Therapy for schizophrenia
Schizophrenia is a form of psychosis in which, on the one hand, sensory perception can be disturbed and hallucinations can occur, and on the other hand, the thinking itself can be severely disturbed. The processing of perceptions can e.g. lead to delusions.
All in all, people in a psychotic state gradually lose touch with reality and thus with their life. Various drugs and psychotherapeutic approaches are available for the treatment of schizophrenia, which usually lead to a weakening or alleviation of the symptoms.
Modern therapy for schizophrenia takes into account the various causal approaches to its development. A distinction is therefore made between drug-based (pharmacological) and so-called social therapeutic therapy. Therapy should always be initiated and monitored by a psychiatrist.
Because schizophrenia is a potentially life-threatening condition, medication is essential to treat it. The generic term for medication for the treatment of schizophrenic symptoms is neuroleptics. In addition to treating the acute illness, neuroleptics also protect against relapses into the illness. Neuroleptics are extremely unpopular drugs with many patients because they can have a number of side effects.
Neuroleptics are divided into highly potent, moderately potent and weakly potent (potent = effective). The more potent the neuroleptics, the greater the antipsychotic effect (but also the side effect). It is not uncommon for patients to refuse to take tablets because of excessive side effects and thus risk frequent relapses of the disease and forced placement (see also the topic of childcare law).
In such patients, so-called depot drugs are suitable, which are administered by syringe and whose effect can last for several weeks.
Overall, it is recommended that schizophrenic patients take medication for a period of 3-5 years in order to have the greatest possible protection against relapse.
In addition to neuroleptics, other groups of drugs can be used for treatment. Since in most cases neuroleptics only work after days or weeks, the group of benzodiazepines (e.g. Valium) is used to provide the patient with rapid help. Benzodiazepines, however, are by no means suitable for long-term treatment, as they are addictive with long-term use.
In addition, the group of antidepressants is used for depression, which can occur as a side effect of schizophrenia.
Furthermore, various drugs from the group of so-called anti-epileptics are given to protect against relapse.
Also read: Schizophrenia - These Drugs Are Used!
Which drugs are used?
The so-called antipsychotics, which were previously known as neuroleptics, are the drugs that have the best effect on severe forms of schizophrenia. Halo- and benperidol are important representatives of the "typical" neuroleptics, with the newer "atypical" substances mainly Clozapine or Risperdal are used. These drugs reduce the so-called plus symptoms of a schizophrenic episode, such as delusions, hallucinations or mania. In addition to antipsychotics, bezodiazepines such as lorazepam (®Tavor) or diazepam (®Valium) are often used to calm the patient during an acute schizophrenic flare-up.
Antidepressants may also be administered for concomitant depression, e.g. Citalopram.
Unfortunately, the drugs mentioned hardly have any effect on the so-called minus symptoms such as apathy, tiredness or flattening of emotions and it is not yet possible to treat these symptoms satisfactorily.
Further information on this topic can be found at: Schizophrenia - These Drugs Are Used!
Neuroleptics used to treat schizophrenia
The first choice for the treatment of schizophrenia are the aforementioned neuroleptics or antipsychotics. A distinction is made between typical antipsychotics, which block an important dopamine receptor in the brain, and atypical antipsychotics, which also influence other messenger substances. Since dopamine also plays an important role in motor skills, the typical neuroleptics have very unpleasant side effects, such as involuntary movements and twitching. These undesirable effects are difficult to treat and can persist even after stopping the neuroleptic.
Therefore, nowadays it is preferred to use the newer, atypical antipsychotics, which develop their effect through a very complex impairment of several important messenger substances in the brain. This also leads to numerous side effects, but these are easier to control and treat in such a way that they do not permanently affect the patient.
Further information on this topic can be found at: Schizophrenia - These Drugs Are Used!
Relapse rate among those affected without therapy
Without neuroleptics, the probability of falling ill again within a year is almost 90%.
Read more on the topic: Can schizophrenia be cured?
Can you treat schizophrenia without medication?
Avoiding medication if you have severe schizophrenia is very risky and usually not recommended. Especially in an acute episode, the patient has no insight into the disease and may endanger himself and others. No doctor will therefore let an acutely psychotic patient go home without medication.
Only in very mild cases, if the patient decisively rejects a medication, can it be dispensed with. However, one should be aware that the chance of a complete resolution of the symptoms and thus of a cure are significantly higher if the first symptoms of schizophrenia are treated immediately.
Once the schizophrenic episode is over, a good attitude through psychotherapy and behavioral therapy can replace medication. But you should be very careful and let the medication taper off to prevent a relapse.
We recommend our site to: Schizophrenia - These Drugs Are Used!
