Schizophrenia usually first appears in a person during his or her late teens or twenties. It affects more men than women, and is considered a life-long condition that is rarely “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 their medication for strectches of time, 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 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., 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.
Treatment of Schizophrenia
Antipsychotics: The mainstay of psychiatric treatment for schizophrenia is antipsychotic medication. This can reduce most “positive” symptoms of psychosis. Most antipsychotics take around 7–14 days to have their main effect. Treatment was revolutionized in the mid-1950s with the development and introduction of the first antipsychotic: chlorpromazine. Others, such as haloperidol and trifluoperazine, soon followed.
Though expensive, the newer, atypical antipsychotic drugs are usually preferred for initial treatment over the older typical antipsychotics; they’re often better tolerated and associated with lower rates of tardive dyskinesia, although they’re more likely to induce weight gain and obesity-related diseases. Of the atypical antipsychotics, olanzapine and clozapine are the most likely to induce weight gain. The effect is more pronounced if high doses of olanzapine are used. Smaller amounts of weight gain are induced by risperidone and quetiapine. Ziprasidone and aripiprazole are considered to be weight-neutral antipsychotics.
- Nevertheless, some findings indicate that, in the long term, many schizophrenic individuals function better without antipsychotic medicine. In a 2007 study, only 28% of patients who weren’t being treated medicinally showed signs of psychotic activity, while 64% of those on antipsychotics had psychotic activity. The authors of the study cautioned that some of this gap may be accounted for by the increased likelihood of symptomatic patients to be placed on antipsychotic medicine, but also noted that some of the difference held even when on-antipsychotic and off-medicine patients of similar prognosis were compared.There are many newer antipsychotic medications available since the 1990s, 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.
- LY219873: A new schizophrenia drug “LY219873” yielded promising results, as it targets in the brain glutamate receptors rather than dopamine and has few side effects. The Nature Medicine study, by drug firm Eli Lilly, found it promising and Dr. Sandeep Patil’s team proved that LY2140023 appears to work as an antipsychotic when tested upon rodents.
- Nicotine patch: Following an observation that tobacco smoking eases the effects of schizophrenia, Dr. Tony George from the Yale School of Medicine proposed nicotine patch as a treatment for schizophrenia.
Psychological and social interventions
- Psychotherapy: This method is also widely recommended and used in the treatment of schizophrenia, although services may often be confined to pharmacotherapy because of reimbursement problems or lack of training. Cognitive behavioral therapy (CBT) is used to reduce symptoms and improve related issues such as self-esteem, social functioning and insight. Although the results of early trials were inconclusive, more recent reviews suggest that CBT can be an effective treatment for the psychotic symptoms of schizophrenia.
- Remediation therapy: This is a technique aimed at remediating the neurocognitive deficits sometimes present in schizophrenia. Based on techniques of neuropsychological rehabilitation, early evidence has shown it to be cognitively effective, with some improvements related to measurable changes in brain activation as measured by MRI. A similar approach known as cognitive enhancement therapy, which focuses on social cognition as well as neurocognition, has shown efficacy.
- Family Therapy or Education: This method addresses the whole family system of an individual with a diagnosis of schizophrenia and has been consistently found to be beneficial, at least if the duration of intervention is longer term. Aside from therapy, the impact of schizophrenia on families and the burden on careers has been recognized with the increasing availability of self-help books on the subject. There’s also some evidence for benefits from social skills training, although there have also been significant negative findings. Some studies have explored the possible benefits of music therapy and other creative therapies.In addition to involvement in seeking help, family, friends and peer groups can provide support and encourage the person with schizophrenia to regain his social abilities. It’s important that goals be attainable, since a patient who feels pressured and/or repeatedly criticized by others will probably experience stress that may lead to a worsening of symptoms. Like anyone else, people with schizophrenia need to know when they’re doing things right. A positive approach may be helpful and perhaps more effective in the long run than criticism. This advice applies to everyone who interacts with the person.
- Electroconvulsive therapy: This isn’t considered a first line treatment but may be prescribed in cases where other treatments have failed. It’s more effective where symptoms of catatonia are present, and is recommended for use under NICE (National Institute for Health and Clinical Excellence) guidelines for catatonia if previously effective, though there’s no recommendation for use for schizophrenia otherwise.
- Psychosurgery: This has now become a rare procedure and isn’t a recommended treatment for schizophrenia with the controversies surrounding lobotomy and other surgeries.
- Service-user led movements: These movements have become integral to the recovery process in Europe and America, groups such as the Hearing Voices Network and the Paranoia Network have developed a self-help approach that aims to provide support and assistance outside the traditional medical model adopted by mainstream psychiatry.By avoiding the framing of personal experience in terms of criteria for mental illness or mental health, they aim to lift the stigma of the experience and encourage individual responsibility and a positive self-image. Partnerships between hospitals and consumer-run groups are becoming more common, with services working toward remediating social withdrawal, building social skills and reducing rehospitalization.
- The Soteria model: This is an alternative treatment to institutionalization and early use of antipsychotics. It’s described as a milieu-therapeutic recovery method, characterized by its founder as “the 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective and tolerant social environment.” Soteria or Soteria-based houses are currently run in Sweden, Germany, Switzerland and Hungary. The Soteria house in Berne, Switzerland is associated with a psychiatrist who teaches at the University of Berne, and has been featured in the Schweizerische Aertzezeitung, the Bulletin of Swiss Physicians.
- Orthomolecular Psychiatry: The biologically based branch of alternative medicine that deals with schizophrenia is known as orthomolecular psychiatry. Some scientists claim that schizophrenia can be treated effectively with nutrients like niacin, vitamin C and B6, omega-3 EFAs (fish oil) along with various minerals and amino acids.The body’sadverse reactions to gluten and other allergens are implicated in some alternative theories as the cause of some cases. This theory—discussed by one author in three British journals in the 1970s—is unproven. A 2006 literature review suggests that gluten may be a factor for a subset of patients with schizophrenia, but further study is needed to confirm the association between gluten and schizophrenia. On that note, another unconventional approach is the use of omega-3 fatty acids, with one study finding some benefits from their use as a dietary supplement.
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 shouldn’t 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.
With support, determination and understanding, people who have 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 patients and their therapist or doctor while 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.