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“Clozapine was the first atypical and is still a standard by which the other [drugs] are measured,” Bohrer says. “It’s sometimes portrayed in a negative light, often by those who have limited experience with the drug. Obviously, providers are going to try the other atypicals first because not as much monitoring is needed with those drugs. But I’ve seen clozapine work for many clients where nothing else has.”

Atypical antipsychotics help control the symptoms of schizophrenia by adhering to specific receptors in the brain and regulating levels of key neurotransmitters, according to Brady.

“Schizophrenia is a neurochemical-type disorder characterized by imbalances of dopamine, serotonin, and other neurotransmitters,” she says. “The atypicals try to balance and reregulate them.”

One of the greatest benefits of the new atypicals: They cause fewer of the debilitating adverse effects that made the previous generation of antipsychotics such a mixed bag for patients and providers alike. However, the atypicals are not without potential adverse effects of their own, including weight gain, type-2 diabetes, a prolonged QT interval, and even sudden death, Steates says.

“Treatment varies according to the individual. The most important thing is finding a medication the patient likes; otherwise, the patient probably is not going to take it,” Steates says. “We’re constantly assessing that, asking patients, ‘How is your medicine working?’ Very often they’re extremely pleased when we switch them from one of the older drugs like Haldol to one of the newer atypicals. They’ll say, ‘I love my medicine! It’s great!’”

Nurses and others can help patients with schizophrenia achieve optimum benefit from their medications by aggressively addressing the drugs’ potential adverse effects, Mahoney says.

“Both patients and providers are challenged to think about early interventions to prevent some of these side effects or the exaggeration of these side effects,” she says. “If you know, for example, that a certain percentage of patients on Zyprexa gain weight, then I think one of your interventions should be about preventing weight gain, either through an exercise program, setting up meal planning with patients, or by some other means. We have to be proactive with these patients. A lot of nurses are already doing that, but not all.”

Advantage: Nurses

Successful treatment of schizophrenia requires a multidisciplinary approach that includes psychologists, psychiatrists, nurses, and social workers. Nurses are often responsible for ensuring patients remain on the right medications and take those medications as prescribed – but they bring much more to the table than that, Steates says.

“Nurses function as patient advocates,” she says. “In the mental health setting, we strive to establish a therapeutic rapport with patients, one that promotes healing by alleviating the stress the patient experiences. The nurse also functions as a liaison between the patient, physicians, and family members. Nurses are central to the multidisciplinary team. They contribute assessments and ensure patients’ needs are met in the acute care setting and follow-up care is in place.”

Brady agrees. “Nurses are experts at establishing and maintaining relationships with patients with schizophrenia and managing their inpatient milieu,” she says. “Doctors and residents come and go, but nurses are usually pretty stable. Nurses bring a wealth of experience and education. They truly are holistic. It’s not just the mental illness they see — it’s the whole person. I can’t imagine treating patients with schizophrenia without nurses.”

Don Vaughan is a freelance writer.

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