Therapy for Schizophrenia: What Options Are Available?

By Michael Puskar

Updated November 26, 2019

Schizophrenia is a complex and chronic mental condition that is estimated to affect around 1 percent of the United States population. [1] Unfortunately, it is incurable, but treatment is available, and people can manage their symptoms and live productive lives. This article will discuss schizophrenia therapy options, including medical ones, which are safer and more effective than ones in the past.

What Is Schizophrenia & Its Symptoms?

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Schizophrenia belongs to a group of mental conditions known as the Schizophrenia Spectrum and Other Psychotic Disorders, and treatment is typically centered around addressing its many symptoms, which is the complete DSM-5 criteria for schizophrenia: [2]

  1. Two or more markers below must be present for a notable amount of time over a month. There's an exception if symptoms dissipate in less than a month due to successful treatment). One of the symptoms must be items 1, 2, or 3.
  2. Hallucinations
  3. Delusions
  4. Disorganized speech (incoherent speech, or derailment from topics)
  5. The absence of emotions or facial expressions
  6. Substantially disorganized behavior or catatonia

There are circumstances where just one criterion. A symptom must be present. This is true if an individual experiences bizarre delusions, if the hallucinations are of a voice consistently providing commentary on the individual's thoughts or behavior, or if multiple voices are having a conversation with one another.

1. The ability to function in one or more significant areas of life, including work, school, interpersonal relationships, or self-care activities, has decreased substantially from the time of the onset of disturbance for a notable portion of time since the start of symptoms. Alternatively, if individuals have an onset of schizophrenia during childhood or adolescent years, a failure to present the anticipated level of functioning in school, interpersonal relationships, or occupational areas, is present.

2. Duration: Symptoms of the disturbance are persistent and continue for at least six months. During this period, the individual must experience a month or more (less if treated) of active phase symptoms listed in Criterion A and could include periods of prodromal or residual symptoms. At the time of these prodromal or residual periods, signs of disturbance might be displayed solely through negative symptoms or more than two markers listed in Criterion A present in an attenuated form such as strange or unusual beliefs, and abnormal perceptual experiences.

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3. Schizoaffective disorder, depression, or bipolar disorder with psychotic features have been ruled out. This is because either (1) episodes of mania or depression haven't occurred in coherence with the active-phase symptoms, or (2) if periods of mood disturbance have occurred at the same time as active-phase symptoms. They have presented during very little of the total period in which the active and residual periods took place.

4. Individuals experience symptoms that are not attributed to another condition or the use of substances such as drugs, alcohol, or medication.

5. An individual with Autism Spectrum Disorder (ASD) or a communication disorder which started in childhood, will be diagnosed with schizophrenia if hallucinations or delusions and other markers of schizophrenia persist for a minimum of one month. The exception is if symptoms dissipate in less than a month due to successful treatment).

Aside from a few additional specifications, these are the main things that mental health professionals look for to make a diagnosis for schizophrenia. It's crucial to go over them carefully and accurately because it can impact the course of treatment or even lead to an entirely different diagnosis. Therefore, a thorough examination is necessary to rule out conditions and substance abuse that can imitate schizophrenia symptoms. [1]

For example, depending on the symptoms and the timing of them, a patient can have a bipolar or major depressive disorder with psychotic or catatonic features, not schizophrenia.

Thankfully, the DSM-5 simplified its criteria. It has dropped the various types of schizophrenia that were once there in the previous edition (i,e., paranoid, catatonic, etc.). Additionally, when diagnosing schizophrenia, these symptoms must have interfered with the patient's functioning, such as work, interpersonal relationships, and self-care.

Nonetheless, treatments aim to provide relief for these symptoms, and the remainder of this article will discuss both medical and non-medical schizophrenia therapy options that patients can use to improve.

What Kinds Of Therapy Is Available For Patients With Schizophrenia?

The symptoms of schizophrenia are manageable through different means, and various therapeutic options can significantly improve the quality of life for someone struggling with schizophrenia. This section will show you how people with schizophrenia can live better lives through pharmacological and non-pharmacological options.

Pharmacological Therapy Options

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Medical therapy for schizophrenia will always be required for a person diagnosed with the condition because the symptoms have biological causes, such as abnormalities in neurotransmission, especially dopamine. [3] However, taking medication prescribed by a psychiatrist will allow individuals to go on to explore other therapies for schizophrenia, while the drugs control the primary symptoms.

