GETTING HELP

Treatment

Schizophrenia treatment requires an all-encompassing approach, and it is important to develop a plan of care that is tailored to each person's needs. Mental health care providers and the individual needing mental health help should work together to craft this plan.

The Schizophrenia Patient Outcomes Research Team (PORT) recommends that treatment for schizophrenia includes both medications as well as psychosocial support. The PORT recommendations, issued in 1998 and updated in 2003 and 2010, were funded by the Agency for Healthcare Research and Quality and the National Institute of Mental Health.

A cure for schizophrenia has not yet been found, but mental health recovery is possible as most people's symptoms can be improved with medication. The primary medications for schizophrenia, called antipsychotics or neuroleptics, help relieve the hallucinations, delusions and, to a lesser extent, the thinking problems people can experience.

These medications are thought to work by correcting an imbalance in the chemicals that help brain cells communicate with each other.

It is estimated that nearly 50% of patients do not receive appropriate medication to treat the disorder. It's important that your doctor gives you a thorough physical examination before you start taking antipsychotics, and that you work together to find the right one for you. It may take some time to find the right medication and the right dose that works for you.

First-episode psychosis. The PORT review recommends using any antipsychotic except clozapine (Clozaril) and olanzapine (Zyprexa) because these drugs are most likely to cause significant weight gain and other metabolic side effects. Because patients experiencing psychosis for the first time are both more responsive to medications and more likely to have side effects, antipsychotics should be prescribed at doses that are lower — generally about half — compared with those recommended for patients with chronic schizophrenia.

Relapse. Patients who initially responded to medication but suffer a relapse of symptoms have several options. The PORT team recommends any first- or second-generation antipsychotic other than clozapine and stipulates that medication is prescribed at the lowest effective doses to reduce side effects. Choice of which antipsychotic to use depends on patient preference, past medication response, side effects, and medical history.

Maintenance therapy. Studies that have followed patients with first-episode or chronic schizophrenia for one to two years have concluded that continuous maintenance antipsychotic treatment reduces the risk of relapse. The maintenance dose is usually lower than the effective dose that was given to manage the positive symptoms of schizophrenia. The PORT review recommends that intermittent maintenance therapy — a strategy of stopping antipsychotics until symptoms reappear or worsen — be reserved only for patients who refuse to continue taking an antipsychotic or for those who cannot tolerate the side effects.

Clozapine or Clozaril is reserved for people who do not respond to any of the other antipsychotic medicines. It is usually only given if two different antipsychotics have been tried and have failed. It has a number of side effects including an effect on the white blood cell count and consequently regular blood testing is necessary when this drug is prescribed.

Psychosocial interventions

Psychotherapy. While medication can alleviate the symptoms of Schizophrenia, psychotherapy can help individuals learn how to function in appropriate, effective and satisfying ways. By teaching individuals how to cope, psychotherapy can help people overcome dysfunction and regain their lives.

Skills training. Schizophrenia can create impairments in many aspects of life, such as social interactions, ability to live independently, and functioning in the community. Skills training programs aim to provide interpersonal skills, practice, feedback, and positive reinforcement. Although programs once relied on giving patients homework to acquire and reinforce skills, some have now shifted to community-based practice sessions facilitated by individual trainers.

Supported employment. The key element of supported employment programs is rapid job placement rather than an extensive training period. Other important components include integration of vocational and mental health services, solicitation of the patient's preference about the type of job, and support while on the job. Most randomised controlled studies have found that at least half of the patients enrolled in supported employment programs were able to find jobs, although it is not clear how long they kept them.

Family services. Schizophrenia affects the whole family, not just the patient. The PORT team, therefore, recommends that when patients with schizophrenia have ongoing contact with their families, the relatives be offered a family intervention. Evidence suggests that programs lasting six to nine months help reduce rates of relapse and rehospitalisation for the patient and increase rates of adherence to treatment. Shorter interventions are also recommended, although outcomes of such programs may be limited to improvement in understanding of the illness, personal satisfaction, and family relationships.

Alcohol and substance abuse interventions. People with schizophrenia often struggle with co-occurring alcohol and drug abuse, including high rates of smoking. Alchohol and drug abuse can jeopardise mental health recovery. When a patient with schizophrenia uses alcohol or other psychoactive substances, the PORT team recommends adjunctive substance abuse treatment consisting of two key elements — motivational enhancement and behaviour therapy. The goals of treatment are to increase a patient's ability to cope with stress, promote abstinence, and reduce the risk of relapse.

Weight management. Some second-generation antipsychotics cause significant weight gain. The report recommends that patients with schizophrenia who are overweight or obese (defined as a BMI of 25 or more) participate in a weight-loss program that is at least three months long and includes nutritional counselling and encouragement to engage in physical activity.

How can I help someone I know with schizophrenia?

Caring for and supporting a loved one with schizophrenia can be hard. It can be difficult to know how to respond to someone who makes strange or false statements. It is important to understand that schizophrenia is a biological illness.

Here are some things you can do to help your loved one:

  • Get them treatment and encourage them to stay in treatment
  • Remember that their beliefs or hallucinations seem very real to them
  • Tell them that you acknowledge that everyone has the right to see things their way
  • Be respectful, supportive, and kind without tolerating dangerous or inappropriate behaviour
  • Check to see if there are any support groups in your area

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