Treatment
The treatment of schizophrenia requires a treatment plan tailored to each individual’s needs, which needs to be overseen by mental health professionals. The treatment may be tailored according to the different stages of the condition. The options for treatment include drug treatments (i.e., medications), physical treatments (e.g., brain stimulation or exercise), psychotherapy (e.g., CBT), and other skills training (e.g., cognitive training, occupational therapy).
Antipsychotic drugs are often divided into first- and second-generation antipsychotics. Various medications are adjunctively administered, such as benzodiazepines, mood stabilisers, essential fatty acids, herbal therapies, and many more. There are also non-pharmacological options, such as electroconvulsive therapy, transcranial magnetic stimulation, acupuncture, and exercise.
Drug treatment is generally considered essential in schizophrenia, with other treatment approaches tailored around it.
Pharmacological treatments
Currently, the available antipsychotic drugs control the symptoms of schizophrenia but do not cure the condition. The main drugs used to treat schizophrenia are usually called antipsychotics. They are especially effective against so-called positive symptoms of schizophrenia but far less effective against negative and cognitive symptoms.
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First-generation antipsychotics, also known as "typical" antipsychotics or “neuroleptics”, are the older class of medication. They primarily address positive symptoms associated with schizophrenia, such as hallucinations (perceptual abnormalities) and delusions (fixed, false, irrational beliefs). Today, they are used as third-line drugs or under specific circumstances only.
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Second-generation antipsychotics, often called "atypical" antipsychotics, are the newer class of antipsychotic medication. They effectively target the positive symptoms of schizophrenia. Some claims suggest that they may be more effective than first-generation antipsychotics in treating the negative symptoms of schizophrenia, although the evidence supporting this assertion is not overwhelmingly strong. However, their side-effect profile is supposed to be better than that of:
Non-pharmalogical treatments
People with schizophrenia have additional options if pharmacological treatments are not sufficiently working. These options encompass electroconvulsive therapy, transcranial magnetic stimulation, acupuncture, transcranial direct current stimulation, and exercise. Additionally, there are other alternatives like art and drama therapy, dance and music therapy, as well as animal-assisted therapy and mindfulness that may add a benefit even if the antipsychotic medication is working fine. Certain therapies are tailored to specific groups and desired outcomes, such as high-risk groups, individuals with substance use disorders, children, individuals with cognitive impairments, or those experiencing negative symptoms.
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People with schizophrenia have a variety of psychotherapy choices available to them. The most prevalent options include cognitive-behavioural therapy, family therapy, case management, psychoeducation, group therapy, and social-skills training. Psychotherapy in schizophrenia almost always requires a concomitant antipsychotic pharmacological intervention to be most effective and valuable.
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Besides the already mentioned treatments and interventions, support may be helpful to build or maintain work skills through modern occupational therapy and work therapy approaches. Further, modern and effective cognitive training programs have been established to maintain cognitive functions that may be affected in schizophrenia. These programs are normally computer-based and have been found quite effective.
Side effects of the antipsychotics
Antipsychotics can also cause side effects (Correll, 2007). It is now widely accepted that the primary consideration in selecting antipsychotics should be side effects. These include extrapyramidal symptoms (EPS) such as dyskinesias (repetitive, involuntary, and purposeless body or facial movements), Parkinsonism (cogwheel muscle rigidity, pill-rolling tremor, and reduced or slowed movements), akathisia (motor restlessness, especially in the legs, and resembling agitation), sexual side effects, and dystonias (muscle contractions causing unusual twisting of parts of the body, most often in the neck). These effects are caused by the dopamine receptor antagonist action of antipsychotics. Other side effects may include weight gain, hormonal and metabolic changes, and increased sedation.
Treatment plan for first-break psychosis
In cases where it is feasible, it is recommended that decisions regarding treatment should be made collaboratively between the patient, their family, and the psychiatrists. This shared decision-making process not only demonstrates respect for the patient and their family but also enhances their commitment to treatment and improves adherence to medication. By involving both the patient and family, joint decision-making offers a framework for evaluating the benefits and drawbacks of treatment within the context of rebuilding life following a diagnosis of schizophrenia.
The treatment plan for initial psychosis should follow a diagnostic approach based on the international guidelines. This includes a number of technical investigations such as a 3T brain Magnetic-Resonance-Image (MRI scan) following a specific protocol commonly used for epilepsy patients as well as the use of MRI contrast (Gadolinium) if possible. Further, an extended analysis of blood pathology, a neuropsychological assessment, and a clinical routine EEG are recommended. In some countries, recommendations also include the investigation of cerebrospinal fluid (CSF) in parallel to the blood, because several findings may only occur in CSF and don’t show up in peripheral bloods. This should take place best before antipsychotic medication is initiated (Furrey Torrey, 2019)
How to find a good doctor
When seeking a good doctor to treat schizophrenia, a valuable approach is to seek recommendations from healthcare professionals about whom they would entrust their own family members to in similar circumstances.
What attributes should one seek in a proficient doctor specializing in schizophrenia treatment? Ideally, they should possess a blend of technical expertise, a genuine interest in the disease, and empathy towards those affected by it.
Additionally, good doctors in this field display the ability to collaborate with the patient, their family, and the rest of the treatment team, recognizing the importance of a collaborative approach. The ultimate goal in looking for a good doctor, is to find one who is knowledgeable and who also views people with schizophrenia, in the words of one psychiatrists, “as a suffering patient, not a defective creation of abstruse, mystical, psychic body parts” (Furrey Torrey, 2019)