Psychotherapy makes sense for most schizophrenic patients to enable them to cope with their illness. First and foremost, this includes so-called psychoeducation, i.e. informing the person concerned about their illness, therapy and possible consequences. It must be clear to the patient that he or she will benefit from treatment in order to generate the necessary motivation for long-term medication and psychotherapy.
In addition to psychoeducation, cognitive behavioral therapy plays a major role, in which the patient learns which behaviors in the context of schizophrenia are useful and which are harmful for him. Neither of these methods is about talking the patient out of their schizophrenia. For example, if the person suffers from delusions, these can usually not be refuted with logical arguments, because they are completely real to the patient. However, it must be made clear to those affected that they are disadvantaged by the symptoms of their schizophrenia and that they would be better off with treatment.
Social therapeutic approach
Providing information (psychoeducation)
It has proven to be beneficial to include relatives and partners in addition to individual therapy.
The content of the information transfer should be: To convey an idea of how cooperation (taking medication) on the one hand and reducing stress on the other hand can contribute to improvement. The objectives of the information phase are:
- Give those affected an explanation for the combined approach of neuroleptic therapy and family care / psychotherapy.
- The "self-management skills" promote e.g. by assigning the affected person an active role and making the patient an expert on his disease (Theories on origin, frequency, course, symptoms ...)
- Reduction of misunderstandings, prejudices and feelings of guilt.
- Information about neuroleptics
Behavioral family care
The therapeutic approach developed by Falloon, Boyd and McGill in 1984 represents a version of behavioral family care that is adapted to the special needs of schizophrenic patients and their families.
The central components are:
- Neuroleptic medication
- Diagnostics, analysis of family conflicts and stress
- Information about schizophrenia and medication
- Communication training (direct expression of positive and negative feelings, active listening)
- Problem solving training
- If necessary: individual therapy
Family care should be carried out as outpatient follow-up care and - if possible - follow on from inpatient treatment.
The patient should be symptom-free to the extent that he is able to concentrate on working for approx. 45 minutes.
It is recommended to hold approximately every 4th session in the family household.
The duration is approx. 25 sessions within the first year, the frequency is adapted to the family. The care should be planned for a two-year period. In the event of a crisis, an unscheduled meeting must be arranged quickly.
Training of social skills
This therapeutic approach is about improving social skills, i.e. the ability to interact with other people and to solve interpersonal problems. This therapy is carried out in groups and includes exercises to improve social awareness and behavior. To be practiced:
- Receiver skills (perception exercises, active listening, summarizing the speaker's utterances)
- Initiation, maintenance and termination of short conversations
- Expressing positive feelings such as praise and appreciation
- Expressing negative feelings
- Stand up for your own rights and reject unjustified claims
- Problem solving training
Sociotherapy and rehabilitation
Schizophrenia accompanies those affected for years, if not for life. These people therefore leave their professional and social life for a long time and have to be reintegrated as part of a successful therapy. In most cases, this works even if the schizophrenia persists. Doctors and therapists, social workers, relatives and of course the patient must work closely together. The most important aspects here are the continuation of drug and / or psychotherapeutic treatment, care in the home environment and finding a suitable job if the patient is able to work.
In many cases, with the right help, those affected find their way back into their own lives, can live independently and pursue a job. More severely affected patients need support in everyday life because they cannot cope on their own. In this case, a supported living situation should be aimed for and a job in which colleagues can keep an eye on you, such as as a ward aid in the clinic. In cases in which the patient poses a danger to himself or others, reintegration is not possible and placement in a closed institution may be necessary.
How long does therapy for schizophrenia take?
Schizophrenia is not an illness that can be cured by medication, but a serious psychological disorder that is sometimes more, sometimes less pronounced in episodes. In many cases the symptoms subside after a while, but in others they last a lifetime.
Therapy is therefore necessary as long as symptoms are present and for some time after that to avoid relapses. It is therefore only possible to start a first attempt at elimination after months or years without symptoms. If the schizophrenia does not return, the patient no longer needs medication. If the schizophrenic phase occurs again, the person concerned may be dependent on treatment for the rest of his life. But even without relapse, many patients still need at least psychological therapy long after the symptoms have subsided.
Depending on the individual clinical picture, therapy for schizophrenia therefore lasts from a few years to lifelong, depending on how the disease develops and how stable the patient remains without medication.
Read more on the topic: Can schizophrenia be cured?
Can I support schizophrenia with homeopathy?
There are some homeopathic substances that can complement psychiatric treatment, depending on the appearance of schizophrenia. In psychotic phases, for example, calming agents could be considered, in apathetic episodes stimulating substances.
However, homeopathic support should be discussed with the attending psychiatrist, as some remedies can interact with other medications.
