How is schizophrenia treated?
Because the causes of schizophrenia are still unknown, current treatments focus on eliminating the symptoms of the disease.
Antipsychotic medications
Antipsychotic
medications have been available since the mid-1950s. They effectively
alleviate the positive symptoms of schizophrenia. While these drugs
have greatly improved the lives of many patients, they do not cure
schizophrenia.
Everyone responds differently to antipsychotic
medication. Sometimes several different drugs must be tried before the
right one is found. People with schizophrenia should work in
partnership with their doctors to find the medications that control
their symptoms best with the fewest side effects.
The older
antipsychotic medications include chlorpromazine (Thorazine®),
haloperidol (Haldol®), perphenazine (Etrafon®, Trilafon®), and
fluphenzine (Prolixin®). The older medications can cause extrapyramidal
side effects, such as rigidity, persistent muscle spasms, tremors, and
restlessness.
In the 1990s, new drugs, called atypical
antipsychotics, were developed that rarely produced these side effects.
The first of these new drugs was clozapine (Clozaril®). It treats
psychotic symptoms effectively even in people who do not respond to
other medications, but it can produce a serious problem called
agranulocytosis, a loss of the white blood cells that fight infection.
Therefore, patients who take clozapine must have their white blood cell
counts monitored every week or two. The inconvenience and cost of both
the blood tests and the medication itself has made treatment with
clozapine difficult for many people, but it is the drug of choice for
those whose symptoms do not respond to the other antipsychotic
medications, old or new.
Some of the drugs that were developed
after clozapine was introduced—such as risperidone (Risperdal®),
olanzapine (Zyprexa®), quietiapine (Seroquel®), sertindole
(Serdolect®), and ziprasidone (Geodon®)—are effective and rarely
produce extrapyramidal symptoms and do not cause agranulocytosis; but
they can cause weight gain and metabolic changes associated with an
increased risk of diabetes and high cholesterol.8
People
respond individually to antipsychotic medications, although agitation
and hallucinations usually improve within days and delusions usually
improve within a few weeks. Many people see substantial improvement in
both types of symptoms by the sixth week of treatment. No one can tell
beforehand exactly how a medication will affect a particular
individual, and sometimes several medications must be tried before the
right one is found.
When people first start to take atypical
antipsychotics, they may become drowsy; experience dizziness when they
change positions; have blurred vision; or develop a rapid heartbeat,
menstrual problems, a sensitivity to the sun, or skin rashes. Many of
these symptoms will go away after the first days of treatment, but
people who are taking atypical antipsychotics should not drive until
they adjust to their new medication.
If people with schizophrenia become depressed, it may be necessary to add an antidepressant to their drug regimen.
A
large clinical trial funded by the National Institute of Mental Health
(NIMH), known as CATIE (Clinical Antipsychotic Trials of Intervention
Effectiveness), compared the effectiveness and side effects of five
antipsychotic medications—both new and older antipsychotics—that are
used to treat people with schizophrenia. For more information, visit
the NIMH CATIE page.
Length of Treatment.
Like diabetes or high blood pressure, schizophrenia is a chronic
disorder that needs constant management. At the moment, it cannot be
cured, but the rate of recurrence of psychotic episodes can be
decreased significantly by staying on medication. Although responses
vary from person to person, most people with schizophrenia need to take
some type of medication for the rest of their lives as well as use
other approaches, such as supportive therapy or rehabilitation.
Relapses
occur most often when people with schizophrenia stop taking their
antipsychotic medication because they feel better, or only take it
occasionally because they forget or don't think taking it regularly is
important. It is very important for people with schizophrenia to take
their medication on a regular basis and for as long as their doctors
recommend. If they do so, they will experience fewer psychotic symptoms.
No
antipsychotic medication should be discontinued without talking to the
doctor who prescribed it, and it should always be tapered off under a
doctor's supervision rather than being stopped all at once.
There
are a variety of reasons why people with schizophrenia do not adhere to
treatment. If they don't believe they are ill, they may not think they
need medication at all. If their thinking is too disorganized, they may
not remember to take their medication every day. If they don't like the
side effects of one medication, they may stop taking it without trying
a different medication. Substance abuse can also interfere with
treatment effectiveness. Doctors should ask patients how often they
take their medication and be sensitive to a patient's request to change
dosages or to try new medications to eliminate unwelcome side effects.
There
are many strategies to help people with schizophrenia take their drugs
regularly. Some medications are available in long-acting, injectable
forms, which eliminate the need to take a pill every day. Medication
calendars or pillboxes labeled with the days of the week can both help
patients remember to take their medications and let caregivers know
whether medication has been taken. Electronic timers on clocks or
watches can be programmed to beep when people need to take their pills,
and pairing medication with routine daily events, like meals, can help
patients adhere to dosing schedules.
