Schizophrenia

Treatment Overview

Being diagnosed with schizophrenia can be terrifying and devastating. Learning more about the disease, including learning what types of treatment are available, and finding a support network through family and community services may provide some relief and encouragement. Unfortunately, people with schizophrenia often do not seek treatment or they stop treatment due to unpleasant side effects of medicines or lack of support. Treatment is also more difficult when symptoms are not caught early on.

The goals of treatment are to eliminate symptoms, reduce the number of relapses, and reduce the severity of the illness.⁸ Improving the level of social function and relationships is also important. Treatment for schizophrenia is lifelong and includes medications, professional counseling, and support from family or community services.

Medicines are the most effective treatment, and it is important to continue to take them as prescribed by your doctor. If you discontinue treatment, your quality of life will suffer, and it may take a long time to return to an acceptable level of functioning.

Initial treatment

Negative symptoms of schizophrenia (such as lack of emotion or loss of motivation) usually occur first and can be confused with other health problems such as depression or substance abuse. Substance abuse often occurs before the symptoms of schizophrenia become apparent.⁶ Negative symptoms can be difficult to treat and often do not respond well to medicines. They can also be disabling, because the symptoms are long-lasting and reduce the motivation to perform daily tasks or relate to others.

Medicines used most often to treat schizophrenia include:⁹

• First-generation antipsychotics, such as haloperidol (Haldol) or chlorpromazine (Thorazine), which are used to reduce anxiety and agitation, and to stop delusions and hallucinations. These medicines can be very effective, but they often have significant side effects, such as tardive dyskinesia, which is a condition that causes uncontrolled body movements.
• Second-generation antipsychotics, such as risperidone (Risperdal), paliperidone (Invega), olanzapine (Zyprexa), ziprasidone (Geodon), and quetiapine (Seroquel). These medicines effectively treat symptoms of schizophrenia and may help reduce the risk for relapse.
  • Clozapine, such as Clozaril or Leponex, is usually considered a second-generation antipsychotic. This drug is approved in the United States for treating suicidal behavior associated with schizophrenia and for severe schizophrenia which has not improved with other treatment. But in the U.S., your doctor will need special authorization to prescribe clozapine for schizophrenia symptoms, and special monitoring is needed when clozapine is used.

Other medicines may be added to help reduce other symptoms, such as:

• Lithium carbonate, such as Lithobid, Lithane, and Eskalith, to regulate moods.
• Antianxiety medicines, such as alprazolam (Xanax) and diazepam (for example, Valium), to reduce anxiety and nervousness.
• Anticonvulsant medicines, such as carbamazepine (for example, Tegretol) and valproate (for example, Depakote), to reduce symptoms during relapse.
• Antidepressant medicines, such as selective serotonin reuptake inhibitors (SSRIs) (for example, Zoloft or Celexa) or tricyclic antidepressants (for example, Pamelor), to reduce symptoms of depression.

In addition to medicines, other effective treatment can improve the quality of your life while you are living with schizophrenia, such as:

• Cognitive-behavioral therapy (CBT), especially compliance therapy (teaching and motivating the person to continue with treatment), which has been shown to reduce the symptoms of schizophrenia and reduce the distress associated with the illness.¹¹
• Family therapy, which helps improve compliance with treatment.
• Assertive community treatment (ACT), a community rehabilitation service.
• Education about schizophrenia, to improve your quality of life while you are living with this disease.
• Vocational therapy or job training, which evaluates and trains you and then places you in a job where you can be successful and improve your sense of self-worth.
• Social skills training, to help you develop communication and coping skills. This may include cognitive enhancement therapy, a treatment that may help you improve how well you understand and interact with other people.

Your success will hinge on your ability to stick with your treatment plan. Once your symptoms are well controlled, work with your health professional to develop a treatment plan so you know what to do if you begin to show signs of relapse. If you stop taking your medicines, you are much more likely to relapse. You will need to rely on others to help you help you get through relapses and regain control over your symptoms. Therapy can help you learn how to follow your treatment plan and will improve the likelihood of treatment success.⁹

Ongoing treatment

Treatment for people with schizophrenia during relapse is different than treatment during times of remission.

• During relapse, most people with schizophrenia need constant care and may need to be admitted to a hospital. Medication doses may be increased or additional medicines prescribed. During relapse, most people with schizophrenia are not able to participate in the treatment for their illness. Continuing with medicines for at least 6 to 9 months and getting counseling after an acute episode can help reduce the risk of another relapse.¹⁰
• During remission, most people with schizophrenia do not need to be in a hospital. But they may need to continue to take medicines, sometimes in lower doses. Treatment during remission includes professional counseling, classes that help a person learn about the illness, social skills training, vocational therapy and job training, and other group activities.

