, such as diabetes, hypertension, and coronary artery disease3. They produce a broader range of neurochemical actions in the brain than do the first-generation antipsychotic drugs, acting on both serotonin receptors and dopamine receptors, leading to more success with reduction of positive symptoms and, perhaps, less risk of motor symptom development. 7. EpidemiologyA. Biological factors
1. Strong support for a genetic influencea. Genetics—the role of genetics has been studied more extensively with schizophrenia than with any other mental disorder. The evidence suggests an important genetic component.b. Family studies—as genetic similarity increases between two people, the risk for schizophrenia increases; for example, siblings have a 50 percent chance, and nieces, nephews, and cousins have a 25 percent chancec. Twin studies—higher concordance rates among schizophrenics for monozygotic (48 percent) than for dizygotic twins (17 percent)d. Adoption studies—children of schizophrenic parents who are adopted by nonschizophrenic parents are as likely to be diagnosed with schizophrenia as they would be if their schizophrenic parent had raised them. One study of children who had been removed from their schizophrenic mothers before three days old (and not given contact with their mothers or the mothers’ families) still found a 16.6 percent lifetime morbidity risk of schizophrenia.

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