Treatment Of Schizophrenia

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Schizophrenia is a chronic, complex mental health condition that causes hallucinations, delusions, and impaired cognitive ability. However, with effective schizophrenia treatment one can live a relatively normal life.

Need For Schizophrenia Treatment

Schizophrenia is a disabling mental illness which can affect the sufferer’s thoughts, emotions, decision making and even personal relationships. As there is no specific cure for this disorder, seeking schizophrenia treatment early can help the patient overcome the symptoms better. The treatment process primarily focuses on managing the symptoms and involves medications and psychotherapy. As there are different types of medications and various forms of therapy available for this mental illness, consulting a doctor or a mental health expert is very important.

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Treatment For Schizophrenia

As of now, there is no specific cure for schizophrenia. Anyone having this disorder will require lifelong treatment to manage symptoms and improve day to day functioning abilities. When diagnosed with this condition, the patients must seek immediate treatment from mental health professionals, like a psychiatrist, to manage the intensity of symptoms.

Here are some of the common and most effective schizophrenia treatment options available:

1. Medications

Medications 1 are the first-line of treatment for treating schizophrenia. Primarily, antipsychotic medications are prescribed by healthcare professionals. Although antipsychotics do not directly cure the disorder, it significantly helps in reducing prominent symptoms like hallucinations, delusions and distorted thinking. Medications help to regulate these symptoms by affecting the neurotransmitter dopamine in the brain. Apart from antipsychotics, the doctor may also prescribe anti-anxiety drugs and antidepressants depending on the individual and the severity of the condition.

Antipsychotics 2 can greatly help in decreasing the frequency and intensity of psychotic symptoms. However, it should be noted that antipsychotic medication can often have certain side effects, like drowsiness, dry mouth, restlessness and weight gain. But in most cases, the side effects recede with time. If someone stops taking their medicines as a part of schizophrenia treatment, then it may make the symptoms worse. This is why it is crucial to follow the instructions of medical professionals and consult them frequently. “Shared decision making between doctors and patients is the recommended strategy for determining the best type of medication or medication combination and the right dose,” explains NIMH.

Here are some commonly prescribed medications for this condition:

A. First-Generation Antipsychotic Drugs

These drugs help to block the neurotransmitter dopamine in the brain but may cause certain movement disorders, such as dystonia or tardive dyskinesia. These may generally include:

  • Haloperidol (Haldol)
  • Trifluoperazine (Stelazine)
  • Perphenazine (Trilafon)
  • Chlorpromazine (Thorazine)
  • Loxapine (Loxitane)
  • Thioridazine (Mellaril)
  • Fluphenazine (Proxlixin)
  • Pimozide (Orap)
  • Thiothixene (Navane)

B. Second-Generation Antipsychotic Drugs

These are newer medications that cause fewer side effects compared to first-generation antipsychotics. However, these drugs can increase cholesterol levels, blood sugar and result in weight gain. These medications include:

  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Cariprazine (Vraylar)
  • Aripiprazole (Abilify)
  • Lumateperone tosylate (Caplyta)
  • Quetiapine (Seroquel)
  • Asenapine (Saphris)
  • Pimavanserin (Nuplazid)
  • Brexpiprazole (Rexulti)
  • Lurasidone (Latuda)
  • Iloperidone (Fanapt)
  • Paliperidone (Invega)
  • Ziprasidone (Geodon)

Clozapine is the only medication for treating this disorder that has been approved by the FDA. This medicine also helps to reduce suicidal behavior in patients. One study 3 revealed that “Clozapine produced significantly greater improvement,” in patients. Another 2014 study 4 found that “Clozapine is the most effective antipsychotic in terms of managing treatment-resistant schizophrenia.” It has proved to be 30% effective in managing symptoms in patients who are resistant to schizophrenia treatment. Moreover, only 1-2% of patients taking clozapine experience side effects, according to the National Institute of Mental Health (NIMH).

2. Psychosocial interventions

In addition to medications, psychological and social interventions can also be an excellent option for schizophrenia treatment. This can include a number of options, like:

A. Individual therapy

Psychotherapy techniques, like cognitive behavioural therapy (CBT), supportive therapy, assertive community treatment and other individual therapy methods can help in managing the symptoms. These can also help to regulate thought and behavior patterns and encourage the patient to normalize them. Psychotherapy can also empower the patient to manage stress & anxiety and recognize early warning signs of relapse.