Medication Interactions. Antipsychotic medications can produce unpleasant or dangerous side effects when taken with certain other drugs. For
this reason, the doctor who prescribes the antipsychotics should be
told about all medications (over-the-counter and prescription) and all
vitamins, minerals, and herbal supplements the patient takes. Alcohol
or other drug use should also be discussed.
Psychosocial treatment
Numerous studies have found that psychosocial treatments can help patients who are already stabilized on antipsychotic medications
deal with certain aspects of schizophrenia, such as difficulty with
communication, motivation, self-care, work, and establishing and
maintaining relationships with others. Learning and using coping
mechanisms to address these problems allows people with schizophrenia
to attend school, work, and socialize. Patients who receive regular
psychosocial treatment also adhere better to their medication schedule
and have fewer relapses and hospitalizations. A positive relationship
with a therapist or a case manager gives the patient a reliable source
of information, sympathy, encouragement, and hope, all of which are
essential for for managing the disease. The therapist can help patients
better understand and adjust to living with schizophrenia by educating
them about the causes of the disorder, common symptoms or problems they
may experience, and the importance of staying on medications.
Illness Management Skills.
People with schizophrenia can take an active role in managing their own
illness. Once they learn basic facts about schizophrenia and the
principles of schizophrenia treatment, they can make informed decisions
about their care. If they are taught how to monitor the early warning
signs of relapse and make a plan to respond to these signs, they can
learn to prevent relapses. Patients can also be taught more effective
coping skills to deal with persistent symptoms.
Integrated Treatment for Co-occurring Substance Abuse.
Substance abuse is the most common co-occurring disorder in people with
schizophrenia, but ordinary substance abuse treatment programs usually
do not address this population's special needs. Integrating
schizophrenia treatment programs and drug treatment programs produces
better outcomes.
Rehabilitation. Rehabilitation
emphasizes social and vocational training to help people with
schizophrenia function more effectively in their communities. Because
people with schizophrenia frequently become ill during the critical
career-forming years of life (ages 18 to 35) and because the disease
often interferes with normal cognitive functioning, most patients do
not receive the training required for skilled work. Rehabilitation
programs can include vocational counseling, job training, money
management counseling, assistance in learning to use public
transportation, and opportunities to practice social and workplace
communication skills.
Family Education. Patients with
schizophrenia are often discharged from the hospital into the care of
their families, so it is important that family members know as much as
possible about the disease to prevent relapses. Family members should
be able to use different kinds of treatment adherence programs and have
an arsenal of coping strategies and problem-solving skills to manage
their ill relative effectively. Knowing where to find outpatient and
family services that support people with schizophrenia and their
caregivers is also valuable.
Cognitive Behavioral Therapy.
Cognitive behavioral therapy is useful for patients with symptoms that
persist even when they take medication. The cognitive therapist teaches
people with schizophrenia how to test the reality of their thoughts and
perceptions, how to "not listen" to their voices, and how to shake off
the apathy that often immobilizes them. This treatment appears to be
effective in reducing the severity of symptoms and decreasing the risk
of relapse.
Self-Help Groups. Self-help groups for
people with schizophrenia and their families are becoming increasingly
common. Although professional therapists are not involved, the group
members are a continuing source of mutual support and comfort for each
other, which is also therapeutic. People in self-help groups know that
others are facing the same problems they face and no longer feel
isolated by their illness or the illness of their loved one. The
networking that takes place in self-help groups can also generate
social action. Families working together can advocate for research and
more hospital and community treatment programs, and patients acting as
a group may be able to draw public attention to the discriminations
many people with mental illnesses still face in today's world.
Support groups and advocacy groups are excellent resources for people with many types of mental disorders.
What is the role of the patient’s support system?
Support
for those with mental disorders can come from families, professional
residential or day program caregivers, shelter operators, friends or
roommates, professional case managers, or others in their communities
or places of worship who are concerned about their welfare. There are
many situations in which people with schizophrenia will need help from
other people.
Getting Treatment. People with schizophrenia
often resist treatment, believing that their delusions or
hallucinations are real and psychiatric help is not required. If a
crisis occurs, family and friends may need to take action to keep their
loved one safe.
The issue of civil rights enters into any attempt
to provide treatment. Laws protecting patients from involuntary
commitment have become very strict, and trying to get help for someone
who is mentally ill can be frustrating. These laws vary from state to
state, but, generally, when people are dangerous to themselves or
others because of mental illness and refuse to seek treatment, family
members or friends may have to call the police to transport them to the
hospital. In the emergency room, a mental health professional will
assess the patient and determine whether a voluntary or involuntary
admission is needed.
