Schizophrenia usually first appears during early adulthood — either in a person’s late teens or at some point in their twenties. It affects more men than women and is considered a life-long condition that is rarely considered “cured,” but rather requiring chronic treatment.
The primary treatment for schizophrenia and similar thought disorders is medication. Unfortunately, compliance with a medication regimen is often one of the largest challenges associated with the ongoing treatment of schizophrenia. Because people who live with this disorder often decide to discontinue their medication during certain 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.
In more recent years, a new treatment option has become available to help with ensuring patients take the medications prescribed. Called long-acting treatment (LAT) or long-acting injectables (LAI), medications are given to the patient through an injection. These can be administered anywhere from once every few weeks to once every few months, providing longer-term symptom relief than prior medications taken orally.
Successful treatment of schizophrenia, therefore, depends upon a life-long regimen of both drug and psychosocial or support therapies. While the medication helps control the symptoms and 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.
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 by the medication and therapy. Stopping treatment suddenly will most often lead to a relapse of the symptoms associated with schizophrenia and then a gradual recovery as treatment is reinstated.
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While most people believe that psychotherapy doesn’t play an important role in the treatment of schizophrenia, a wealth of research suggests otherwise. Schizophrenia, like all mental illness, is not a pure brain or genetic disorder. Therefore, treating schizophrenia with appropriate psychotherapeutic interventions is important.
Research published in 2015, for instance, demonstrated that people who experienced their first episode of psychosis (typically in their 20s) enjoyed the best outcomes when a team-based treatment approach was used. The team-based treatment approach incorporated psychotherapy, low doses of antipsychotic medications, family education and support, case management, and work or education support. (You can learn more about the study here.)
In conjunction with a good medication plan, psychotherapy can help keep a person in treatment, help them 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 people in their 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; social and work roles and interaction; cooperation with drug therapy and discussion of its side effects; or 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 who receive 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 by increasing awareness and acceptance of their presence. With the proper awareness, they can now reduce their focus on symptoms (and their impact) and redirect it to 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. 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.
Similarly, Cognitive Adaptation Treatment (CAT) targets cognitive barriers of schizophrenia that interfere with daily functioning, such as apathy, impulsivity, and trouble taking the mental steps required for problem solving. CAT involves several repeated visits to the patient’s home. During these, the therapist will devise ways to help the patient compensate with their difficulties. For example, they may arrange things in the patient’s environment, make checklists/reminders, or go through a routine with a patient.