SCHIZOPHRENIA ( Second Part)

How is schizophrenia treated? 

Because the causes of schizophrenia are still unknown, treat­ments focus on eliminating the symptoms of the disease. Treatments include antipsychotic medications and various psychosocial treatments. 

Antipsychotic medications 

Antipsychotic medications have been available since the mid-1950’s. The older types are called   conventional or “typical” antipsychotics. Some of the more commonly used typical medications include: 

• Chlorpromazine (Thorazine) 
• Haloperidol (Haldol) 
• Perphenazine (Etrafon, Trilafon) 
• Fluphenazine (Prolixin)

In the 1990’s, new antipsychotic medications were devel­oped. These new medications are called second generation, or “atypical” antipsychotics. One of these medications, clozapine (Clozaril) is an effective medication that treats psychotic symptoms, hallucinations, and breaks with reality. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. People who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of  blood tests make treatment with clozapine difficult for many people. But clozapine is potentially helpful for people who do not respond to other antipsychotic medications. 

Other atypical antipsychotics were also developed. None cause agranulocytosis. Examples include:

• Risperidone (Risperdal) 
• Olanzapine (Zyprexa) 
• Quetiapine (Seroquel) 
• Ziprasidone (Geodon) 
• Aripiprazole (Abilify) 
• Paliperidone (Invega)

What are the side effects? 

Some people have side effects when they start taking these medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include: 

• Drowsiness 
• Dizziness when changing positions 
• Blurred vision 
• Rapid heartbeat 
• Sensitivity to the sun 
• Skin rashes 
• Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism. This may increase a person’s risk of getting diabetes and high choles­terol. A person’s weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.

Typical antipsychotic medications can cause side effects related to physical movement, such as: 

• Rigidity 
• Persistent muscle spasms 
• Tremors 
• Restlessness. 

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can’t control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication. TD happens to fewer people who take the atypical antipsychotics, but some people may still get TD. People who think that they might have TD should check with their doctor before stopping their medication. 

How are antipsychotics taken and how do people respond to them? 

Antipsychotics are usually in pill or liquid form. Some anti-psychotics are shots that are given once or twice a month. Symptoms of schizophrenia, such as feeling agitated and hav­ing hallucinations, usually go away within days. Symptoms like delusions usually go away within a few weeks. After about six weeks, many people will see a lot of improvement. However, people respond in different ways to antipsychotic medications, and no one can tell beforehand how a person will respond. Sometimes a person needs to try several medi­cations before finding the right one. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Some people may have a relapse—their symptoms come back or get worse. Usually, relapses happen when people stop tak­ing their medication, or when they only take it sometimes. 

Some people stop taking the medication because they feel better or they may feel they don’t need it anymore. But no one should stop taking an antipsychotic medication without talking to his or her doctor. When a doctor says it is okay to stop taking a medication, it should be gradually tapered off, never stopped suddenly.

How do antipsychotics interact with other medications? 

Antipsychotics can produce unpleasant or dangerous side effects when taken with certain medications. For this rea­son, all doctors treating a patient need to be aware of all the medications that person is taking. Doctors need to know about prescription and over-the-counter medicine, vitamins, minerals, and herbal supplements. People also need to discuss any alcohol or other drug use with their doctor. 

Psychosocial treatments 

Psychosocial treatments can help people with schizophre­nia who are already stabilized on antipsychotic medication. Psychosocial treatments help these patients deal with the everyday challenges of the illness, such as difficulty with communication, self-care, work, and forming and keeping relationships. Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work.

Patients who receive regular psychosocial treatment also are more likely to keep taking their medication, and they are less likely to have relapses or be hospitalized. A thera­pist can help patients better understand and adjust to living with schizophrenia. The therapist can provide education about the disorder, common symptoms or problems patients may experience, and the importance of staying on medica­tions.

Illness management skills

People with schizophrenia can take an active role in managing their own illness. Once patients learn basic facts about schizophrenia and its treat­ment, they can make informed decisions about their care. If they know how to watch for the early warning signs of relapse and make a plan to respond, patients can learn to prevent relapses. Patients can also use coping skills to deal with persistent symptoms.

Integrated treatment for co-occurring substance abuse

Substance abuse is the most common co-occurring disorder in people with schizophrenia. But ordinary substance abuse treatment programs usually do not address this population’s special needs. When schizophrenia treatment programs and drug treatment programs are used together, patients get better results. 

Rehabilitation

Rehabilitation emphasizes social and voca­tional training to help people with schizophrenia function better in their communities. Because schizophrenia usually develops in people during the critical career-forming years of life (ages 18 to 35), and because the disease makes nor­mal thinking and functioning difficult, most patients do not receive training in the skills needed for a job. Rehabilitation programs can include job counseling and training, money management counseling, help in learning to use public transportation, and opportunities to practice com­munication skills. Rehabilitation programs work well when they include both job training and specific therapy designed to improve cognitive or thinking skills. Programs like this help patients hold jobs, remember important details, and improve their functioning.

Family education

People with schizophrenia are often discharged from the hospital into the care of their families. So it is important that family members know as much as possible about the disease. With the help of a therapist, family members can learn coping strategies and problem-solving skills. In this way the family can help make sure their loved one sticks with treatment and stays on his or her medication. Families should learn where to find outpatient and family services. 

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a type of psychotherapy that focuses on thinking and behavior. CBT helps patients with symptoms that do not go away even when they take medication. The therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, how to “not listen” to their voices, and how to manage their symptoms overall. CBT can help reduce the severity of symptoms and reduce the risk of relapse. 

Self-help groups

Self-help groups for people with schizo­phrenia and their families are becoming more common.Professional therapists usually are not involved, but group members support and comfort each other. People in selfhelp groups know that others are facing the same problems, which can help everyone feel less isolated. The networking that takes place in self-help groups can also prompt families to work together to advocate for research and more hospital and community treatment programs. Also, groups may be able to draw public attention to the discrimination many people with mental illnesses face. 

How can you/we help a person with schizophrenia? 

Family members usually are a patient’s primary caregivers. People with schizophrenia often resist treatment. They may not think they need help because they believe their delusions or hallucinations are real. In these cases, family and friends may need to take action to keep their loved one safe. It is not helpful to say they are wrong or imaginary. But going along with the delusions is not helpful, either. Instead, calmly say that you see things differently. Tell them that you acknowledge that everyone has the right to see things his or her own way. In addition, it is important to understand that schizophrenia is a biological illness. Being respectful, supportive, and kind without tolerating dangerous or inappropriate behavior is the best way to approach people with this disorder. When people with a mental illness are pressured and criticized, they usually do not get well. Often, their symptoms may get worse.