Schizophrenia Treatment:Types of Therapies and Medication

Schizophrenia is a serious mental illness that affects a person’s thinking, emotions, relationships, and decision making. And because there’s no cure, getting the proper treatment early is the best way to improve chances of managing the illness.

Schizophrenia treatment will center on managing the person’s symptoms. To do that, they’ll probably need to take medication for an open-ended period of time, possibly even for life. Psychotherapy, a kind of talk therapy, will likely also be a big part of the plan to help them understand and manage their symptoms. There’s more than one kind of psychotherapy and many types of medications, so you’ll want to know what’s involved.

Types of Psychotherapy

  • Individual psychotherapy . During sessions, a therapist or psychiatrist can teach the person how to deal with their thoughts and behaviors. They’ll learn more about their illness and its effects, as well as how to tell the difference between what’s real and what’s not. It also can help them manage everyday life.
  • Cognitive behavior therapy (CBT). This can help the person change their thinking and behavior. A therapist will show them ways to deal with voices and hallucinations. With a combination of CBT sessions and medication, they can eventually tell what triggers their psychotic episodes (times when hallucinations or delusions flare up) and how to reduce or stop them.
  • Cognitive enhancement therapy (CET). This type of therapy is also called cognitive remediation. It teaches people how to better recognize social cues, or triggers, and improve their attention, memory, and ability to organize their thoughts. It combines computer-based brain training and group sessions.

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Types of Psychosocial Therapy

If a person with schizophrenia sees improvement during psychotherapy sessions, it’s likely they’ll need more help learning how to become part of a community. That’s where psychosocial therapy comes in.

  • Social skills training. This type of instruction focuses on improving communication and social interactions.
  • Rehabilitation. Schizophrenia usually develops during the years we are building our careers. So rehabilitation may include job counseling, problem-solving support, and education in money management.
  • Family education. Your knowledge of psychosis and schizophrenia can help a friend or family member who has it. Research shows that people with schizophrenia who have a strong support system do better than those without the encouragement of friends and family.
  • Self-help groups. You should encourage your loved one to participate in community care and outreach programs to continue working on his social skills. The National Alliance on Mental Illness (NAMI) is an outreach organization that offers a free peer-to-peer program, for instance. It includes 10 sessions for adults with mental illness who want to learn more about their condition from people who have experienced it themselves or been through it with a loved one.
  • Coordinated specialty care (CSC). This is for people experiencing an episode of psychosis for the first time. It’s a team approach that combines medication and psychological therapies. It includes social and employment services and tries to include the family whenever possible. The aim is to change the direction and prognosis for the disease by catching it in its earliest stages. Research shows that people with schizophrenia who get early and intensive treatment have the best long-term results.
  • Assertive community treatment (ACT). This offers highly personalized services to help people with schizophrenia meet life’s daily challenges, like taking medications. ACT professionals also help them handle problems proactively and work to prevent crises.
  • Social recovery therapy. This treatment puts the focus on helping the person set and achieve goals and building a sense of optimism and positive beliefs about themselves and others.

Second-Generation Antipsychotic Drugs

These newer medications are less likely to cause certain side effects than the first-generation antipsychotics. But many medications in this family can cause weight gain and raise blood sugar and cholesterol levels. Changes in nutrition and exercise, and possibly medication intervention, can help address these side effects. They include:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Brexpiprazole (Rexulti)
  • Cariprazine (Vraylar)
  • Clozapine (Clozaril)
  • Iloperidone (Fanapt)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Pimavanserin (Nuplazid)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

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First-Generation Antipsychotic Drugs

You might hear these drugs called typical or conventional. These medications block a brain chemical called dopamine and are more likely than second-generation antipsychotics to cause significant movement disorders like intense muscle stiffness (called dystonia) or a condition that may develop over long-term exposure called tardive dyskinesia. Drugs in this group include:

Electroconvulsive Therapy (ECT)

In this procedure, electrodes are attached to the person's scalp. While they’re under general anesthesia, doctors send a small electric shock to the brain. A course of ECT therapy usually involves 2-3 treatments per week for several weeks. Each shock treatment causes a controlled seizure. A series of treatments over time leads to improvement in mood and thinking. Scientists don’t fully understand exactly how ECT and the controlled seizures it causes help, although some researchers think that ECT-induced seizures may affect the release of neurotransmitters in the brain. It can help when medications no longer work or if severe depression or catatonia makes treating the illness difficult.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on December 20, 2018

Sources

SOURCES:

National Institute of Mental Health: "How Is Schizophrenia Treated?"

National Institute of Mental Health: "What Is Schizophrenia?"

National Institute of Mental Health: "Schizophrenia."

National Alliance on Mental Illness: "Treatment, Services, and Support."

National Alliance on Mental Illness: “Peer to Peer.”

National Guideline Alliance: "Psychosis and schizophrenia in adults: treatment and management.

Mayo Clinic: “Schizophrenia.”

Schizophrenia Research: “Social Recovery Therapy in improving activity and social outcomes in early psychosis: Current evidence and longer term outcomes.”

National Alliance on Mental Illness: “Schizophrenia.”

UpToDate: “Selected adverse effects of antipsychotic medications for schizophrenia.”

Johns Hopkins Medicine: “Frequently Asked Questions about ECT.”

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