Schizophrenia Treatment

By Psych Central Staff

Table of Contents


Introduction

Schizophrenia usually first appears in a person during their late teens  or throughout their twenties. It affects more men than women, and is considered a life-long condition which rarely is “cured,” but rather treated. The primary treatment for schizophrenia and similar thought disorders is medication.  Unfortunately, compliance with a medication regimen is often one of the largest problems associated with the ongoing treatment of schizophrenia. Because people who live with this disorder often go off of their medication during periods throughout their lives, the repercussions of this loss of treatment are acutely felt not only by the individual, but by their family and friends as well.

Successful treatment of schizophrenia, therefore, depends upon a life-long regimen of both drug and psychosocial, support therapies. While the medication  helps control the psychosis associated with schizophrenia (e.g., the delusions and hallucinations), it cannot help the person find a job, learn to be effective in social relationships, increase the individual’s coping skills, and help them learn to communicate and work well with others. Poverty, homelessness, and unemployment are often associated with this disorder, but they don’t have to be. If the individual finds appropriate treatment and sticks with it, a person with schizophrenia can lead a happy and successful life. But the initial recovery from the first symptoms of  schizophrenia can be an extremely lonely experience. Individuals coping with the onset of schizophrenia for the first time in their lives require all the support  that their families, friends, and communities can provide.

With such support, determination, and understanding, someone who has schizophrenia can learn to cope and live with it for their entire life. But stability with this disorder means complying with the treatment plan set up between the person and their therapist or doctor, and maintaining the balance provided for by the medication and therapy.  A sudden stopping of treatment will most often lead to a relapse of the symptoms  associated with schizophrenia and then a gradual recovery as treatment is reinstated.

Psychotherapy

Psychotherapy is not the treatment of choice for someone with schizophrenia. Used as an adjunct to a good medication plan, however, psychotherapy can help maintain the individual on their medication, learn needed social skills, and support the person’s weekly goals and activities in their community. This may include advice, reassurance, education,  modeling, limit setting, and reality testing with the therapist. Encouragement in setting small goals and reaching them can often be helpful.

People with schizophrenia often have a difficult time performing ordinary life  skills such as cooking and personal grooming as well as communicating with others in the family and at work. Therapy or rehabilitation therapy can help a person regain the confidence to take care of themselves and live a fuller life.

Group therapy, combined with drugs, produces somewhat better results than drug treatment alone, particularly with schizophrenic outpatients.  Positive results are more likely to be obtained when group therapy focuses on real-life plans, problems, and relationships; on social and work roles and interaction; on cooperation with drug therapy and discussion of its side effects; or on some practical recreational or work activity.  This supportive group therapy can be especially helpful in decreasing social isolation and increasing reality testing (Long, 1996).

Family therapy can significantly decrease relapse rates for the schizophrenic family member.  In high-stress families, schizophrenic patients given standard aftercare relapse 50-60% of the time in the first year out of hospital.  Supportive family therapy can reduce this relapse rate to below 10 percent.  This therapy encourages the family to convene a family meeting whenever an issue arises, in order to discuss and specify the exact nature of the problem, to list and consider alternative solutions, and to select and implement the consensual best solution. (Long, 1996).

Other treatments are accruing moderate-to-strong research support in treating schizophrenia. Strongly supported by research, for both schizophrenia and other types of problems alike, is cognitive behavioral therapy (CBT). Treatment is not focused on a “cure” but on symptom management and quality of life.

The mindfulness-based Acceptance and Commitment Therapy (ACT)  has been applied to a number of conditions, including psychosis (see detailed description of ACT within the Depression Treatment article). By design, the major aim of ACT is not to directly reduce psychosis symptoms; rather, ACT aims to reduce a patient’s suffering by enhancing their ability to tolerate psychotic symptoms (e.g., through increased awareness and acceptance of their presence; by reducing the focus, and thus impact of symptoms and redirecting the patient’s focus on their core values).

Another form of evidence-based treatment for schizophrenia, also abbreviated as “ACT” (not to be confused with Acceptance and Commitment Therapy) is Assertive Community Treatment. This ACT is a multidisciplinary team approach, typically including case managers, psychiatrists, social workers, and other mental health clinicians. It is an augmentative approach to intensive case management in which the team members share a caseload, have a high frequency of patient contact (typically at least once a week), and provide outreach to patients in the community. ACT treatment is typically ongoing and highly individualized to each client’s changing needs. The goals of ACT are to reduce hospitalization rates and help clients adapt to life in the community. ACT is most appropriate for individuals who are at high risk for repeated hospitalizations and have difficulty remaining in traditional mental health treatment.

