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Treatment & Remission

  • There are several treatment approaches available and they all start with a good medical consultation. Adherence is key!

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Treatment

After a schizophrenia diagnosis the doctor will have a conversation with the person diagnosed about starting a treatment plan. Once treatment begins, there are two main goals to work together with the doctor towards: reducing frequency and severity of acute psychotic episodes and improving quality of life.1

Guidelines on treatment, such as those from NICE, encourage early intervention whenever the first symptoms are noticed, because this can decrease the risk of developing psychosis.2
The doctor will discuss options with the person with schizophrenia, in order to choose the best type of medication to fit their needs. Ultimately, the choice will be made based on medical history, phase of treatment and side effects which may be expected with the pharmacological treatment.2

However, the treatment people with schizophrenia receive is not limited to a pharmacological approach. A system called “multi-modal treatment” is in place. This means that the treatment will likely cover, on top of antipsychotic medication, the following: 1

Psychotherapy

Social skills training

Personal education

Family intervention, training

Schizophrenia treatment depends on the person being treated but is usually a combination of therapy and medication. While there is not currently a cure for schizophrenia, many symptoms can get better with treatment and some people find that their symptoms may stop altogether.
If you have schizophrenia you may be treated with:


Cognitive Behavioural Therapy (CBT)

CBT is a type of therapy that can help you recover from ongoing positive and negative symptoms of schizophrenia. It helps you to identify the thinking patterns which may be causing you to have unwanted feelings or behaviour and to replace these with more realistic thoughts.12

You may need between 8-20 sessions of CBT over 6-12 months, however this can vary. Each session usually lasts about half an hour.12

Arts Therapy

Arts therapy can help you to express your experience with schizophrenia. Sometimes the negative symptoms of schizophrenia mean you may find it difficult to relate to others.13 Arts therapy can be a good way to share your feelings and may even help to give you a new outlook on schizophrenia.12

Family Therapy

Family can play an important role in helping to manage your schizophrenia. However, sometimes it can be challenging for family members. Family therapy can help you and your family understand and cope better with your schizophrenia. It involves discussion with an expert on ways to provide support and practical tips on how to deal with any problems. Family therapy can be especially helpful if you have recently experienced an acute episode. 12,13

Medication

Your doctor may prescribe antipsychotic drugs for your symptoms of schizophrenia. The type of drug depends on your symptoms and will only be given to you after an examination by your doctor. These medications may be oral pill-based or sometimes given as an injection.12 Generally antipsychotic medication can be classed as first generation or second generation. Speak to your doctor for more information about the differences between these two groups of medications.

The amount of time you may be asked to take medication can vary. While some side effects can be expected, if they become severe make sure that you tell your doctor. There may be alternative medication or additional medications that can help.12

It is important that you do not stop taking any antipsychotic medication without first consulting your doctor. If you do stop, your symptoms may get worse. 12


What is medication adherence and why is it important?

Good medication adherence means that the person with schizophrenia complies to taking the medication exactly as prescribed by their doctor.3 This can be hard for a lot of people living with schizophrenia – in particular, their reported adherence to medication is around 50%, which means they fail to take half their medication as indicated.3-5

People living with schizophrenia may find the number and frequency of medicines too hard to remember, or a medicine may have certain side effects which are too uncomfortable, leading to discontinuation. 6-9 It may also be difficult for them to maintain treatment consistency when they think it’s no longer necessary.9
If people with schizophrenia find that they’re struggling to take their medicines, they should speak to their doctor to consider different options for them.
Skipping medication or taking a different dosage is the main reason why people relapse and experience new psychotic episodes.9


Treating negative symptoms

Negative symptoms are common for people living with schizophrenia.10 These symptoms are presented with reduced desire to speak, socialise, or take part in everyday activities.10

Unfortunately, even second generation drugs for schizophrenia (called atypical antipsychotics) haven’t been able to fully tackle negative symptoms.10
In general, the current types of treatment aim at resolving the positive symptoms (psychosis and acute episodes) and only after this is achieved there is a relative improvement in negative symptoms.11

Negative symptoms can interfere with a person’s quality of life, so it’s extremely important to talk about these with a doctor early on.10


Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology
Thomas RE Barnes and the Schizophrenia Consensus Group of the British Association for Psychopharmacology
Barnes TR and the Schizophrenia Consensus Group of the British Association for Psychopharmacology. J Psychopharmacol. 2011;25(5):567-620

References

  1. Haller CS, Padmanabhan JL, Lizano P, Torous J, Keshavan M. Recent advances in understanding schizophrenia. F1000Prime Rep. 2014 Jul 8;6:57
  2. NICE CG178 https://www.nice.org.uk/guidance/cg178. [accessed August 2019]
  3. Bebbington PE. Int Clin Psychopharm 1995;9(Suppl.5): 41–50
  4. Cramer JA. Psychiatr Serv 1998;49: 196–201
  5. Velligan DI. Schizophr Bull 2006;32:724–742
  6. Byerly MJ. Psychiatric Clin North America 2007;30: 437–452
  7. Mitchell AJ Adv Psychiatr Treat 2007;13: 336–346
  8. Barnes TR and the Schizophrenia Consensus Group of the British Association for Psychopharmacology. J Psychopharmacol. 2011;25(5):567-620
  9. Weiden PJ. J Clin Psychiatry 2007;68(Suppl. 14): 14–19
  10. Sicras-Mainar A. Neuropsychiatr Dis Treat 2015:11 51–57
  11. Sicras-Mainar A, Maurino J, Ruiz-Beato E, Navarro-Artieda R. Impact of negative symptoms on healthcare resource utilization and associated costs in adult outpatients with schizophrenia: a population-based study. BMC Psychiatry. 2014 Aug 6;14:225
  12. NHS, Treatment Schizophrenia, 2016. https://www.nhs.uk/conditions/schizophrenia/treatment/ [Accessed October 2019]
  13. NHS, Symptoms, 2016. https://www.nhs.uk/conditions/schizophrenia/symptoms/ [Accessed October 2019]
  14. NICE, Psychosis and schizophrenia in adults: prevention and management, 2014. https://www.nice.org.uk/guidance/cg178/chapter/1-Recommendations#subsequent-acute-episodes-of-psychosis-or-schizophrenia-and-referral-in-crisis-2 [Accessed October 2019]
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