A person with mental illness who does not
want treatment may hide strange behavior or ideas from a professional;
therefore, family members and friends should ask to speak privately
with the person conducting the patient's examination and explain what
has been happening at home. The professional will then be able to
question the patient and hear the patient's distorted thinking for
themselves. Professionals must personally witness bizarre behavior and
hear delusional thoughts before they can legally recommend commitment,
and family and friends can give them the information they need to do so.
Caregiving.
Ensuring that people with schizophrenia continue to get treatment and
take their medication after they leave the hospital is also important.
If patients stop taking their medication or stop going for follow-up
appointments, their psychotic symptoms will return. If these symptoms
become severe, they may become unable to care for their own basic needs
for food, clothing, and shelter; they may neglect personal hygiene; and
they may end up on the street or in jail, where they rarely receive the
kind of help they need.
Family and friends can also help patients
set realistic goals and regain their ability to function in the world.
Each step toward these goals should be small enough to be attainable,
and the patient should pursue them in an atmosphere of support. People
with a mental illness who are pressured and criticized usually regress
and their symptoms worsen. Telling them what they are doing right is
the best way to help them move forward.
How should you respond
when someone with schizophrenia makes statements that are strange or
clearly false? Because these bizarre beliefs or hallucinations are real
to the patient, it will not be useful to say they are wrong or
imaginary. Going along with the delusions will not be helpful, either.
It is best to calmly say that you see things differently than the
patient does but that you acknowledge that everyone has the right to
see things in his or her own way. Being respectful, supportive, and
kind without tolerating dangerous or inappropriate behavior is the most
helpful way to approach people with this disorder.
Twelve Great Books on Schizophrenia:
- Schizophrenia Revealed: From Neurons to Social Interactions by Michael Foster Green (Paperback - May 15, 2003)
-
Me, Myself, and Them: A Firsthand Account of One Young Person's
Experience with Schizophrenia (Adolescent Mental Health Initiative) by
Kurt Snyder, Raquel E. Gur, and Linda Wasmer Andrews (Paperback - Oct
29, 2007)
-
The Quiet Room: A Journey Out of the Torment of Madness by Lori Schiller and Amanda Bennett (Paperback - Jan 1, 1996)
-
Center Cannot Hold, The: My Journey Through Madness by Elyn R. Saks (Paperback - Aug 12, 2008)
-
Surviving Schizophrenia: A Manual for Families, Consumers, and
Providers (4th Edition) by E. Fuller Torrey (Paperback - May 8, 2001)
-
Schizophrenia Revealed: From Neurons to Social Interactions by Michael Foster Green (Paperback - May 15, 2003)
-
Schizophrenia: A Very Short Introduction by Christopher Frith and Eve Johnstone (Kindle Edition - Sep 25, 2003) - Kindle Book
-
Promoting Wellness: Schizophrenia (Online Tutorial for Individuals) by
Adrianne Avillion, DEd, and Mary Dreher, EdD, Educational Global
Technologies, Inc. (CD-ROM)
-
Living with Schizophrenia by Monkey See Productions (DVD)
-
Getting Your Life Back Together When You Have Schizophrenia by Roberta Temes (Paperback - Sep 2, 2008)
-
The Complete Family Guide to Schizophrenia: Helping Your Loved One Get
the Most Out of Life by Kim T. Mueser and Susan Gingerich (Hardcover -
May 26, 2006)
-
Recovered, Not Cured: A Journey Through Schizophrenia by Richard McLean (Paperback - May 1, 2005)
Resource and Support Groups for Schizophrenia:
- Schizophrenia.com
- Schizophreniaconnection.com
- Schizophrenia Support Organizations USA
- Support4hope
- Daily Strength
- North American Society for Childhood Onset Schizophrenia
- Our Beautiful Minds
- Yahoo Support Groups for Schizophrenia
Additional Resources:
- For related articles on
schizophrenia disorders on the Web, click on: “Sphere: Related Content”
located at the bottom of this blog post.
- For related books or blog
posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to
“Psychiatric Disorders: Schizophrenia” or type in the keyword
“schizophrenia” into “Google Search” located in the sidebar.
- For more books with related
content, click any hyperlinked keyword in the blog or type in the keyword,
“schizophrenia” into “Amazon Search” on the Amazon banner located in the
side bar.
Sources: National Insittute of Mental Health, See also blogposts in: Psychiatric Disorders: Schizophrenia
Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com
