Ask the experts
I've recently been diagnosed with schizophrenia. Is this disease something I can live a normal life with?
There is currently not thought to be a cure for schizophrenia, but there are a number of helpful treatments available, of which medication remains the cornerstone of treatment for people with this condition. These medications are often referred to as antipsychotics since they help decrease the intensity of psychotic symptoms. Many health care professionals prescribe one of these medications, sometimes in combination of one or more other psychiatric medications, in order to maximize the benefit for the person with schizophrenia.
Medications that have been found to be particularly effective in treating the positive symptoms of schizophrenia and therefore are considered top choices or first-line treatments, include orally taken medications like risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), lurasidone (Latuda), brexpiprazole (Rexulti), and iloperidone (Fanapt). Medications that may be taken by injection or by mouth include chlorpromazine, haloperidol (Haldol), fluphenazine, risperidone (Risperdal Consta), olanzapine (Zyprexa Relprevv), aripiprazole (Abilify, Abilify Maintena, Aristrada), and paliperidone (Invega Sustenna). Injectable medications tend to be more long-acting compared to oral preparations, lasting as much as four weeks at a time, thereby improving consistency of treatment.
Although older antipsychotic medications in this class like haloperidol (Haldol), thioridazine (Mellaril), perphenazine (Trilafon), and molindone (Moban) are more likely to cause muscle stiffness, impaired motor coordination, shakiness, and very rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health care professionals appropriately monitor the people they treat for these potential side effects, as well. Some of the abnormal muscle movements, like tremors (for example, akathisia) or stiffness (dystonia) can be managed using anti-tremor medications like benztropine (Cogentin) or amantadine (Symmetrel). Also, more recent research regarding all antipsychotic medications seems to demonstrate that the older (first-generation) antipsychotics are just as effective as the newer ones, both in the management of current symptoms and prevention of future symptoms, and have no higher rate of people stopping treatment because of any side effect the medications cause. Not all medications that treat schizophrenia in adults have been approved for use in treating childhood schizophrenia.
Clozapine (Clozaril), while thought to be highly effective for treating schizophrenia, has potentially serious, even fatal side effects that prevent it from being used prescribed more often. Those side effects can include dangerously low white blood cell count, inflammation of the heart muscle (myocarditis), as well as what are classified as metabolic side effects, like elevated blood sugar and cholesterol levels, weight gain, and elevated prolactin levels. While reserpine, a medication that also reduces blood pressure, has also been found to decrease psychotic symptoms, the fact that safer, more effective medications now exist has resulted in its being far less frequently used these days. Prochlorperazine (Compazine) has strong antipsychotic effects but is used to treat nausea, vomiting, and vertigo.
Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) can be useful in treating mood swings that sometimes occur in individuals who have a diagnosable mood disorder in addition to psychotic symptoms (for example, schizoaffective disorder, depression, in addition to schizophrenia). These medications may take a bit longer to work compared to the antipsychotic medications. Some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels, and some can be associated with birth defects when taken by pregnant women. Divalproex and lamotrigine carry the rare potential of causing a potentially rare autoimmune reaction (Stevens-Johnson syndrome).
Antidepressant medications are the primary medical treatment for the depression that can often accompany schizophrenia and meta-analyses (systematic reviews of published studies) of how people with this illness fare when taking antidepressants support treatment with these medications. Examples of antidepressants that are commonly prescribed for that purpose include serotonergic (SSRI) medications that affect levels of the neurotransmitter serotonin (like fluoxetine [Prozac], sertraline [Zoloft], paroxetine [Paxil], citalopram [Celexa], escitalopram [Lexapro], vortioxetine [Trintellix], and vilazodone [Viibryd]) and combination serotonergic/adrenergic medications (SNRIs) (like venlafaxine [Effexor] and duloxetine [Cymbalta] and levomilnacipran [Fetzima], as well as bupropion [Wellbutrin], which is a dopaminergic [affecting dopamine levels] antidepressant medication).
Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose schizophrenia has inadequately responded to a number of medication trials and psychosocial interventions.
When treating pregnant women with schizophrenia, health care practitioners take great care to balance the need to maintain the person's more stable thoughts and behavior while minimizing the problems that medications used to treat this disorder may present. While some medications that treat schizophrenia may carry risks to the fetus in pregnancy and during breastfeeding, careful monitoring of how much medication is administered and the health of the fetus and of the mother can go a long way toward protecting the fetus from any such risks, while maximizing the chance that the fetus will grow in the healthier environment provided by an emotionally healthy mother.
Psychosocial interventions for schizophrenia
Family psycho-education and support: In addition to educating family members about the symptoms, course, and treatment of schizophrenia, this form of treatment consists of providing family with supportive therapy, problem-solving skills, and access to ongoing community supports, including care providers during times of crises. When this intervention is consistently provided for at least several months, it has been found to decrease the relapse rate for the person with schizophrenia and improve social and emotional outcomes. Also, the burden that family members experience as a result of having a loved one with schizophrenia is less, family members tend to be more knowledgeable about the disorder and feel more supported by the professionals involved, and family relationships are improved.
Assertive community treatment (ACT): This intervention consists of members of the person's treatment team meeting with that individual on a daily basis, in community settings (for example, home, work, or other places the person with schizophrenia frequents) rather than in an office or hospital setting. The treatment team is made up of a variety of professionals. For example, a psychiatrist, nurse, case manager, employment counselor, and substance-abuse counselor often make up an ACT team. Over the long term, ACT tends to be successful in reducing how often people with schizophrenia are psychiatrically hospitalized or become homeless.
Substance abuse treatment: Providing medical and psychosocial interventions that address substance abuse should be an integral part of treatment as about 50% of individuals with schizophrenia suffer from some kind of substance abuse or dependence.
Social skills training: Also called illness management and recovery programming, social-skills training involves teaching clients ways to handle social situations appropriately. It may be conducted as part of individual or group psychotherapy and often involves the person scripting (thinking through or role-playing) situations that occur in social settings in order to prepare for those situations when they actually occur. This treatment type has been found to help people with schizophrenia resist using drugs of abuse, as well as improve their relationships with health care professionals and with people at work.
Supported employment: This intervention provides supports like a job coach (someone who periodically or consistently counsels the client in the workplace), as well as instruction on constructing a résumé, interviewing for jobs, and education and support for employers to hire individuals with chronic mental illness. Supported employment has been found to help schizophrenia sufferers secure and maintain employment, earn more money, and increase the number of hours they are able to work.
Cognitive behavioral therapy (CBT): CBT is a reality-based intervention that focuses on helping a client understand and change patterns that tend to interfere with his or her ability to interact with others and otherwise function. Except for people who are actively psychotic, CBT has been found to help individuals with schizophrenia decrease symptoms and improve their ability to function socially. This intervention can be done either individually or in group therapy.
Group therapy: Group therapy is usually supportive and expressive, in that participants are encouraged in their efforts to care for themselves and otherwise engage in healthy, appropriate behaviors in the community.
Weight management: Educating people with schizophrenia about weight gain and related health problems that can be a side effect of some antipsychotic and other psychiatric medications has been found to be helpful in resulting in a modest weight loss. That is also true when schizophrenia sufferers are provided with behavioral interventions to help with weight loss.
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