Schizophrenia Treatment Options - OmniMedicalSearch.com

Conditions & Diseases: Psychological & Mental Health

Schizophrenia

Schizophrenia Treatment

Schizophrenia is a chronic, lifetime mental disorder that cannot be cured, but can be effectively treated and managed. Research conducted in developed countries revealed that about 20 to 35 percent of patients undergo a rapid improvement when treated. Approximately, 70 percent of the patients suffer a relapse of acute symptoms within the next 2 to 5 years after being discharged from hospital. The risk of relapse usually decreases 10 years after the initial onset.

A positive long-term outcome is associated with an acute onset featured by positive symptoms which occurs after adolescence. Unfortunately, a poor prognosis is associated with several conditions: (1) slow, gradual onset that occurs at a young age, (2) male gender, (3) no precipitating signs, (4) predominance of negative symptoms, (5) delay in receiving treatment, (6) family history of the disorder, and (7) presence of other conditions (substance abuse).

Most individuals can overcome their schizophrenia symptoms, but they need to remain on medication. The recovery rate widely varies between 29 and 83 percent, however 20 to 30 percent of the people with schizophrenia deteriorate rather than recover. Recovery is possible through a variety of different services that include pharmacologic management (medication), and rehabilitation programs in an inpatient or outpatient setting.

Most individuals diagnosed with schizophrenia require hospitalization at some point or another during the course of the disorder. In most cases, hospitalization is needed during acute or severe psychotic episodes that require intensive observation and care, and when the signs and symptoms exhibited constitute a possible risk of danger to the safety and health of the patient and those around them. For some individuals with schizophrenia, day care programs are available which can be an alternative to hospitalization. The advantage of this type of programs is that patients are allowed "to remain in their familiar surroundings and thus avoid the stigma that results from patients no longer being visible among their peers and friends" (19), while continuing the treatment. Outpatient treatment is recommended to all individuals that have experienced an acute episode of psychotic symptoms. It offers the advantage of a more exclusive relationship, patient - psychiatrist, and fulfills the patient's need for autonomy which is important in long-term treatments.

Pharmacologic Management

The psychiatric treatment for different mental illnesses, especially schizophrenia, have benefitted from the marked progress in the pharmaceutical industry. Before medication, schizophrenics were carrying the stigma of a mental disorder and were institutionalized for long periods of time away from family and society, and condemned to a life in isolation. Medication helped individuals with schizophrenia to live relatively normal and fulfilled lives within the boundaries of the community.

The first choice of treatment for individuals diagnosed with schizophrenia is antipsychotic medication. Antipsychotic medication does not cure, but is the best treatment available. It reduces the positive and negative symptoms by correcting the chemical imbalance that contributes to them. Usually, more than one antipsychotic medication is prescribed and it is recommended for patients to keep on taking the medication once they started. Antipsychotic medication requires approximately 4 to 6 weeks to reduce symptoms and stabilize behavior. However, finding the right drug or drug combination, and the right dosage takes time.

There are two type of antipsychotic medication:
1. Conventional neuroleptic agents are the first antipsychotic medication developed to treat schizophrenia symptoms. They are effective in reducing positive symptoms (hallucinations and delusions) by influencing different neurotransmitters, particularly dopamine (by blocking the receptors in the brain's dopamine pathways). Some researchers believe that positive symptoms in schizophrenia are caused by too much dopamine in the brain or sensitive dopamine receptors.

Some of the most common conventional antipsychotic medication includes: haloperidole (Haldol), zuclopenthioxol (Cisordinol), perphenazin (Trilafon), fluphenazine (Prolixin), alimemazin (Theralen), thiothixene (Navane), trifluoperazine (Stelazine), thioridazine (Mellaril), and chlorpromazine (Hibernal). Some of the conventional neuroleptics agents side effects include: dry mouth, blurred vision, drowsiness, movement disorders (tremor, muscle stiffness, a sense of restless motion, inability to be still), tardive dyskinesia (a variety of uncontrolled facial movements and involuntary, repetitive body movements such as jerking or twisting), and hyperprolactinaemia (the presence of abnormally high levels of prolactin).

