Acute schizophrenia is a term used to describe episodes of relatively severe schizophrenia-related symptoms that have a strongly negative impact on a person’s ability to function. Doctors can combat the effects of these episodes with the help of a number of different antipsychotic medications. However, these medications only work in certain individuals and typically come with a substantial risk for damaging side effects. According to the results of a study published in July 2013 in the journal JAMA Psychiatry, doctors may be able to improve acute schizophrenia treatment by using a blood pressure medication called sodium nitroprusside.
Acute Schizophrenia Basics
Schizophrenia is the most well known mental illness in a group of conditions called “schizophrenia spectrum and other psychotic disorders,” or simply psychotic disorders. Its primary symptoms center on psychosis, a severely altered mental state that produces hallucinations, thought abnormalities called delusions and a general increase in chaotic or disrupted thinking. Along with an unusual increase or decrease in normal body movements, psychosis belongs to a group of schizophrenia symptoms known technically as “positive” symptoms. Another group of schizophrenia symptoms, called “negative symptoms,” produces such things as a decline in emotional responsiveness, an aversion to verbal communication, an inability to make plans or follow through on existing plans, and an inability to take pleasure from one’s experiences.
People with acute schizophrenia are actively under the influence of their schizophrenia-related symptoms. Typically, affected individuals experience a spike in their level of psychosis, as well as a spike in their negative symptoms, an unusually disturbed mood and disruptions in their everyday conscious thought processes. Some people in the middle of acute episodes also experience sharp increases in their levels of agitation and aggression toward others. Even without producing heightened agitation and aggression, acute schizophrenia can severely restrict a person’s sense of well-being, increase the likelihood of behaviors that damage ongoing relationships and heavily impair the ability to function. In many cases, affected individuals require inpatient hospital treatment to restore some sense of normalcy.
Antipsychotic agents currently used to treat acute schizophrenia include three medications—aripiprazole (Abilify), olanzapine (Zyprexa) and risperidone (Risperdal)—that belong to a class of drugs called atypical antipsychotics. Doctors may also use another medication, called haloperidol (Haldol), which belongs to an older class of drugs called typical antipsychotics. In addition, doctors may use sedative medications called benzodiazepines in combination with antipsychotics to help reduce a patient’s levels of aggression and agitation. Typical antipsychotics, in particular, may pose severe side effect risks for people affected by acute schizophrenia, up to and including a potentially permanent movement disorder called tardive dyskinesia. Atypical antipsychotics generally pose fewer risks, but can still produce harm in a number of ways. In addition, the American College of Neuropsychopharmacology notes, substantial numbers of people fail to respond to the treatment effects of typical or atypical antipsychotics.
Sodium nitroprusside (Nitropress) was specifically designed to treat hypertensive crisis, a rapid, severe rise in blood pressure levels that can potentially kill affected individuals. Doctors also sometimes use the medication to purposefully produce artificially low blood pressure levels during surgery as a precaution against excessive bleeding. In the study published in JAMA Psychiatry, a team of Canadian and Brazilian researchers gave a single intravenous infusion of sodium nitroprusside to a small group of people between the ages of 19 and 40 diagnosed with acute schizophrenia. All of these patients had received their diagnoses in the five-year period before the study began and had taken antipsychotic medications as part of their previous treatment. Before and after receiving sodium nitroprusside, each participant was assessed for his or her level of “positive” and “negative” schizophrenia-related symptoms.
After reviewing their findings, the researchers concluded that a single IV infusion of sodium nitroprusside produces a significant reduction in the symptoms of acute schizophrenia in just a four-hour time period. This reduction included both “positive” and “negative” symptoms, and remained in effect for a full month following treatment.
Use of sodium nitroprusside comes with its own set of potential risks, including dangerously low blood pressure, a form of poisoning called cyanide toxicity, dangerous changes in red blood cell function and alteration of normal function in the heart, gastrointestinal system and thyroid gland. However, because the medication produces its benefits for acute schizophrenia treatment when used only monthly, doctors may be able to safely prescribe it to large numbers of affected individuals. The authors of the study in JAMA Psychiatry believe that approved and properly monitored use of sodium nitroprusside could substantially improve doctors’ ability to successfully treat and control acute schizophrenia.