Medicines used most often to treat schizophrenia include:

• First-generation antipsychotics, such as haloperidol (Haldol) or chlorpromazine (Thorazine), which are used to reduce anxiety and agitation, and to stop delusions and hallucinations. These medicines can be very effective but often have significant side effects, such as tardive dyskinesia, which is a condition that causes uncontrolled body movements.
• Second-generation antipsychotics, such as risperidone (Risperdal), paliperidone (Invega), olanzapine (Zyprexa), ziprasidone (Geodon), and quetiapine (Seroquel). These medicines effectively treat symptoms of schizophrenia and may help reduce the risk for relapse.
  • Clozapine, such as Clozaril or Leponex, is usually considered a second-generation antipsychotic. This drug is approved in the United States for treating suicidal behavior associated with schizophrenia and for severe schizophrenia which has not improved with other treatment. But in the U.S., your doctor will need special authorization to prescribe clozapine for schizophrenia symptoms, and special monitoring is needed when clozapine is used.

Other medicines may be added to help reduce other symptoms, such as:

• Lithium carbonate, such as Lithobid, Lithane, and Eskalith, to regulate moods.
• Antianxiety medicines, such as alprazolam (Xanax) and diazepam (for example, Valium), to reduce anxiety and nervousness.
• Anticonvulsant medicines, such as carbamazepine (for example, Tegretol) and valproate (for example, Depakote), to reduce symptoms during relapse.
• Antidepressant medicines, such as selective serotonin reuptake inhibitors (SSRIs) (for example, Zoloft or Celexa) or tricyclic antidepressants (for example, Pamelor), to reduce symptoms of depression.

For the best outcome, other treatment is added to medicines and includes:

• Cognitive-behavioral therapy (CBT), especially compliance therapy (teaching and motivating the person to continue with treatment), which has been shown to reduce the symptoms of schizophrenia and reduce the distress associated with the illness.¹¹
• Family therapy, which helps improve compliance with treatment.
• Assertive community treatment (ACT), a community rehabilitation service.
• Education about schizophrenia, to improve your quality of life while you are living with this disease.
• Vocational therapy or job training, which evaluates, trains, and places you in a job where you can be successful and improve your sense of self-worth.
• Social skills training, to help you develop communication and coping skills. This may include cognitive enhancement therapy, a treatment that may help you improve how well you understand and interact with other people.

In some cases, electroconvulsive therapy (ECT) may be an option. During this procedure, which is done under a general anesthetic, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.

Other conditions often occur with schizophrenia (such as depression or substance abuse), and additional treatment is needed for these conditions.

Treatment if the condition gets worse

If your symptoms of schizophrenia have not improved or stabilized with a combination of medicines, counseling, and family and community support, other treatment may be needed.

Hospitalization or admission to a treatment facility may be the safest place for someone whose symptoms have not improved or have become worse even with treatment. If quality of life has deteriorated to the point where the person is a danger to himself or herself or to others, seeking around-the-clock care from a facility that specializes in treating schizophrenia may be needed.

In some cases, electroconvulsive therapy (ECT) may be an option. During this procedure, which is done under a general anesthetic, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.

What To Think About

Schizophrenia affects the entire family. It can be difficult to watch a family member who was once happily planning for the future develop symptoms of confusion and paranoia. Family members often have very important roles in the lives and treatment of a person with schizophrenia. They may also need to seek support or treatment to help cope with the demands of the illness and the loss they feel.

Continuing to take medicines for at least 6 to 9 months after a relapse will help prevent another one.¹⁰ Most people with schizophrenia need to take medicines and participate in counseling throughout their lives, even during remissions.

Unfortunately, the negative symptoms of schizophrenia can be very difficult to treat, even with medicines and appropriate professional treatment and support. Negative symptoms often continue even when the positive symptoms are in remission.

It is important to diagnose schizophrenia early in the disease progression because early treatment may prevent or reduce relapses. Treating teens early can give them the opportunity to finish school and learn job skills.

Treating schizophrenia can be frustrating. Medicines can cause bothersome or intolerable side effects, and you may want to quit taking them. If side effects are interfering with your life, talk with your doctor to see whether you can try a different medicine.

Unfortunately, many people don't seek treatment for mental health problems. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them

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Author:	Jeannette Curtis	Last Updated: February 5, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Lisa S. Weinstock, MD - Psychiatry
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