According to a 2009 study 5 , CBT is considered as a “standard treatment in the United Kingdom” for this disorder and is “gaining more interest and acceptance in the United States as an adjunctive treatment for people with schizophrenia.” Another 2018 study 6 found that cognitive behavioral therapy for psychosis (CBTp) reduces distress and improves quality of life in schizophrenia patients.

B. Social skills training (SST)

Social training can greatly help to improve the sufferers social interaction and communication skills. Moreover, it can enable them to also enhance their capacity to engage in regular activities. One 2018 study 7 explains “consistently-replicated findings that SST improves social skills, negative symptoms and functioning relative to standard care suggests that existing standard services for schizophrenia can be improved by adding SST.”

C. Family therapy

This can not only help families learn about schizophrenia, but it can provide education and support in dealing with a loved one affected by this condition. By improving the knowledge of family and friends regarding psychotic symptoms, their ability to support the recovery process can be improved. Research 8 reveals that schizophrenia treatment involving family therapy can reduce negative emotions within families. It can also reduce chances of frequent relapses, decreases over-involvement, hostility and excessive criticism & even makes families more emotionally expressive. A 2015 study 9 states “Family interventions for schizophrenia have been amply demonstrated to be effective and are recommended by most of the international clinical guidelines.”

D. Cognitive enhancement therapy (CET)

Also known as cognitive remediation, CET helps patients to learn how they can successfully identify social triggers and enhance their thoughts, memory, attention and decision making abilities. Cognitive enhancement therapy generally involves computer-based brain training in group sessions. Research indicates that CET enhanced with supportive therapy can have significant positive effects on cognitive deficits within-group effect sizes. According to a 2004 study 10 , “Many cognitive deficits and related behaviors of patients with stable schizophrenia are improved when sufficient exposure to relevant rehabilitation is provided.”

E. Rehabilitation

This refers to vocational rehabilitation which helps patients to gain necessary occupational skills, find jobs and sustain employment. It may also provide social skills to enable schizophrenics live and function independently in the community.

F. Other psychological & psychosocial interventions

Apart from the therapy options mentioned above, schizophrenia treatment may also involve the following types of psychosocial interventions as well:

  • Family education
  • Arts therapy
  • Coordinated specialty care (CSC)
  • Assertive Community Treatment (ACT)
  • Animal Assisted Therapy
  • Social recovery therapy
  • Self-help groups

3. Hospitalization

At times, hospitalization may be required to ensure that the patient remains safe, gets adequate nutrition & sleep and stays in an hygienic environment. For people with schizophrenia, hospitalization is needed, when:

  • They have severe symptoms
  • They are prone to harming or injuring others or themselves
  • They are unable to care for themselves or continually engage in self-neglect

4. Electroconvulsive therapy (ECT)

When an adult patient doesn’t respond to medications and therapy, then ECT may be considered as an helpful and effective option.This process involves electrical stimulation of the brain when the patient is under anesthesia. One 2018 study 11 has found that “There is growing evidence to support the use of ECT for augmentation of antipsychotic response in the treatment of schizophrenia.”

Coping With Schizophrenia

Coping With Schizophrenia

Apart from seeking medical help and following the schizophrenia treatment plan, one can implement certain self help strategies under the guidance of their doctor to fasten the recovery process. Once you learn to manage your symptoms, you will be able to lower the chances of serious relapses. Self-care and coping strategies may include:

  • Identifying signs of acute episodes
  • Taking medications properly as prescribed
  • Going for regular checkups
  • Talking to friends, family members and coworkers about the disorder
  • Actively coping with and preventing accidents, minor illness and long-term conditions
  • Following a healthy lifestyle and having enough sleep, exercise and a healthy diet
  • Taking steps to maintain good mental health
  • Stopping or reducing smoking and caffeine consumption
  • Avoiding alcohol and drug abuse
  • Seeking support and joining support groups

Support groups often provide helpful advice on coping with the conditions and help people seek schizophrenia treatment. It can also help to talk with someone who is already coping with a similar mental disorder. Following a healthy self-care routine will enable you to live a better quality of life and live more independently.