2. Atypical antipsychotic medication is a newer approach in treating psychotic symptoms and it offers better results in relieving negative symptoms (withdrawal, lack of energy, and thinking problems), improve cognitive functioning, and produce less side effects. Some of the atypical antipsychotic drugs include: clozapine (Clozaril) usually prescribed when other antipsychotic drugs do not work, risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexal), and abilify (Aripiprazole). The atypical antipsychotic medication side effects include: weight gain, the risk of diabetes, obesity, high cholesterol, and agranulocytosis (low white blood cell count). Agranulocytosis is one of the clozapine's side effects.

In the past, in addition to medication doctors had used different physical treatments to reduce some of the schizophrenia symptoms and manifestations, most of them have been discarded in time such as hot or cold baths, wet or dry packs (a patient was wrapped into a dry or wet sheet to keep him immobile), or insulin therapy. Such physical treatment used in rare cases is the electroconvulsive treatment (ECT) or electroshock therapy. Despite the bad press attached to this procedure, electroconvulsive treatment is a safe and humane treatment that seems to help schizophrenics that "respond poorly to drugs and who, as a the result of their disordered thinking and feelings, are severely disorganized, cannot eat, or are suicidal." One of the electrochock therapy side effects is memory loss, however the modern electroconvulsive treatment device uses less current which causes mild and transitory memory disturbances. (20)

Rehabilitation programs

While medication helps to control schizophrenia psychotic symptoms, rehabilitation programs help the person to be more adaptable in society (to keep a job and manage money, to communicate, work and establish functional relationships with those around them, and to cope with the condition). Rehabilitation programs include a wide range of non-medical intervention such as psychotherapy, vocational rehabilitation, and cognitive rehabilitation.

Individual psychotherapy. Psychotherapy is an important part of the treatment for a person that suffers from schizophrenia, and is used as an adjunct to medication. Psychotherapy helps the patient to stay on medications, to establish and achieve weekly goals, it allows them to explore feelings, thoughts, and experiences connected to the disorder, to learn how to cope and to come to terms with what it means to suffer from a psychotic illness, and it helps the patient reintegrate into society. Individual psychotherapy offers the understanding, acceptance, and reassurance that individual with schizophrenia need in order to become constructive and build a fulfilled life for them in the terms of the disorder.

Group therapy. Group therapy is also used as an adjunct to medication and it proved to be more efficient than medication alone. Patients with schizophrenia tend to benefit from this type of treatment when everyday problems caused by the disorder are discussed. Group therapy offers mutual support and comfort for its members by reducing the social isolation often experienced by patients with schizophrenia.

Family therapy. This form of therapy was particularly popular a few years ago when family problems were thought to cause schizophrenia. These days, family therapy continues to be important in the treatment of schizophrenia because it focuses on the family education on the nature of the disorder, problem-solving training, crisis intervention training, and support. Studies have showed that when family is involved in the treatment - the rate of relapses, noncompliance to treatment, and rehospitalization significantly decreased among patients with schizophrenia.

Cognitive rehabilitation. Cognitive rehabilitation is becoming an important intervention in the treatment of schizophrenia, although there is lot of debate among researchers whether this type of treatment is really effective (the available data supporting its efficiency are not impressive). Cognitive rehabilitation focuses on improving the cognitive functioning by retraining the ability to think, use judgment, and make decisions, and correcting deficits in memory, perception, learning, planning, sequencing, attention, and concentration. (21)

Vocational rehabilitation. Vocational rehabilitation includes a set of services offered to individuals with schizophrenia with the purpose of helping them to achieve an independent lifestyle and to integrate in society (family, local community, and workplace). This type of intervention is designed to "enable participants to attain skills, resources, attitudes, and expectations needed to compete in the interview process, get a job, and keep a job". (22)

Schizophrenia is sometimes misspelled as: scizophrenia, scizophrenic, schizoprenia shizophrnia schitzophrenia schizofrenia and schizophenia.

Article by Alina Morrow,
MS Psychology
OmniMedicalSearch.com