Cognitive remediation (CR) is intended as a short-term intervention for enhancing cognitive skills required for everyday social/vocational functioning in individuals with schizophrenia, such as using computers and handling paper and pencil tasks. Most CR interventions additionally take into account the motivational and emotional deficits that are highly prevalent in schizophrenia. There is some evidence that these short-term cognitive training therapies can alter neural connections as shown by some studies in neuropsychological testing. Is is unclear, however, whether these brain functioning improvements are sustained or translate to functioning.

Medications

Schizophrenia appears to be a combination of a thought disorder, mood disorder, and anxiety disorder. The medical management of schizophrenia often requires a combination of antipsychotic, antidepressant, and antianxiety medication. One of the biggest challenges of treatment is that many people don’t keep taking the medications prescribed for the disorder.  After the first year of treatment, most people will discontinue their use of medications, especially ones where the  side effects are difficult to tolerate.

As a recent National Institute of Mental Health Study indicated, regardless of the drug, three-quarters of all patients stop taking their medications. They stopped the schizophrenia medications either because they did not make them better or they  had intolerable side effects. The discontinuation rates remained high when they were switched to a  new drug, but patients stayed on clozapine about 11 months, compared with only three months for  Seroquel, Risperdal or Zyprexa, which are far more heavily marketed — and dominate sales. Because of findings such as this, it’s generally recommended that someone with schizophrenia begin their treatment with a drug such as clozapine (clozapine is often significantly cheaper than other antipsychotic medications). Clozapine (also known as clozaril) has  been shown to be more effective than many newer antipsychotics as well.

Antipsychotic medications help to normalize the biochemical imbalances that cause schizophrenia. They are also important in reducing the likelihood of relapse.  There are two major types of antipsychotics, traditional and new antipsychotics.

Traditional antipsychotics effectively control the hallucinations, delusions, and confusion of schizophrenia. This type of antipsychotic drug, such as haloperidol, chlorpromazine, and fluphenazine, has been available since the mid-1950s. These drugs primarily block dopamine receptors and are effective in treating the “positive” symptoms of schizophrenia.

Side effects for antipsychotics may cause a patient to stop taking them. However, it is important to talk with your doctor before making any changes in medication since many side effects can be controlled. Be sure to weigh the risks against the potential benefits that antipsychotic drugs can provide.

Mild side effects: dry mouth, blurred vision, constipation, drowsiness and dizziness. These side affects usually disappear a few weeks after the person starts treatment.

More serious side effects: trouble with muscle control, muscle spasms or cramps in the head and neck, fidgeting or pacing, tremors and shuffling of the feet (much like those affecting people with Parkinson’s disease).

Side effects due to prolonged use of traditional antipsychotic medications: facial ticks, thrusting and rolling of the tongue, lip licking, panting and grimacing.

There are many newer antipsychotic medications available since the 1990′s, including Seroquel, Risperdal, Zyprexa and Clozaril. Some of these medications may work on both the serotonin and dopamine receptors, thereby treating both the “positive” and “negative” symptoms of schizophrenia.  Other newer antipsychotics are referred to as atypical antipsychotics,  because of how they affect the dopamine receptors in the brain. These newer medications may be more effective in treating a broader range of symptoms of schizophrenia, and some have fewer side effects than traditional antipsychotics. Learn more about the atypical antipsychotics used to help treat schizophrenia.

Coping Guidelines For The Family

  1. Establish a daily routine for the patient to follow.
  2. Help the patient stay on the medication.
  3. Keep the lines of communication open about problems or fears the patient may have.
  4. Understand that caring for the patient can be emotionally and physically exhausting. Take time for yourself.
  5. Keep your communications simple and brief when speaking with the patient.
  6. Be patient and calm.
  7. Ask for help if you need it; join a support group.

Self-Help

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Adjunctive community support groups in concurrence with psychotherapy is usually beneficial to most people who suffer from schizophrenia. Caution should be utilized, however, if the person’s symptoms aren’t under control of a medication. People with this disorder often have a difficult time in social situations, therefore a support group should not be considered as an initial treatment option. As the person progresses in treatment, a support group may be a useful option to help the person make the transition back into daily social life.

Another use of self-help is for the family members of someone who lives with schizophrenia. The stress and hardships causes of having a loved one with this disorder are often overwhelming and difficult to cope with for a family. Family members should use a support group within their community to share common experiences and learn about ways to best deal with their frustrations, feelings of helplessness, and anger.

 

 

APA Reference
Psych Central. (2014). Schizophrenia Treatment. Psych Central. Retrieved on December 19, 2014, from http://psychcentral.com/disorders/schizophrenia-treatment/

Symptom criteria summarized from:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Association.
        or
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 21 Aug 2014
    Published on PsychCentral.com. All rights reserved.