Medication For Schizophrenia: Treatment Options

By Sarah Fader

Updated March 23, 2020

Reviewer Erika Schad, LCP, CWLC

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A Brief Overview Of Schizophrenia

Schizophrenia is one of the less common mental disorders, but it is also one of the most severe because of the hindrance it can have on a person's quality of life. Symptoms of schizophrenia can cause patients to lose touch with their surroundings, as well as make them feel out of touch with their behaviors, feelings, and thoughts.

Schizophrenia symptoms are broken down into three main categories: positive, negative, and cognitive. Positive symptoms are behaviors that healthy people don't have; alternatively, negative symptoms are behaviors that normal people usually have. Cognitive symptoms are alterations in a patient's memory or ability to think. Here are some more common symptoms for each category:

Positive

  • Hallucinations: seeing, hearing, or even smelling things that aren't there
  • Delusions: having thoughts or ideas that are untrue
  • Cluttered thoughts
  • Agitation

Negative

  • Emotions: decreased facial expressions, as well as expressing emotions in general
  • Lack of pleasure in activities
  • Activities: difficult beginning and continuing activities
  • Speaking less than normal
  • Inability to sustain relationships

[Some negative symptoms can be misinterpreted as depression]

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Cognitive

  • Working memory: difficulty using information that had just been learned
  • Issues with focusing and paying attention
  • Inability to understand or process information given
  • Problems with making decisions
  • Completing tasks is much more difficult

Medications

Schizophrenia is primarily treated with medication; however, like any mental illness, a combination of therapy and prescribed medication is usually the best course of action.

Patients with schizophrenia are usually prescribed antipsychotic medication to help decrease delusions, hallucinations, and other symptoms that could hinder one's quality of life. Antipsychotic medications work by regulating dopamine, which then regulates and affects the patient's behavior. Many psychiatrists will use a combination of drugs, sometimes with the use of antidepressants or medications for anxiety.

Since some antipsychotics can cause adverse side effects, psychiatrists will try to use medications at the lowest dose possible to prevent these side effects. This is what's led to the two groups of antipsychotics: first-generation and second-generation. First-generation antipsychotics are older and usually less expensive; however, they are known to have more neurological side effects that can be reasonably harmful. In fact, tardive dyskinesia is a movement disorder that has been an irreversible side effect of some first-generation antipsychotics. Nevertheless, here are some main first-generation antipsychotics:

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  • Perphenazine
  • Chlorpromazine
  • Haloperidol
  • Fluphenazine

Second-generation antipsychotics are more modern and, when compared to first-generation, have a much lower risk of side effects. Therefore, psychiatrists prefer second-generation medications. Here are some more common second-generation antipsychotics:

  • Ziprasidone (also known as Geodon)
  • Brexpiprazole (also known as Results)
  • Asenapine (also known as Saphris)
  • Aripiprazole (also known as Abilify)
  • Olanzapine (also known as Zyprexa)
  • Lurasidone (also known as Latuda)
  • Risperidone (also known as Risperdal)
  • Quetiapine (also known as Seroquel)
  • Paliperidone (also known as Invega)
  • Iloperidone (also known as Fanapt)
  • Clozapine (also known as Clozaril)
  • Cariprazine (also known as Vraylar)

Therapy

The primary therapies used for schizophrenia are psychotherapy and psychosocial therapy. Psychotherapy has many subsets, but it usually involves a patient talking to a therapist to understand their symptoms and learn how to manage them. Here are the most common subsets of psychotherapy:

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  • Individual Psychotherapy involves the patient and a therapist or psychiatrist in a one on one setting, where the patient can learn about their schizophrenia and how it manifests. One of the most beneficial outcomes that can result from individual psychotherapy is when the patient can learn about their hallucinations and delusions, eventually learning to identify what is and isn't real and how to manage their life.
  • Cognitive Behavior Therapy helps a patient change their behavior and ways of thinking, especially in a manner of dealing with hallucinations. CBT is very effective when it comes to helping a patient understand what causes their psychotic episodes to be triggered. Once these causes are recognized, a therapist can provide them with coping mechanisms to help reduce or stop hallucinations from occurring.
  • Cognitive Enhancement Therapy, also known as cognitive remediation, CET involves organizing a patient's thoughts to improve attention span and memory. It is also used to help a patient better understand social cues.

