Schizophrenia Treatments

Psychiatrists have found a number of antipsychotic medications that help bring biochemical imbalances closer to normal. The medications significantly reduce the hallucinations and delusions and help the patient maintain coherent thoughts. Like all medications, however, antipsychotic drugs should be taken only under the close supervision of a psychiatrist or other physician.

Antipsychotic medications are important in reducing or eliminating the chances of relapse. One study showed that 60 to 80 percent of those who did not take medication as part of their treatment had a relapse the first year after leaving the hospital. Between 20 and 50 percent of those who did take medication were re-hospitalized that first year; however, if the patients continued taking medication beyond the first year, relapse rates fell to 10 percent.

Like virtually all other medications, antipsychotic agents have side effects. While the patient's body adjusts to the medication during the first few weeks, he or she may have to contend with dry mouth, blurred vision, constipation and drowsiness. One may also experience dizziness when standing up due to a drop in blood pressure. These side effects usually disappear after a few weeks.

Other side effects include restlessness (which can resemble anxiety), stiffness, tremor, and a dampening of accustomed gestures and movements. Patients may feel muscle spasms or cramps in the head or neck, restlessness, or a slowing and stiffening of muscle activity in the face, body, arms and legs. Though discomforting, these are not medically serious and are reversible.

Because some other side effects may be more serious and not fully reversible, anyone taking these medications should be closely monitored by a psychiatrist. One such side effect is called tardive dyskinesia (TD), a condition that affects 20 to 30 percent of people taking antipsychotic drugs. TD is more common among older patients.

It begins with small tongue tremors, facial tics and abnormal jaw movements. These symptoms may progress into thrusting and rolling of the tongue, lip licking and smacking, pouting, grimacing, and chewing or sucking motions. Later, the patient may develop spasmodic movements of the hands, feet, arms, legs, neck and shoulders.

Most of these symptoms reach a plateau and do not become progressively worse. TD is severe in less than 5 percent of its victims. If medication is stopped, TD also fades away among 30 percent of all patients and in 90 percent of those younger than 40. There is also evidence that TD subsides eventually, even in patients who continue with medication. Despite the risk of TD, many suffering with schizophrenia accept medication because it so effectively ends the horrifying and painful psychoses brought on by their illness. However, the unpleasant side effects of antipsychotic medication also leads many patients to stop using medication against the advice of their psychiatrist. The refusal of patients with schizophrenia to comply with psychiatrists' treatment recommendations is a serious challenge to those specializing in the treatment of chronically mentally ill people. Psychiatrists treating people with schizophrenia must often practice with tolerance and flexibility to overcome this resistance.

There is also hope that the newer generations of antipsychotic drugs now being introduced and under development will prove to be a great help to people with schizophrenia that has been resistant to treatment in the past, with fewer side effects and greater effectiveness with schizophrenia's symptoms. Clozapine and risperidone (were among the first approved by the U.S. Food and Drug Administration) provide two examples. Clozapine doesn't list TD as one of its side effects and has helped many whose conditions were not substantially improved by the older generation of neuroleptic medications. Use of clozapine is restricted, however, by an expensive medical monitoring system made necessary by the fact that the medicine can cause agranulocytosis, a blood disorder that occurs in one to two percent of patients who take it and which can prove fatal if it is not observed. Risperidone may be safer than clozapine and have fewer of its side effects, including agranulocytosis. By ending or reducing the painful hallucinations, delusions and thought disorders, medications allow a patient to gain benefit from rehabilitation and counseling aimed at promoting the individual's functioning in society. Social skills training, which can be provided in group, family or individual sessions, is a structured and educational approach to learning social relationship and independent living skills. By using behavioral learning techniques, such as coaching, modeling and positive reinforcement, skills trainers have been successful in overcoming the cognitive deficits that interfere with rehabilitation. Research studies show that social skills training improves social adjustment and equips patients with means of coping with stressors, thereby reducing relapse rates by up to 50 percent.

Another type of learning-based treatment that has been documented to reduce relapse rates is behaviorally oriented, psychoeducational family therapy. Mental health professionals recognize the important role families play in treatment and should maintain open lines of communication with the families as treatment evolves over time. Providing family members, including the patient, with a better understanding of schizophrenia and its treatment, while helping them to improve their communication and problem-solving skills, is becoming a standard practice in many psychiatric clinics and mental health centers. In one study, when psychoeducational family therapy and social skills training were combined, the relapse rate during the first year of treatment was zero.

Psychiatric management and supervision of regular medication use, social skills training, behavioral and psychoeducational family therapy, and vocational rehabilitation must be delivered within the context of a community support program. The key personnel in community support programs are clinical case managers who are experienced in linking the patient to needed services, assuring that social services as well as medical and psychiatric treatment is delivered, forming solid and supportive long-term helping relationships with the patient, and advocating for patients' needs when there is a crisis or problem.

When continuing treatment and supportive care is available in the community, with a partnership of family, patient and professional caregivers, patients can learn to control their symptoms, identify early warning signs of relapse, develop a relapse prevention plan, and succeed in vocational and social rehabilitation programs. For the vast majority of persons with schizophrenia, the future is bright with optimism--new and more effective medications are on the horizon, neuroscientists are learning more and more about the function of the brain and how it goes awry in schizophrenia, and psychosocial rehabilitation programs are increasingly successful in restoring functioning and quality of life.

more: Atypical Antipsychotic Medications for Treatment of Schizophrenia or Detailed Info on Treatment of Schizophrenia

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