Schizophrenia: Living in a Different World
Page Four
Treatment
Because of its impact on so many areas of functioning, schizophrenia requires intense and multi-faceted treatment.
Medication
Anti-psychotic medication has been used to treat schizophrenia since the 1950s and is still thought to be the best treatment available. For the majority of people suffering from schizophrenia, anti-psychotics can decrease the presence of delusions, hallucinations and confusion. Some people believe that medications are used to tranquilize or sedate patients with schizophrenia, and anti-psychotics do often have a calming effect. Sedation, however, is not the purpose of anti-psychotic medication. Their purpose is to reduce hallucinations, delusions, and confusion so that individuals with schizophrenia can function more effectively in the real world. Most people with schizophrenia show marked improvement with anti-psychotic medication. In fact, anti-psychotic treatment can reduce relapse by more than 50 percent.
Unfortunately, anti-psychotic medications are not a miracle cure for schizophrenia. They do not necessarily prevent any and all future psychotic episodes. Furthermore, in certain individuals they are ineffective in reducing or eliminating the psychotic symptoms. In fact, one-fifth to one-third of all people with schizophrenia do not respond to medication. Anti-psychotics are also not as helpful with schizophrenic symptoms involving a loss of function, such as decreased motivation and emotional inexpressiveness, as they are with distorted functions, hallucinations, delusions, and confusion.
Older antipsychotic medications may also have troublesome side effects. Many individuals using these medications complain of sleepiness, dry mouth, restlessness, or blurred vision. Some antipsychotic medications cause side effects involving muscle spasms and other problems with nerves and muscles. In fact, up to 70 percent of individuals taking the older antipsychotic medications experience these unpleasant side effects. Even after discontinuing the medication, these side effects can last for weeks or even months. In the most severe cases, the symptoms may even be permanent.
Side effects involving the nerves and muscles can look a lot like the effects of Parkinson's Disease, which is a result of not enough dopamine (remember that schizophrenia appears to involve too much dopamine). While untreated schizophrenia is associated with too much dopamine in the brain, anti-psychotic medications that block dopamine's reception in the brain can result in symptoms that look like not enough dopamine in the brain. Finding the delicate balance of dopamine appears to be one of the central challenges in medically treating schizophrenia. Sometimes doctors prescribe anti-Parkinsonian drugs to combat these side effects, but most oppose the routine use of anti-Parkinsonian drugs when treating schizophrenia medically.
Newer medications for schizophrenia are much less likely to produce side effects in the nerves and muscles, but they carry their own problems, such as weight gain. However, their effectiveness and less risky side effects appear quite promising. Research continues on these newer drug treatments for schizophrenia
 Although medication is by far the most
important component of the treatment of
schizophrenia, psychotherapy and other
counseling related treatments play a vital
role in the treatment of schizophrenia.
Psychotherapy and Psychosocial Support
Although medication is by far the most important component of the treatment of schizophrenia, psychotherapy and other counseling related treatments play a vital role in the treatment of schizophrenia. They serve several important functions. First, since many individuals with schizophrenia are unable to accept that their perception of reality and their world is not the world, they do not believe they are sick. In fact, many insist that they have a clearer and more accurate vision of reality than their doctors, family members or friends. And since they do not believe they are sick, getting them to take their medicine regularly tends to be one of the greatest challenges to doctors, family members, and friends of individuals with schizophrenia.
In addition to the patient's resistance to taking medicine, sometimes well-meaning but uninformed family members or friends encourage the individual to stop taking medication as soon as he or she returns to normal or feels better. Unfortunately, relapse is much more common when people stop taking their medication or take it inconsistently.
In view of this, the first task of psychotherapy and psychosocial treatment of schizophrenia is usually establishing and adhering to a treatment plan designed with the medical doctor. Therapists can work with patients and their families on adhering to a treatment plan.
Because of the broad impact of schizophrenia on all areas of functioning, most treatment involves helping people improve their ability to care for themselves (i.e., general hygiene, sleeping and eating patterns). Therapists typically work with individuals on improving social skills, managing stress, and improving problem-solving, communication and job skills.
Relapse prevention is another central task of psychosocial treatment. Therapists can work with patients and their families on recognizing early signs of relapse. They can help individuals and their families design a course of action when symptoms begin to appear.
In recent years, a few psychotherapists have begun to conduct long-term in-depth psychotherapy with schizophrenics, sometimes with excellent results. This form of therapy is designed to help schizophrenic patients understand how and why they distort reality and to help them learn to deal with their deep emotional and relational pain without retreating from reality or distorting their thinking. This is a long and difficult form of therapy, but in combination with medication appears to hold out the best hope for significant growth toward psychological help since it aims to go beyond symptom removal and minimal social adjustment.
In addition to psychotherapy, many individuals with schizophrenia can profit from a variety of rehabilitation programs, which may provide job training or supervised job placement programs. Support groups, self-help groups, and family education groups are other possible sources of reinforcement for schizophrenic patients and their families. Residential programs or group treatment homes can provide more consistent support for individuals with schizophrenia who are unable to function without this additional structure.
A Special Word to Family Members
If you have a family member with schizophrenia, you have probably experienced overwhelming feelings of frustration and helplessness. Watching someone you love suffer from a debilitating illness can be extremely painful.
As a parent of an individual with schizophrenia, you may wonder if you did something wrong to cause this disorder. You may be financially supporting your child or providing his or her housing. You may be constantly wondering whether you're doing too much or too little, whether you are overinvolved or underinvolved in your adult child's life.
 Continued on Page Five
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