Currently, second-generation antipsychotics (SGA) is the first course of treatment because they have fewer and less-severe, side-effects than the first generation ones, and the development of SGAs in the 1990s was believed to be revolutionary because of this and their increased efficacy. [4] These classes of drugs address the psychotic symptoms that characterize the condition, such as auditory and visual hallucinations, delusional thoughts and behaviors, and paranoia.

Antipsychotics are effective in treating other conditions like schizoaffective disorder, delusional disorder, and bipolar disorder. These conditions can also display psychotic symptoms. This is why the DSM-5 criteria are critical because it can help rule out these other disorders.

In the event of an acute psychotic episode, it is advised that drug therapy for schizophrenia is given as soon as possible to start reducing hostility and allowing the patient to regain basic functioning such as sleeping and eating. Following this, there will be a maintenance phase, and this aims to increase socialization and improve self-care and mood. This phase is essential to prevent relapses, and those who commit to it have an 18% to 32% chance of relapsing, whereas those who do not stick with the maintenance phase have a 60% to 80% chance of having a relapse. [3]

Medical professionals recommend that drug therapy should last for least 12 months after the first psychotic episode has subsided. Doctors that patients avoid taking any substances, including caffeine and nicotine, because of the risk of adverse drug interactions. [3]

Antipsychotics are typically pills, but some individuals who struggle to adhere to them may opt for a long-acting injectable version. In some cases, mood stabilizer drugs may also be used in some treatment-resistant patients. While mood stabilizers like lithium do not have antipsychotic effects, it can still improve a person's mood and behavior. [3]

Non-Pharmacological Therapy Options

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In addition to medication, there are various psychotherapy options available to help people with schizophrenia. While they are effective, they must be intended to be used alongside medicine and are not a substitute for them. Medication will provide relief for the primary symptoms. Still, psychotherapy is beneficial in other ways and fills in any gaps that prescription drugs leave, which is why they should be used concurrently. [3]

Psychotherapy can be beneficial in helping patients stick with their treatment plans and provide them with skills so that they can become integrated into their communities once again. There are several types of therapies that patients can find helpful, and they can be divided into three categories - individual, group, and cognitive-behavioral. [3]

Individual therapy aims to provide the skills above to the patient, and some forms of psychotherapy that can be included in this group are social skill therapies, vocational sheltered rehabilitation therapies, and counseling support.

While individual therapy for schizophrenia can improve social skills, group therapy mainly serves to provide social interaction for the patient and allows them to talk and listen to more than one person simultaneously. In contrast, individual therapy is a one-on-one basis, which can be limiting in that regard.

The cognitive-behavioral category includes CBT and compliance therapy, and these are the ones that will help the patient change their thought processes and increase the likelihood that they continue to take their medication. For example, if a patient is in denial that they have an illness or he or she feels that medicine is not needed, a therapist can help resolve that.

In addition to these, assistance from family and friends is always encouraged, and a professional can help teach them how to monitor the patient and report any adverse reactions to medication or negative behaviors. With support from these individuals, it provides another avenue for social interaction, and it has also been shown to decrease hospitalization rates. [3]

Conclusion

Through a combination of medication and psychotherapy, patients with schizophrenia can significantly improve their long-term outcomes and become completely functional members of society.

If you are looking for a therapist for schizophrenia, ReGain offers online services from licensed professionals who can help individuals cope with their condition and decrease the odds of them relapsing. Therapy can also be beneficial to people who have a loved one struggling with schizophrenia, and they need someone to talk to or want to learn ways that they can help.

Hopefully, this article has encouraged you or someone close to you to seek treatment as soon as possible. Unfortunately, without it, schizophrenia can only get worse. However, with the advancements in medicine and the various other therapies, it can become a manageable condition as long as the individual follows a treatment plan.

References

  1. American Psychiatric Association. (2017, July). What Is Schizophrenia? Retrieved August 5, 2019, from https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia
  2. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.22, DSM-IV to DSM-5 Schizophrenia Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t22/
  3. Patel, K., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: Overview and Treatment Options. Pharmacy and Therapeutics, 39(9), 638-645. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/.
  4. Lally, J., &Maccabe, J. H. (2015). Antipsychotic medication in schizophrenia: A review. British Medical Bulletin,114(1), 169-179. doi:10.1093/bmb/ldv017

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