Meds, therapy, and more can help.

By Amanda Gardner
April 15, 2019

Schizophrenia is a complex, lifelong disorder that needs specialized, long-term treatment—and it’s a disorder that tends to be even harder to treat than other mental illnesses.

“We aren’t sure why, but it is more common for people with schizophrenia to have difficulty acknowledging their symptoms,” says Timothy B. Sullivan, MD, chair of psychiatry and behavioral sciences at Northwell Health at Staten Island University Hospital in New York City. “People with schizophrenia also have more executive function impairments that particularly affect social interactions, and that includes social interactions with caregivers.”

The most successful schizophrenia treatments usually combine medication, some kind of therapy, and social and family support.

“There is decent evidence that repeated episodes of psychosis are harmful. The more episodes you have, the longer it takes to recover and the more difficult it is to get symptoms under control, so there’s a strong emphasis on trying to prevent acute episodes,” Dr. Sullivan says.

Here are the main components of schizophrenia treatment.

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Medications

Most people with schizophrenia are treated with antipsychotic medications. No one knows exactly what causes the disorder, but drugs can reduce the severity of symptoms like hallucinations, delusions, and agitation. There are two classes of antipsychotics: older first-generation antipsychotics and newer second-generation drugs.

Experts usually begin with the newer drugs such as aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) first.

“They all primarily work the same way,” says Dr. Sullivan. “They differ from one another mainly because of the side-effect profile.”

Some of the earlier antipsychotics like haloperidol (Haldol) and chlorpromazine (Thorazine) can cause Parkinson’s-like movement symptoms, which may not be reversible. The newer drugs may result in weight gain and even diabetes, but lifestyle changes may mitigate some of this risk.

Meds for schizophrenia can be given as daily pills or liquid but also as long-acting injectables, which only need to be given once or twice a month and can make it easier for patients to stick with schizophrenia treatment.

Some people also benefit from mood stabilizers like lithium, antidepressants, or anti-anxiety medications. And in cases where patients don’t benefit from drugs and/or if they have depression, doctors may try electroconvulsive therapy (ECT).

“The medications we have currently are not ideal,” says Dr. Sullivan. “They sometimes make cognitive and other symptoms worse, and we historically have a lot of trouble keeping people engaged in treatment.”

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Psychotherapy

That’s where other treatment types step into the picture. One is therapy. This can be individual, family, or group, and it can take different forms including supportive psychotherapy, cognitive enhancement therapy (CET), or cognitive behavioral therapy (CBT).

The goal of therapy for schizophrenia is to help the person cope with symptoms and to move on with their lives in terms of social relationships, education, and work. It also helps people comply with their medication regimens. Up to three-quarters of people with schizophrenia don’t take their meds as instructed because of side effects, because they’re in denial about their symptoms, or due to other reasons related to the disease.

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Other psychosocial treatments

Along with different types of therapy, help in learning how to communicate with others along with job training and housing support can also help people with schizophrenia live successful lives in their communities.

There are several models that combine these different aspects of treatment and have shown good results. For instance, assertive community treatment (ACT) has professionals working one-on-one with patients in different domains of treatment. Coordinated specialty care (CSC) similarly covers many bases by providing medication, therapy, education, and job help as well as case management.

“They focus on education and attempting to engage the patient in their own recovery and in particularly emphasizing reintegration into the community through assistance with social connections as well as work or school engagement,” says Dr. Sullivan.

The evidence for this type of program has been around a long time. One study in the 1980s looked at people with severe schizophrenia more than 20 years after they had participated in a comprehensive rehabilitation program and found that many of them had been able to stay in the community.

“They were doing really well,” says Dr. Sullivan. “It was just really contingent on their being given that level of social engagement, helping them to make that connection.”

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