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Schizophrenia

How Is Schizophrenia Treated?

Last modified: 
24/04/2012 - 12:47

Contributing Author: Guy Slowik FRCS

Because the progression and symptoms of schizophrenia vary from one person to another, treatment must be an individualized decision. Schizophrenia cannot be cured, but it can be effectively managed in many people.

Treatment options include:

Antipsychotic Medications

Antipsychotic medication has been available since the mid-1950s, and it has greatly improved the outlook for people with schizophrenia.These medications reduce the symptoms of psychosis and usually allow a person to function more effectively and appropriately.

Typical antipsychotic drugs (also called neuroleptic drugs) work by blocking receptors in the brain of the chemical messenger dopamine, which is thought to play a role in schizophrenia. These medications have the most significant impact on the symptoms of hallucinations and delusions.

Antipsychotic drugs include:

  • Chlorpromazine (Thorazine)
  • Haloperidol (Haldol)
  • Perphenazine (Trilafon)
  • Thioridazine (Mellaril)
  • Mesoridazine (Serentil)
  • Trifluoperazine (Stelazine)
  • Fluphenazine (Prolixin)

Side effects of antipsychotic medications include:

  • Sleepiness and lethargy (which usually decreases over time)
  • Dry mouth
  • Eye problems
  • Allergic reactions
  • Weight gain
  • Menstrual irregularities in women
  • Sexual dysfunction

Nearly every antipsychotic drug can cause abnormal muscle spasms or involuntary movement of the nerves and muscles controlling movement and coordination. These are known as extrapyramidal symptoms. If this occurs, the doctor will reduce the dosage or switch to a different type of medication.

Tardive dyskinesia is a syndrome of involuntary movements especially around the mouth, and it is associated with long-term antipsychotic drug treatment. It occurs in about 15 to 20 percent of people who have been taking antipsychotic medication for many years. It also can develop in people who have been treated with these drugs for shorter periods of time. In many cases, the symptoms of tardive dyskinesia are mild, and the person may be unaware of them.

Need To Know:

A serious but rare side effect is a condition called neuroleptic malignant syndrome, in which dangerously high body temperatures occur. Without immediate treatment, which side effect can be fatal in 20 percent of the people who develop it.

Atypical Medications

Since 1990, a number of newer medications have been introduced to treat schizophrenia. These so-called "atypical drugs" work in areas of the brain that are different from those affected by typical antipsychotic drugs.

Atypical drugs include:

  • Clozapine (Clozaril) - The first of these newer drugs, clozapine is particularly useful in younger people. Side effects include nasal congestion, drooling, low blood pressure, headache, sleepiness, and weight gain. Serious side effects include seizures and, rarely, a potentially life-threatening decrease in a person's white blood cells (a condition called agranulocytosis). People taking this medication must be monitored with blood tests every one to two weeks.
  • Risperidone (Risperdal) - This drug works better than typical antipsychotic drugs in many people. Common side effects include sleepiness, weight gain, and dizziness.
  • Olanzapine (Zyprexa) - This drug has a lower risk for seizures and agranulocytosis. As with risperidone, common side effects include sleepiness, weight gain, and dizziness.

Need To Know:

Some people are concerned about long-term use of antipsychotic medications. In addition to side effects, they worry about addiction. Keep in mind that:

  • Antipsychotic drugs do not produce a "high" or addictive behavior in people who take them.
  • Antipsychotic drugs do not "knock out" people, control their minds, or take away their free will.
  • Any sedation effects are due to the drugs' ability to diminish the hallucinations, agitation, confusion, and delusions of a person with schizophrenia.

Other Useful Medications

Other medications that can help symptoms of schizophrenia in some people include:

  • Antidepressants. Depression is common in people with schizophrenia. One study concluded that antidepressants may help prevent relapse of schizophrenic symptoms.
  • Antianxiety drugs. Benzodiazepines are normally used to treat anxiety, but they have been found to reduce schizophrenic symptoms in some people.
  • Lithium. Ordinarily used for bipolar disorder, lithium is useful for some individuals, particularly those who have no family history of schizophrenia.
  • Antiepileptic drugs. Drugs ordinarily prescribed for epilepsy can help people who are violent and who do not respond to other drugs.

Electroconvulsive ("Shock") Therapy

Electroconvulsive therapy (ECT) is commonly called shock therapy because a low-voltage electric current is used to cause a seizure. It is the seizure, not the shock, that is therapeutic. The methods of conducting ECT have been refined over the years, and some physicians today feel it is safer than drug therapy.

Need To Know:

ECT was introduced in the 1930s, and in those days it was performed in a somewhat primitive manner. Images from Hollywood have perhaps fostered an unnecessary fear of ECT. In the film "One Flew Over the Cuckoo's Nest," for example, a patient is administered ECT by cold, institutional personnel. In reality, however, modern ECT is administered in a safe, humane, and painless manner.

Psychotherapy

Psychotherapy is any of a large number of related methods of treating mental and emotional disorders by psychologic techniques rather than by physical means. Professionals trained in psychotherapy include psychiatrists, psychologists, social workers, and some nurses.

Psychotherapy is used along with medication. Most experts believe that an integrated program that offers both medical and psychological treatment of the individual and support to the family is important for the long-term improvement of people with schizophrenia.

Most effective are cognitive-behavioral methods of therapy, which attempt to strengthen the person's capacity for normal thinking using mental exercises and self-observation. Cognitive therapy teaches people to change their negative patterns of thought and behavior by helping them learn problem-solving techniques and other strategies.

A psychotherapy session may focus on current or past problems, experiences, thoughts, feelings, or relationships. By sharing such experiences, people with schizophrenia may gradually come to understand more about themselves and their disorder. They also may learn to sort out the real from the unreal.

Family Support

It is deeply painful for anyone to see the behavior of a loved one determined not by a healthy response to the real world, but by a mysterious internal mechanism. Fewer than 10 percent of families of people with schizophrenia receive support and education, even though studies have shown the benefits of such a program for both the person and the family.

Many studies have shown that people with schizophrenia do worse in families who are overly emotional, hostile, or critical. Support groups can be helpful, and studies have shown that individuals improve when families are in self-help groups.

Rehabilitation

Rehabilitation includes a wide variety of nonmedical interventions for people with schizophrenia. Such programs emphasize social and vocational training.

People with schizophrenia often have a difficult time performing ordinary life skills such as cooking and personal grooming. Rehabilitation can help a person regain the confidence to take care of themselves and lead a productive life.

Nice To Know:

Community treatment programs, in which a team of professionals provides treatment and support for people with schizophrenia in their homes, is both beneficial and cost effective. Unfortunately, such a program is not available in all communities.

How To Information:

Avoiding a relapse

Even with continued treatment, some people who have recovered will suffer relapses. However, far higher relapse rates are seen when medication is discontinued or taken irregularly. Continued use of medication will reduce the intensity and frequency of relapses.

It is very important that people with schizophrenia work with their doctors and family members to develop and adhere to a good treatment plan. Good adherence involves:

  • Taking prescribed medication at the correct dose and proper times each day.
  • Keeping appointments with the doctor and therapist.
  • Carefully following other treatment procedures.

Substance abuse can interfere with the effectiveness of treatment and can lead individuals to discontinue medications.

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Schizophrenia

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.