Psychosocial therapy will usually come after psychotherapy as it can help indoctrinate the patient back into society and teach them how to be a functioning part of their community. Here are some primary types of psychosocial therapy:

  • Social Skills Training helps patients to develop better their communication skills and how to interact with others.
  • Educating loved ones can give the patient the support group that they need.
  • Rehabilitation can help a patient become a functioning individual in society with things like job counseling, money management, and basic support.
  • Self-help Groups involve support systems and things like group counseling to help introduce patients with schizophrenia to each other and give them opportunities to connect. This can help patients by reminding them that they're not alone.

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A lesser-known treatment plan is an electroconvulsive therapy, which is traditionally used by medical professionals to treat extreme depression. However, it's been proven to be successful when used on patients with schizophrenia, especially those who suffer from catatonia. Catatonia is a symptom of some kinds of schizophrenia that causes an individual to become rigid and stiff to the point where they can't be moved. It's been proven to also aim in decreasing the number of hallucinations and delusions that an individual has, as well as limit the disorganized thoughts that patients may experience.

Electroconvulsive Therapy begins by using general anesthesia and drugs that help relax the patient's muscles, followed by the doctor placing electrodes on the scalp. These electrodes will then have a carefully controlled electric current run through them for a short time, which causes a small seizure to take place in the brain. Of course, since the body has been relaxed, nothing will physically happen to the patient. After the session, they will feel as if they're waking up, and usually, don't recall the treatment to have ever happened.

Professionals recommend that a patient receives ECT anywhere from two to three times a week for two to four weeks, depending on the needs of the patient. Electroconvulsive therapy is usually coupled with some psychotherapy as well as medication.

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Coordinated Specialty Care

Coordinated specialty care uses a team of specialists who will meet with the patient, learn about them and their unique needs and situation, and use that information to put together a treatment plan specifically tailored to that individual. This could include psychotherapy, psychosocial therapy, electroconvulsive therapy, family therapy, or group therapy, and the patient will more than likely be put on some antipsychotic medication. CSC provides quite a lot of support for both the patient and their family or loved ones, which is what makes it so beneficial.

There is an array of different programs that are classified as coordinated specialty care in the United States, including:

  • NAVIGATE
  • The Connection Program
  • OnTrackNY
  • Specialized Treatment Early in Psychosis (STEP) Program
  • Early Assessment and Support Alliance (EASA)

How To Help

Having a loved one or family member who has been diagnosed with schizophrenia can be complicated, but it's important to remember that they need as much support as they can get. Here is a small guide to what you can do to help a loved one with schizophrenia:

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  • Encourage treatment as much as possible (without agitating anyone) and make sure that they stay in treatment. Try checking up on them fairly consistently, remind them to take their medication and, most importantly, remind them that you're there for them.
  • Their hallucinations are real to them, and although you may feel like you're helping, trying to "snap them out of it" can be counterproductive. Don't encourage, but don't discourage either.
  • Validate them. Everyone sees things their way and, to them, their hallucinations are very real and what they experience is still their own. Having schizophrenia doesn't discredit them, they are still human, and they are still your loved one.
  • Be supportive, but also make it clear that dangerous or damaging behavior isn't allowed. Be caring, respectful, and loving, but also be firm. Their safety should be priority number one.
  • Learn as much as you can. Keep reading about schizophrenia and what you can do to help, but it also may be helpful to research support groups in your area. If finances allow it, consider mentioning coordinated specialty care to your friend or family member.
  • Consider social services. Even with treatment and support, some patients just aren't able to live on their own or sustain a job. Social services may be able to help find housing, transportation, and other aspects of daily life.
  • Join them when they go to the doctor, when they pick up medication, or just partake in daily activities with them. Above all, just be there.

To find an online therapist perfect for you, go to www.betterhelp.com/start/

SOURCES

https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449

https://www.webmd.com/schizophrenia/electroconvulsive-therapy

https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-coordinated-specialty-care-csc.shtml

https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizophrenia

https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml


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