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 medications, which may include antipsychotic, antidepressant, and anti-anxiety 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.
According to the research, regardless of the drug, three-quarters of all patients stop taking their medications. Patients stopped taking their 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.
A newer option available that helps address the issue of patients who stop taking their medication are referred to as long-acting injectables (LAIs). Used with atypical antipsychotic medications, they are injections administered to the patient only once every few weeks or months (depending upon the exact medication prescribed). People with schizophrenia and their caregivers often prefer this option, since it takes medication compliance issues off the table. You can learn more about long-acting treatments for schizophrenia here.
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 newer, atypical 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. You can learn more about taking medications for schizophrenia.
There are many newer antipsychotic medications available, 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.
- Establish a daily routine for the patient to follow.
- Help the patient stay on the medication.
- Keep the lines of communication open about problems or fears the patient may have.
- Understand that caring for the patient can be emotionally and physically exhausting. Take time for yourself.
- Keep your communications simple and brief when speaking with the patient.
- Be patient and calm.
- Ask for help if you need it; join a support group.
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.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Beck, A.T., Rector, N.A., Stolar, N. & Grant, P. (2011). Schizophrenia: Cognitive Theory, Research, and Therapy. New York: Guilford Press.
Janicak, P.G., Marder, S.R., Tandon, R., Goldman, M. (2014). Schizophrenia Recent Advances in Diagnosis and Treatment. New York: Springer.
Mueser, K.T. & Gingerich, S. (2006). The Complete Family Guide to Schizophrenia: Helping Your Loved One Get the Most Out of Life. New York: Guilford Press.
National Institute of Mental Health. (2018). Schizophrenia. Retrieved from https://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml on February 27, 2018.
Olukayode, A. et al. (2014). The 4th Schizophrenia International Research Society Conference, 14-18 April 2014, Florence, Italy: A summary of topics and trends. Schizophrenia Research, 159, e1-22. doi: 10.1016/j.schres.2014.08.032
Rado, J. & Janicak, P.G. (2016). Living with Schizophrenia: A Family Guide to Making a Difference. Johns Hopkins Press Health Book.
Simeone, J.C., Ward, A.J., Rotella, P., Collins, J. Windisch, R. (2015). An evaluation of variation in published estimates of schizophrenia prevalence from 1990-2013: A systematic literature review. BMC Psychiatry, 15.