Treating schizophrenia, unlike treatment for other mental health disorders, generally has the goal of improving quality of life rather than providing a “cure” or full remission of symptoms. Goals of treatment can be summarized as:
- Minimizing symptoms
- Preventing suicide
- Avoiding relapse
- Improving self-esteem
- Improving social and occupational functioning
- Providing support to the patient and their loved ones
The most common schizophrenia treatment options are coordinated specialty care, medication management and therapy.
Coordinated Specialty Care
Coordinated specialty care is a treatment method typically utilized following a person’s first episode of psychosis. It involves a team approach between the patient and professionals to create a personalized treatment plan. The team may include supports for medication management, case management and supported employment. Individuals who receive this form of care following their initial psychotic episode are more likely to experience an improved quality of life.
Medications for Schizophrenia
Antipsychotic drugs have long been the top choice of treatment for schizophrenia. Antipsychotics for schizophrenia can be divided into two categories: first-generation antipsychotics (typical antipsychotics) and second-generation antipsychotics (atypical antipsychotics). First-generation antipsychotics are commonly utilized to address hallucinations and delusions, while second-generation antipsychotics are used to improve motivation, social engagement and negative thought patterns.
Antipsychotic drugs are used to treat disorders other than schizophrenia. Other disorders they may be used to treat include bipolar disorder, disruptive mood dysregulation disorder and obsessive-compulsive disorder. At times, antipsychotics are prescribed to complement other medications and boost their efficacy for treatment. For example, Abilify is often used along with an antidepressant medication for major depressive disorder.
Common first-generation antipsychotics include:
Common second-generation antipsychotics include:
Therapy for Schizophrenia
Psychological interventions may be helpful for individuals with schizophrenia once symptoms of psychosis have receded. Therapy options for schizophrenia include the following:
Electroconvulsive therapy or ECT may be used when patients don’t respond to medication. During ECT, under general anesthesia, doctors send controlled electric currents to the brain causing a brief seizure. ECT, traditionally used to relieve symptoms of depression, may be effective for individuals with schiophrenia as well.
Psychotherapy is usually not effective at treating schizophrenia during acute phases of treatment. Because people tend to have short attention spans and difficulty identifying reality during this stage of care, contacts should be kept brief. An actively psychotic patient will benefit more from multiple brief interactions than one or two lengthy interactions.
Even after active psychosis has passed, psychotherapy has only helped patients currently taking antipsychotic medications. In a non-medicated patient, talk therapy may speed the process towards the next psychotic break. Long-term individual psychotherapy will not be useful for a person with schizophrenia. Instead, working through specific issues with a therapist is suggested. Many people experience a depressive episode following a psychotic episode. During this time, it can be helpful for a patient to receive individual psychotherapy, which can reduce depressive symptoms and increase hope for the future.
Cognitive Behavior Therapy (CBT)
Cognitive behavior therapy (CBT), like other forms of individual psychotherapy, is best used during non-acute phases of schizophrenia treatment. Working through the issues that are likely to create a relapse into an acute psychosis should be the focus of CBT. This may include working on negative thought patterns held about oneself, improving social skills and involvement, and challenging reservations about taking medication or other forms of symptom management.
Cognitive Enhancement Therapy (CET)
Cognitive enhancement therapy (CET) was created specifically for people with schizophrenia. It functions to improve cognitive development and, as a result, social skills and occupational opportunities. CET is conducted in highly structured groups and typically lasts for 48 weeks. The benefits of CET include:
- Improved attention
- Improved memory and recall
- Enhanced motivation
- Improved mood
- Improved awareness of social contexts
- Increased vocational effectiveness
- Improved interpersonal skills
- Increased active thinking
- Better awareness and acceptance of disorder and symptoms
- Increased dependability
- Developing the ability to think of future consequences and outcomes
- Developing the ability to consider others’ perspectives
- Improved mental stamina
Psychosocial therapy includes more than just traditional talk therapy. This approach includes case management or care coordination in addition to other approaches to aid the individual in developing social and emotional skills. Psychosocial therapists often work with an individual to identify resources to promote independence. These components are especially valuable for a person with schizophrenia as they may avoid a severe psychotic break if they are able to access proper resources on their own. The disorder is characterized by being easily overwhelmed following a period of psychosis, which makes the availability of case management especially useful as this reduces some burdens from the individual.
Hospitalization for Schizophrenia
Generally, there are no benefits in attempting to engage in talk therapy when a person is actively psychotic. Instead, the most important goals are to stabilize the person and keep them safe. This is best achieved through acute hospitalization when a person’s medications can be adjusted in a safe and controlled environment.
Treatment for Schizophrenia and Co-Occurring Conditions
When co-occurring disorders are present with schizophrenia, addressing both is important. Addressing whichever disorder is currently causing the most acute symptoms is recommended. During active psychosis, treatment will focus on stabilization rather than treating social anxiety. In the case of schizophrenia and substance use disorders, working towards abstinence is important. Once abstinence is achieved and adequate time has passed to allow for major withdrawal symptoms to subside, addressing symptoms of schizophrenia is important. If an individual is using drugs, distinguish symptoms of schizophrenia from signs of substance use can be difficult.
If you or someone you know struggles with addiction and a co-occurring disorder, The Recovery Village can help. Call a representative today for more information or to take the first step toward treatment.