Insulin therapy - an outdated treatment concept
In the middle of the 20th century, psychiatric patients were treated with a so-called insulin shock. An administration of insulin causes massive hypoglycaemia, which among other things leads to seizures. Due to massive side effects, a few deaths and a merely questionable effect, this form of treatment was quickly forgotten.
The principle of an artificially induced seizure, so to speak a “reboot of the brain”, and the resulting positive effect on psychiatric illnesses are now being used by far safer electroconvulsive therapy (ECT), which is also used in schizophrenia.
How quickly can symptoms improve?
How quickly a therapy takes effect depends on the type of treatment. Antipsychotic and depressant medications usually work very quickly to help relieve acute symptoms of schizophrenia. Other psychiatric drugs take a few weeks to show their full effect. Psychotherapeutic measures take months to really take effect. Thus, the various therapy options for different aspects of the disease make sense.
How are accompanying symptoms treated?
Common side effects of schizophrenic patients are depression, anxiety disorders and other psychological problems that often only appear after the schizophrenic episode. However, these can be treated well with antidepressants and psychotherapeutic measures if they are recognized in good time.
However, schizophrenia can in principle trigger all kinds of symptoms, from headache and stomach ache to sleep and concentration disorders, as it is a very complex disease. Many of these accompanying symptoms are of a psychosomatic nature, i.e. they can be traced back to psychological stress. However, the drugs used can also have side effects that may have to be treated.
Each patient therefore has very individual accompanying symptoms that must be treated differently. It is therefore important to have a constant team of doctors and therapists who can address each problem individually. The patient needs to trust this team to report accompanying symptoms and seek help. Larger psychiatric clinics allow such holistic treatment.
Every diagnosis that is made in this country has to be “coded” if one wants to make it professionally and not simply from the gut. This means that there are systems in which all diseases known to medicine are more or less well recorded. So a doctor can't just go and distribute diagnoses unless certain criteria are met that the encryption system requires. According to the diagnostic criteria of schizophrenia according to the ICD-10 criteria:
The schizophrenic disorders are generally characterized by fundamental and characteristic disorders of thought and perception and inadequate or shallow affects. Clarity of consciousness and intellectual abilities are usually not impaired, although certain cognitive deficits can develop over time.
he most important disease-specific phenomena are mental sounding, thought inspiration or withdrawal of thoughts, thought spreading, delusional perception, control mania, influencing mania or the feeling of what has been done, voices that comment on the patient in the third person or speak about him, thought disorders and negative symptoms. The course of schizophrenic disorders can either be continuous, episodic with increasing or stable deficits, or one or more episodes with complete or incomplete remission can occur.
The diagnosis of schizophrenia should not be made in marked depressive or manic symptoms unless schizophrenic symptoms preceded the mood disorder. Likewise, schizophrenia cannot be diagnosed if there is a definite brain disease, during intoxication or during a withdrawal syndrome.
Special forms of schizophrenia
Paranoid hallucinatory schizophrenia (ICD-10 F20.0)
Paranoid schizophrenia is characterized by persistent, often paranoid delusions, usually accompanied by acoustic hallucinations and perceptual disorders. Mood, drive, and speech disorders, catatonic symptoms are either absent or barely noticeable.
Hebephrenic schizophrenia (ICD-10 F20.1)
A form of schizophrenia in which affective changes are in the foreground, delusions and hallucinations are fleeting and fragmentary, behavior is irresponsible and unpredictable, and mannerisms are common. The mood is flat and inappropriate. Thinking is disorganized, language disorganized. The patient tends to isolate himself socially. Because of the rapid development of negative symptoms, especially flattening of affect and loss of drive, the prognosis is mostly poor. As a rule, hebephrenia should only be diagnosed in adolescents or young adults.
Catatonic Schizophrenia (ICD-10 F20.2)
Catatonic schizophrenia is characterized by the predominant psychomotor disorders that can alternate between extremes such as excitement and stupor as well as automatic command and negativism. Constrained postures and postures can be maintained for a long time. Episodic severe agitation can be a characteristic of this clinical picture. The catatonic phenomena can be associated with a dream-like (oneiroid) state with vivid scenic hallucinations.
Schizophrenic residual (ICD-10 F20.5)
A chronic stage in the development of a schizophrenic disease in which there is a definite deterioration from an early to a later stage and which is characterized by long-lasting but not necessarily irreversible "negative" symptoms. These include psychomotor slowdown, decreased activity, flattening of affect, passivity and lack of initiative, qualitative and quantitative language impoverishment, low non-verbal communication through facial expression, eye contact, modulation of voice and posture, neglect of personal hygiene and declining social performance.