Helping A Loved One With Schizophrenia

Helping A Loved One With Schizophrenia

If a friend, family member or a loved one is suffering from the condition, then the best thing you can do to help them is to encourage them to seek schizophrenia treatment under the supervision of a medical professional. However, you should realize that you cannot force anyone to ask for medical attention. Simply support them and help them find a qualified mental health professional. You should also encourage them to talk about their thoughts and emotions openly and actively listen to them without judgment or criticism. If the patient is suicidal or can be dangerous to themselves or others, then make sure to contact emergency services immediately. In some cases, emergency hospitalization may be necessary.

Regardless, supporting and caring for someone with this condition can be challenging. Here are a few tips that can enable you to help your loved one:

  • Encourage them to seek treatment and follow the medical plan
  • Make appointment with doctors and therapists and accompany the patient
  • Realize that this is a serious mental disorder and educate yourself about it
  • Understand that their delusions and hallucinations appear real to the sufferer
  • Acknowledge their right to have their own opinions even if you may not agree with them
  • Practice empathy and compassion. Be kind, supportive and respectful but refuse to tolerate inappropriate behavior
  • Encourage them to join a support group
  • Practice self-care routine and look after your mental and physical health

Recovery Is Possible

According to a recent scientific review 12 , with the help of pharmacological and nonpharmacological treatments, a person with schizophrenia can experience “meaningful improvements in a variety of outcome areas, including psychiatric symptoms, functioning , service utilization, legal system involvement, quality of life, self-harm and aggressive behaviors, treatment engagement and retention, and co-occurring substance abuse.”

Moreover, such positive improvements can be sustained in the long run with manageable and limited negative effects. However, schizophrenia treatment can be a lifelong process so remember to be patient with yourself or your loved one suffering from this condition. With medical treatment and support, one can live a better and healthier life.

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👇 References:
  1. Kane, J. M. (2010). Pharmacologic treatment of schizophrenia. Schizophrenia12(3), 345-357. []
  2. Haddad, P. M., & Correll, C. U. (2018). The acute efficacy of antipsychotics in schizophrenia: a review of recent meta-analyses. Therapeutic advances in psychopharmacology8(11), 303–318. []
  3. Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry. 1988 Sep;45(9):789-96. doi: 10.1001/archpsyc.1988.01800330013001. PMID: 3046553. []
  4. Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. P & T : a peer-reviewed journal for formulary management39(9), 638–645. []
  5. Morrison A. K. (2009). Cognitive behavior therapy for people with schizophrenia. Psychiatry (Edgmont (Pa. : Township)6(12), 32–39. []
  6. Laws, K. R., Darlington, N., Kondel, T. K., McKenna, P. J., & Jauhar, S. (2018). Cognitive Behavioural Therapy for schizophrenia – outcomes for functioning, distress and quality of life: a meta-analysis. BMC psychology6(1), 32. []
  7. Granholm, E., & Harvey, P. D. (2018). Social Skills Training for Negative Symptoms of Schizophrenia. Schizophrenia bulletin44(3), 472–474. []
  8. Pharoah, F., Mari, J., Rathbone, J., & Wong, W. (2010). Family intervention for schizophrenia. The Cochrane database of systematic reviews, (12), CD000088. []
  9. Caqueo-Urízar, A., Rus-Calafell, M., Urzúa, A., Escudero, J., & Gutiérrez-Maldonado, J. (2015). The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatric disease and treatment11, 145–151. []
  10. Hogarty GE, Flesher S, Ulrich R, Carter M, Greenwald D, Pogue-Geile M, Kechavan M, Cooley S, DiBarry AL, Garrett A, Parepally H, Zoretich R. Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. Arch Gen Psychiatry. 2004 Sep;61(9):866-76. doi: 10.1001/archpsyc.61.9.866. PMID: 15351765. []
  11. Sanghani SN, Petrides G, Kellner CH. Electroconvulsive therapy (ECT) in schizophrenia: a review of recent literature. Curr Opin Psychiatry. 2018 May;31(3):213-222. doi: 10.1097/YCO.0000000000000418. PMID: 29528902. []
  12. McDonagh, M. S., Dana, T., Selph, S., Devine, E. B., Cantor, A., Bougatsos, C., Blazina, I., Grusing, S., Fu, R., Kopelovich, S. L., Monroe-DeVita, M., & Haupt, D. W. (2017). Treatments for schizophrenia in adults: A systematic review. []
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