Therapy options to consider for treating schizophrenia

If you or a family member has been diagnosed with schizophrenia, it's crucial to obtain the appropriate treatment to manage symptoms and live a healthy, functional life. As with any neuropsychiatric disease, schizophrenia can impact you and your life in various ways. Seeking professional help, such as cognitive behavior therapy or coordinated specialty care, as soon as possible will assist you in achieving goals and returning to the daily life you desire.

Often, medications like atypical antipsychotics alone do not completely alleviate the symptoms of schizophrenia. In cases where drug therapy alone is not working, psychotherapy, along with other treatments, is a welcomed intervention. For example, cognitive behavioral therapy has been shown to help people manage the mood and anxiety disorders that often accompany severe symptoms. Read further to discover how different psychotherapy methods can help improve anxiety, mood, and other mental health symptoms associated with schizophrenia to help find the best treatment options for you.

Schizophrenia is a serious mental health disorder or mental illness that interferes with a person’s ability to think, manage their emotions, and interpret their reality. People with schizophrenia might develop thoughts that are based in fantasy or delusion. They could experience delusions, hallucinations, and difficulty with concentration and even motivation. Symptoms can include:

• Delusions: A person with schizophrenia may have false beliefs that have no apparent foundation in what is perceived as reality.

• Hallucinations: These can be visual and/or auditory, and the person experiencing them cannot tell that these hallucinations are not real.

• Abnormal Motor Behavior: a person with schizophrenia may find it difficult to start or accomplish tasks. Often, they may resist instructions, not respond to requests, or engage in excessive movement. In some cases, long-term use of antipsychotic medications could result in tardive dyskinesia, causing involuntary muscle movements.

• Disorganized Speech: being able to communicate can be impaired, resulting in speech that is filled with meaningless words.

• Other symptoms: these may include not taking care of personal hygiene, lacking facial expressions when talking, speaking in a monotone voice, experiencing substance abuse, withdrawing from social interactions, and being unable to experience pleasure.

Experiencing a combination of these symptoms could be a warning sign that you or someone you may know may be experiencing schizophrenia and should seek the advice of a healthcare provider immediately. Early intervention can prevent crises and lead to better longer term outcomes through targeted treatments.

Because schizophrenia is a serious mental health condition, diagnosis is typically achieved after completing a series of tests and evaluations, which can help answer questions such as "Do I have schizophrenia?" Like any mental health or medical condition, a typical first step in diagnosing schizophrenia is conducting a full physical examination to rule out other health problems. A therapist will use the Diagnostic and Statistical Manual to determine if a patient meets the diagnostic criteria. 

Then, the method of diagnosis will turn toward psychiatric needs. The doctor will talk with the patient about their thoughts, feelings, and emotional support needs. They will discuss hallucinations, delusions, drug and alcohol use, moods, etc. All these factors will help the doctor to narrow down the potential cause of the symptoms and come closer to making a diagnosis. At that point, the final diagnosis may be made, and a suitable treatment plan, such as group sessions or self-help groups, will begin.

Decades ago, doctors used to categorize schizophrenia into five different subtypes: residual, paranoid, undifferentiated, disorganized, and catatonic. These categories of schizophrenia no longer exist due to recent studies and guidelines by the American Psychiatric Association. Not many people are aware that there is a spectrum, meaning that not everyone has the same symptoms. The spectrum consists of similar disorders that are characterized by how long symptoms have been occurring. 

CBT

The most common way to treat schizophrenia is also one of the most popular: cognitive behavioral therapy (CBT). CBT for schizophrenia can help the patient because it creates a safe environment where the therapist teaches the client how to approach negative thought patterns. According to the American Psychiatric Association, CBT focuses on changing the way a person thinks in order to start the road to recovery through talk therapy.  

In CBT sessions, the focus is not on challenging the delusions that the patient has but on creating new ways to help them develop coping skills to manage the struggles they are facing. It also focuses on developing rational thoughts rather than trying to challenge any of the other thoughts or feelings. Therefore, it tends to have a higher success rate when managing schizophrenia for those who are living with this disorder.

CRT

Cognitive remediation therapy, also known as CRT, is a type of psychosocial therapy that can also be used to treat severe mental disorders. It is considered one of the more successful therapy methods by the National Institute of Mental Health. 

The focus of CRT is to improve cognitive processes, such as social cognition, executive function, attention, and memory so that persons living with schizophrenia can improve their performance in everyday life and solve problems more effectively. Computer programs are used in the teaching process and can vary in length and complexity, lasting for several weeks, depending on the patient's requirements.

Pharmacological interventions

Second-generation antipsychotics are a line of treatment for individuals with schizophrenia. The purpose of these antipsychotic drugs is to ease and/or eliminate the delusions and hallucinations that a person may be experiencing. They can come in a liquid, pill, or injection form, and sometimes may have to be taken for the rest of a person’s life, even if they get better through therapy.

Like with all medications that deal with the chemistry of the brain, there can be some side effects with antipsychotic drugs and mental health medications. Discussing your health information with a medical professional or a therapist for schizophrenia beforehand will assist in arriving at a diagnosis of schizophrenia and which medication will work best for its treatment.

The most common adverse effects include drowsiness, dizziness, blurred vision. Rarely, antipsychotic medications can also cause seizures, low white blood cell count, constipation and nausea, and low blood pressure. Older generation antipsychotics use a hormone called prolactin that result in lower sex drive, affected mood, and the enlargement of breast tissue in men and women. Newer-generation antipsychotics are more prone to causing weight gain and increasing cholesterol and blood sugar levels. Controlled trial studies help assess these side effects and their prevalence.

Assertive community treatment

Assertive Community Treatment (ACT) is a comprehensive, evidence-based approach to providing community care for individuals with severe and persistent mental health disorders, such as schizophrenia. The ACT model emphasizes a multidisciplinary team approach, including ACT professionals like psychiatrists, nurses, social workers, and other mental health experts, to deliver personalized and coordinated care to clients. 

The goal of ACT is to help people achieve stability, reduce hospitalizations, and enhance their overall quality of life through community care. Depending on family dynamics and relationships it may be beneficial to empower loved ones or a family member to help. By involving family support groups, providing family education, and focusing on improving communication, ACT provides a supportive environment that fosters personal growth and development. ACT offers intensive, individualized support in areas such as medication management, housing, job counseling, supported employment, and social skills development.

Electroconvulsive treatment

This was once called shock therapy, and the term can bring about frightening imagery that has become popular in movies. However, electroconvulsive therapy is no longer the painful treatment it was once depicted to be. Also known as ECT, the National Institute of Mental Health has considered it one of the fastest and most effective ways to relieve symptoms of schizophrenia, depression, and bipolar disorder. 

The process involves a general anesthetic being administered to relax all the muscles in the body. Then electrodes are placed on the scalp and a finely controlled electric current is administered for a short period of time. These sessions take place several times a week for a period of two to four weeks. Some common side effects of ECT include headaches, memory loss, muscle aches, and upset stomach.