Schizophrenia (cont.)
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:
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:
When a doctor
says it is okay to stop taking a medication, it should be gradually tapered off,
never stopped suddenly.
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:
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:
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.
To find out more about how antipsychotics work, the National Institute of
Mental Health (NIMH) funded a study called CATIE (Clinical Antipsychotic Trials
of Intervention Effectiveness). This study compared the effectiveness and side
effects of five antipsychotics used to treat people with schizophrenia. In
general, the study found that the older typical antipsychotic perphenazine
(Trilafon) worked as well as the newer, atypical medications. But because people
respond differently to different medications, it is important that treatments be
designed carefully for each person. More information about CATIE is on the NIMH
website.
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. For more information on psychosocial
treatments, see the psychotherapies section on the NIMH website.
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 self-help
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.
Once patients learn basic facts about schizophrenia and its treatment, they
can make informed decisions about their care.
Next: How can you help a person with schizophrenia? »
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