Living with Schizophrenia
Team-based care also is pivotal. A treatment team may include a psychiatrist, licensed therapist and case manager. There are many other professionals who may help, including psychiatric nurses, vocational therapists and rehabilitation therapists. When building a team, Robert E. Drake, M.D., Ph.D, professor of psychiatry and of community and family medicine at Dartmouth Medical School, suggests keeping in mind people who will:
- Serve as the primary contact person to help patients navigate through the system
- Help patients achieve functional goals (e.g., finding an apartment and job)
- Ensure patients get good medical care, understand medication options and learn to use them appropriately
- Treat co-occurring problems.
Substance abuse is the most common co-occurring disorder in individuals with schizophrenia, but physical health conditions also may be present. Try to find the appropriate professional to treat the co-occurring issues.
- When looking for a psychiatrist, search out professionals who specialize in schizophrenia. Ask other families or professionals, like your primary care physician, write Irene S. Levine, Ph.D, and Jerome Levine, M.D., in Schizophrenia for Dummies. You can find families at the National Alliance for the Mentally Ill (NAMI) by checking out your local affiliate. Also, check with the psychiatry or psychology department of a local university or medical school. Visit two to three different providers and ask them about available resources, their outcomes, their team (i.e., do they have a typical team of professionals they work with? How do they put together a team?) and what they can do for you, Dr. Drake said.
Psychosocial Treatments for Schizophrenia
Because “mental illnesses are compounded by a cascade of personal losses — including friendships, work opportunities and a place to call home — effective treatment requires addressing the needs of the whole person and listening to their hopes and dreams,” Irene Levine said. Helpful treatments may include the following:
- Cognitive Remediation/Related Treatments. While hallucinations and delusions can be devastating, it is the cognitive decline — problems with memory, attention, problem solving, processing information — that complicates daily life. Because medication doesn’t treat problems with attention, concentration and memory, treatments that address these issues are vital. Cognitive remediation strives to strengthen patients’ cognitive skills, helping them “pay attention, remember, process information and plan better,” Velligan said. This is usually done with cognitive exercises and compensatory behaviors (things like checklists that help individuals compensate for memory loss).
For instance, Demian Rose, M.D., Ph.D, medical director of the University of California, San Francisco PART Program and director of the UCSF Early Psychosis Clinic, and his research team have developed a cognitive training software package that’s shown good results. Velligan and colleagues use environmental supports — tools that help manage the day-to-day, like checklists, signs, pill boxes and alarms — in their program, Cognitive Adaptation Training, “to bypass cognitive impairments” and help with taking medication, grooming, housekeeping, managing money and participating in leisure activities.
- Family psychoeducation. Families may be confused about schizophrenia and what they can do to help their loved one. “Supportive families can be a godsend for people with schizophrenia. They function as de facto case managers, filling in the gaps of the fragmented system that exists in many communities,” Irene Levine said. Family psychoeducation gives families an accurate understanding of schizophrenia and teaches them how to help.
- Individual psychotherapy. This can take many forms, such as a cognitive-behavioral approach. Dr. Rose recommends individual therapy for various reasons. For one, by the time most individuals have been diagnosed with schizophrenia, they have many problems with relationships. Also, individual therapy gives patients a better understanding of their own symptoms. “I see so much suffering and misunderstanding purely because no one has told (patients) what’s going on,” Dr. Rose said.
- Cognitive-behavioral therapy (CBT). Though using CBT to treat schizophrenia is fairly new, research has shown that it holds promise, according to Dr. Rose. In addition to grasping their symptoms, CBT helps individuals set goals, form new ways of relating to people, examine and challenge persistent beliefs and cope with hallucinations.
- Supported employment. This program helps individuals find a job based on preferences and abilities and usually assists with training and any issues that may come up on the job. For ideas on what questions to ask, this handbook (in PDF format) offers a detailed questionnaire.
Tartakovsky, M. (2013). Living with Schizophrenia. Psych Central. Retrieved on April 26, 2015, from http://psychcentral.com/lib/living-with-schizophrenia/0002711