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 Schizophrenia

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Schizophrenia9

Treatment, Services and Support

Treating Schizophrenia

While there is still no cure for schizophrenia, treatments have been developed that help reduce many symptoms of the disease. There are many medications now available to help treat schizophrenia. Psychosocial rehabilitation and family support are also key aspects in providing a successful treatment. Perhaps most important is to address schizophrenia as soon as it is detected. Early treatment has been shown to be effective in limiting the development and severity of symptoms.

Medication

With the advent of antipsychotic medications in the 1950s, the outlook for people diagnosed with schizophrenia greatly improved. Although these medications, now called conventional or typical antipsychotics, did not provide a cure for schizophrenia, they were able to help improve the positive symptoms linked with the illness. Many people living with mental illness now were able to be released from psychiatric institutions as their positive symptoms-hallucinations, delusions-were relieved with these drugs.

These earlier medications often had side effects. Some of these side-effects included restless motion (called akathisia), Parkinson-like symptoms (e.g., stiffness, dry mouth, sedation) and tardive dyskinesia, a disabling and untreatable movement disorder.

Some first-generation medications used to treat schizophrenia are:

Generic Name Brand Name
Chlorpromazine Thorazine
Fluphenazine* Proxlixin
Haloperidol* Haldol
Loxapine Loxitane
Perphenazine Trilafon
Thioridzaine Mellaril
Thiothixene Navane
Trifluoperazine Stelazine
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Second-generation antipsychotics (SGA), called atypical antipsychotics because they do not cause most of the movement problems related to the first generation of antipsychotics, have been available since the early 1990s. The first of these, clozapine, which was more effective than the previous anti-psychotics by addressing difficult-to-treat symptoms, however, could possibly produce the severe side effect agranulocytosis, which is the loss of white blood cells.

Some of the newest atypical antipsychotics include:

Generic Name Brand Name
Aripiprazole Abilify
Asenapine Saphris
Clozapine Clozaril
Iloperidone Fanapt
Lurasidone Latuda
Olanzapine Zyprexa*
Paliperidone Invega*
Risperidone Risperdal
Quetiapine Seroquel
Ziprasidone Geodon

* Also available in long-acting injectable as of 2/2011.

Some second-generation antipsychotics can sometimes cause metabolic syndrome, which includes dyslipidemia, an abnormal amount of lipids in the blood, abdominal obesity and elevated blood pressure. However, these symptoms are largely preventable. Other initial side effects of antipsychotics include drowsiness, blurred vision, rapid heartbeat and sensitivity to the sun.

Two of these medications, risperidone (Risperdal) and aripiprazole (Abilify), are approved by the FDA for use in teenagers aged 13-17. The FDA periodically approves new medications. For a current list, visit www.fda.gov.

Overall, however, these medications have led to significant improvement in the quality of life of many individuals living with schizophrenia. New developments in medicine include the introduction of paliperidone palmitate (Invega Sustenna), which can be administered monthly instead of bi-weekly.

Choosing an Antipsychotic

The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, funded by the National Institute of Mental Health, released in 2006, looks at medication adherence in individuals with chronic schizophrenia. The study, which raises more questions than it answers, confirms that the differences in side effects in and between these newer and older medications are substantial, which further emphasizes the need to individually tailor the treatment to the individual. Another noteworthy aspect is that among severely ill individuals who did not respond to other treatments, most subjects in the study did not continue their treatments. This is another argument for letting the individual and the doctor choose the best medicine.

Psychosocial Rehabilitation

People living with schizophrenia typically have important goals for themselves similar to those of individuals who are not diagnosed with schizophrenia. They want to be successful in relationships, work and living. Psychiatric rehabilitation strategies are designed to enable people to compensate for, or eliminate, the environmental and interpersonal barriers and the functional deficits created by this illness. By addressing these facets, people can learn to successfully live in independent housing, pursue education, find a job and improve social interactions.

Assertive Community Treatment (ACT) is a service-delivery model that provides comprehensive, locally based treatment to people with serious mental illnesses, such as schizophrenia. Unlike other community-based programs, ACT is not a linkage or brokerage case-management program that connects individuals to mental health or other services, but rather, it provides highly individualized services directly to individuals.

ACT is an evidence-based service that includes fidelity standards, meaning that research has substantiated the effectiveness of the program, when it meets certain standards of practice. Professionals work with individuals living with mental illness to address problems proactively, helping to make sure that crises' do not happen, ensure medications are being properly taken and assist in helping individuals meet the routine challenges of daily life.

Engaging in psychosocial rehabilitation encourages individuals to be more likely to continue taking their medication and less likely to be re-hospitalized in the future because of a relapse.

Medical Care and Co-occurring Disorders

People living with schizophrenia are subject to many medical risks and typically receive poor medical care. High rates of smoking are found in patients with schizophrenia. Beyond the "traditional" health risks of smoking, i.e., lung disease, a study conducted in 2010 found patients who smoke are more likely to relapse and be readmitted to a hospital than non-smoking patients.

About 25 percent of people living with schizophrenia also have a substance abuse disorder. This is frequently referred to as a "dual diagnosis." While it may seem that substance abuse is a method of escape from the distressing experiences associated with the illness, substance abuse is often a byproduct of schizophrenia and can moreover make treatment less effective and patients less likely to follow their treatment plan.

