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HEALTH SYSTEMS EDITIONSchizophreniaA Review ofPharmacologic andNonpharmacologicTreatments© JUPITERIMAGESPatients with mental illness constitute a populationthat can be challenging for any health care provider,but they offer great opportunities for a pharmacistto make a meaningful contribution. The pharmacist’srole might involve assisting in the selection of medicationregimens, managing adverse drug reactions, orfacilitating adherence. These interventions can be particularlyimportant for patients with schizophrenia.DIAGNOSIS AND CLINICAL PRESENTATIONSchizophrenia is a chronic, debilitating mental illnessthat affects approximately 1% of the population. 1 Owingto the 10% lifetime prevalence of suicide in patientswith the disorder, early recognition and appropriatetreatment are imperative. 2 Schizophrenia typically presentsin late adolescence and persists throughout thepatient’s life, and males typically experience symptoms5 to 7 years earlier than females. 1,3Symptoms of schizophrenia may be classified as positive,negative, or cognitive. Positive symptoms includedisorganized speech or behavior and psychotic characteristicssuch as delusions or hallucinations. Delusions,or fixed false beliefs, occur when a patient misinterpretsan experience, leading toerroneous beliefs involving paranoiaor persecution. Hallucinations involvemore vivid sensory disruptions, withauditory hallucinations being themost common. 1,3 Negative symptoms,including affective flattening, alogia,avolition, and reduced social driveStacy Eon, PharmDPGY2 Pharmacy Resident in PsychiatryUniversity of North Carolina HospitalsChapel Hill, North CarolinaJennifer Durham, PharmDClinical PharmacistMoses Cone Memorial HospitalGreensboro, North Carolina(see TABLE 1), involve the diminution or absence ofnormal functions; they often are refractory to treatment.3,4 Cognitive symptoms are highly prevalent andmay include difficulties with verbal fluency, attention,and working memory. 3 Antipsychotic medicationshave little effect on cognitive symptoms; as aresult, these symptoms affect a patient’s ability to obtainemployment, establish personal relationships, and functionin many social settings. 3According to Diagnostic and Statistical Manual ofMental Disorders-IV-TR criteria, a patient can bediagnosed with schizophrenia if he or she presents withat least two of the following symptoms in addition tosocial dysfunction for a significant amount of time duringa 1-month period, with some symptoms persistingfor at least 6 months: delusions, hallucinations, disorganizedspeech, grossly disorganized or catatonicbehavior, or negative symptoms. 4 The diagnosis canalso be made solely on the basis of bizarre delusionsor hallucinations involving voices. 4PATHOPHYSIOLOGYAlthough the neurochemistry behind schizophrenia isnot fully understood, the disorder isthought to be caused by increaseddopaminergic transmission. 1 Thisincrease in dopamine effect causes thebrain to be hypersensitive to stimuli,making it difficult for the patientto distinguish between reality and hisor her delusions or hallucinations. 1HS-2U.S. Pharmacist • November 2009 • www.uspharmacist.com