Therapy of psychoses

What medicinal therapies are available?

Persons with a psychosis are essentially treated using five different types of medication:

  • Those which are effective against psychoses: Antipsychotics
  • Those which are effective against fears observed in a crisis: Benzodiazepines
  • Those which are effective in balancing one's moods: Mood stabilisers
  • Those which are effective against depression: Antidepressants
  • Those which are effective against side effects: Anticholinergics

1. Antipsychotics
These are the primary medications for the treatment of psychoses. They bring about a reduction in the hallucinations, delusions or thinking disorders. Their administration is based upon the observation that individuals with psychoses have an excess of dopamine - a transmitting substance of the brain (see also Causes - disturbances of neurotransmitters). Antipsychotics block the so-called dopamine receptors in the brain, so that the surplus dopamine cannot unfold its injurious effect.

2. Benzodiazepines
Benzodiazepines are generally used along with antipsychotics during the acute phase. They primarily have a calming, anxiolytic effect and help to normalise disturbed sleep once again. After improving the psychotic symptoms, benzodiazepines are discontinued, since they themselves can lead to addiction. Generally, the dose is reduced slowly and then they are discontinued entirely. Frequently used benzodiazepines are diazepam, lorazepam and oxazepam. For sleep disorders, for instance, zolpidem or zopiclone are applied.

3. Mood stabilisers
Mood stabilisers are phase prophylactics. They help people with psychoses, who, aside from their psychotic symptoms, also suffer concomitantly from mood disorders like mania or depression, so that these symptoms of mania and of depression improve and will not reoccur or will only appear again in a milder form. Phase prophylactics which are frequently employed are lithium or valproate.

4. Antidepressants
Antidepressants help individuals with psychoses, who, aside from the psychotic symptoms, also suffer concomitantly from depressions. In addition, they are also used in cases demonstrating extensive negative symptoms. For therapy, a number of different antidepressive agents are available.

5. Anticholinergics
Anticholinergics are used as a sort of "antidote" for certain side effects brought about through antipsychotics, the so-called extrapyramidal symptoms (EPS). Biperiden is a frequently employed anticholinergic.


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