Multiple studies have shown that patients diagnosed with schizophrenia also have an increased risk of diabetes and cardiovascular problems regardless of gender and particularly at a younger age. Research shows that monitoring is often not adequate for these metabolic side effects.

Better and more integrated care is essential for people living with schizophrenia. On the NAMI Hearts & Minds website, you can find tools and information on fostering a culture of activity, self-care and support around maintaining a healthier lifestyle.

When someone is diagnosed with schizophrenia it is not uncommon that another medical or psychiatric condition also occur. Understandably it is important that all aspects of care are coordinated, especially medications. Other medications can include over the counter medicine, vitamins, minerals and herbal supplements.

As mentioned previously, it is not uncommon for people living with schizophrenia to experience depression, although it may be difficult to distinguish depression from negative symptoms that affect someone's ability to display emotions. However, if symptoms of depression are being experienced, it is important to address them as it may significantly increase the likelihood of suicide.

Cognitive Therapy

While medication can provide benefits in alleviating some of the symptoms of schizophrenia, according to multiple scientific studies, psychiatric rehabilitation, which can include practice, special training and other treatment-like procedures, is a vital aspect for helping patients learn social and living skills to aid in their entrance into everyday society.

Cognitive Behavioral Therapy (CBT) has been shown to be an effective part of a treatment for some people living with affective disorders. With more serious disorders, including schizophrenia and psychoses, additional cognitive therapy is added to basic CBT and is known as CBTp. CBT is commonly used in the United Kingdom, but is becoming more widely available in the US. Individuals turn to CBTp to help prevent relapse, prevent the further development of psychosis and to develop proactive coping strategies to help handle persistent symptoms that do not respond to medicine. However, while CBTp has been effective in the latter, it has not been shown to be as effective in preventing relapse.

Peer support groups like NAMI Peer-to-Peer and WRAP (Wellness Recovery Action Plan) encourage involvement in recovery by working on social skills with others. The Illness Management Recovery (IMR) model is an evidence-based approach that emphasizes setting goals and acquiring skills to meet those goals.

Complimentary and Alternative Medicine (CAM) is another option when considering how to treat schizophrenia. Defining what CAM is difficult largely because "unconventional" medicine has not been studied to the degree that conventional medicine has. Conventional medicine is generally characterized as Western medicine. Examples of this alternative therapy include yoga, meditation and acupuncture. While many people often dismiss CAM, 38 percent of adults used some feature of CAM. Many CAM practices embody the idea of connecting the mind and body in an attempt to provide greater recovery. To learn more about the basics of what CAM is, go to the National Institute of Health's, National Center for Complementary and Alternative Medicine.

The Social Aspect of Schizophrenia

Family-specific Support

For people living with schizophrenia, support from family and loved ones is some of the most important medication that can be provided. Families who are educated about schizophrenia can offer strong support and help reduce the likelihood of relapse. The key is to be in tune with what the person is open to at any given time. For example, arguing with an individual about delusions when they do not believe they are having any creates distances and is usually ineffective. Instead, empathizing with someone's distress or success is more likely to foster positive outcomes.

A person providing care for a person living with schizophrenia faces many challenges. One of the hardest is finding ways to support and protect their loved one while allowing room for self-reliance. Every family is different, but family structures tend to vary from culture to culture, with certain groups, like Latino cultures, tending to benefit from treatment solutions that involve the entire family. However, when the stress of care giving is placed on only a few individuals, they themselves may begin to exhibit signs of psychological distress. Mood disorders, such as depression, can occur 40 percent of the time, three times the rate of the general Latino population. Caregiver burnout is not only found in Latino populations but in all groups providing support to patients living with schizophrenia.

Families should also become educated about health privacy laws and legal aspects of providing care for an adult living with schizophrenia who does not understand that they may need treatment.

The Treatment Advocacy Center has state-by-state information regarding commitment laws. Psychiatric advance directives, which allow individuals to designate treatment and contact persons in case they are unable to make their own decisions, can be another tool. State-by-state information on psychiatric advance directives is available at The National Resource Center on Psychiatric Advance Directives.

Because of the confusing path and strain that providing help for a loved one with schizophrenia entails, family members often find it helpful to maintain a journal of all medications, medical visits, treatments and legal actions that have they have undertaken. Having this information can be useful when switching providers or dealing with a crisis.

For all of these reasons, family members should seek support for their own needs from groups specially designed for families, such as NAMI's Family-to-Family educational group.

Employment

Seventy-three percent to 90 percent of individuals diagnosed with schizophrenia are unemployed, and those who are employed only work part time or are employed in non-competitive jobs. However, this is not because people living with schizophrenia do not wish to be employed. Research suggests that as many as 70 percent of patients would like to be engaged in competitive employment.

Being employed not only produces a sense of accomplishment but also improves social skills by providing the individual with in social situations than in isolated settings, which tends to exacerbate negative symptoms. As a review of schizophrenia research notes, unemployment is not symptomatic of schizophrenia but rather a byproduct of the social and economic pressures that individuals living with schizophrenia face.

However, supported employment opportunities are scarce. A good place to begin searching for employment aid is your local Office of Vocational Rehabilitation (OVR) or hospitals, which also occasionally offer supported employment opportunities or referrals.

People receiving Social Security benefits used to the run the risk of losing their eligibility if they began to work, but the new Ticket to Work program gives people more freedom to pursue employment.


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