- Schizophrenia is a mental health disorder that can lead to delusions, hallucinations, trouble with thinking and concentration, bizarre behavior, and lack of motivation.
- It affects nearly 1 out of every 100 people in the United States, and typically begins in late adolescence or early twenties.
- When left untreated, it can lead to a lower quality of life and shortened lifespan.
- Symptoms of schizophrenia can include:
- Hallucinations: hearing or seeing things that do not exist outside of the mind
- Delusions: unusual beliefs not based on reality
- Muddled thoughts or disorganized thinking/speaking
- Losing interest in everyday activities, including things like personal hygiene
- Wanting to avoid people, including friends
- Recovery from schizophrenia is a gradual process that is unique to each person.
- When delivered in a timely, coordinated, and sustained manner, medications and psychosocial treatments can reduce symptoms and help affected individuals to engage in school or work, achieve independence, enjoy personal relationships, and have a good quality of life.
- This guide will help patients and family understand how schizophrenia is diagnosed, what treatment options are available, and what can be done to achieve the best possible outcomes.
Initial Assessment and Evaluation
What To Expect
- Seeking medical help is the first important step in the care process. During the first meeting, a health care professional will review how the patient is doing. This assessment is geared towards learning as much as possible about the patient. This information will help develop a treatment plan that best matches the patient's individual needs.
- The assessment will cover things like:
- A patient's goals and preferences for treatment
- Current and past symptoms, including risk to self or others
- Use of tobacco, alcohol, or any other substances
- Treatment history and any medications currently or recently taken
- Current physical and mental health status
- Any past trauma – physical, sexual, or emotional
- Details such as housing, schooling, finances, occupations, and relationships
- Medical information and testing:
- Vital signs (pulse, blood pressure, temperature)
- Body weight and height
- Blood tests to look for high cholesterol or diabetes
- Pregnancy screening
- Toxicology screen
- Imaging (CT, MRI, or other)
- Heart monitoring (ECG)
- Discussions with patients, family members, and/or others in the support network will also typically occur as part of the initial evaluation. Additional input will be needed as treatment proceeds and the treatment plan is updated.
- Every person's situation is different and, after the assessment, the healthcare clinician will discuss all recommended treatment options. Choosing the best options will be a shared decision between the patient and the clinician, often with input from family members or others in the person's support network.
- The treatment plan is developed in discussion with the patient and includes thoughts, preferences, desires, and goals.
- Family members and friends can be an important part of the care team along with the primary care clinician and other health professionals.
- It is important to incorporate a patient's own goals into the treatment plan relating to things such as:
- social and other support networks
- personal, family, or other intimate relationships
- living situation
- past trauma or victimization
- school or employment
- finances and insurance
- parenting (if applicable)
- legal system involvement (if applicable)
Goals of Treatment
- Prevent harm to the patient or others
- Promote healthy behaviors
- Reduce the severity of symptoms
- Determine and address what leads to acute episodes
- Form a treatment team with clinicians, family, and support network
- Create both short and long-term treatment plans
- Connect the patient with appropriate support and aftercare
- Improve the patient's level of functioning and quality of life
- Psychosocial programs and therapies, both in individual and group format, help the patient manage symptoms and develop recovery skills, such as setting and achieving goals. The choice of specific strategies will depend on a patient's unique needs and on what is available in the community.
- Medications are a complement to psychosocial treatment and an equally important part of the overall care process.
Recommended Psychosocial Treatments and Programs:
- Coordinated Specialty Care: incorporates medication, talk therapy, and other treatment into one program. Receiving these treatments together can be more helpful than receiving each treatment separately.
- Cognitive behavioral therapy for psychosis: helps the patient learn to monitor thoughts, feelings, perceptions, and behaviors and the ways they contribute to symptoms.
- Psychoeducation: provides education about the disease and its treatment as well as how to manage it.
- Supported employment services: provides job training, job support, and mental health treatment to assist in finding and keeping employment.
- Assertive community treatment: uses a team-based approach to give individualized care outside of a formal clinical setting, including home, workplace, or other locations in the community.
Suggested Programs and Therapies:
- Help and support for family members and those involved in care
- Training programs to help with attention, multi-tasking, memory, and other areas of thought that are important to daily life, also called cognitive remediation
- Social skills training programs
- Supportive psychotherapy
Treatment with Antipsychotic Medications
- Medications used for schizophrenia are called antipsychotics.
- The initial goal of treatment with an antipsychotic medication is to reduce or eliminate symptoms and allow a rapid return to the best level of functioning.
- These medications can help the patient feel calmer, clear confusion, and control other symptoms within hours or days, but can take a number of weeks to reach their full effect. Over a longer term, antipsychotics can help to prevent further episodes of psychosis.
- The patient might need to try more than one antipsychotic medication to find the right one. The good thing is that there are many different medication options to choose from. The patient and the clinician can review the other medication options that are available, discuss the possible benefits and side effects of each, and work together to find a medication that will be most effective.
- If the patient is having success with the prescribed medication, it is important to continue taking that same medication regularly as scheduled.
- Long-acting injectable medications are good options for patients who may have trouble remembering to take their medications regularly.
- The patient will be advised to keep taking antipsychotic medications even after the symptoms are controlled. If the medications are stopped too early, there is a high risk that symptoms will return. This may not happen until several months later.
- Other medications are often added to treat other mental health symptoms such as depression, anxiety, and side effects of antipsychotics.
- While taking medications, effectiveness and any potential side effects will be monitored. If a patient believes he or she is experiencing side effects, it is important that the doctor be told BEFORE stopping any prescribed medication.
Comparing Treatment Options
The choice of an antipsychotic medication depends on many factors that are specific to each patient. Before starting any medication, it is recommended that the patient discuss treatment-related preferences, any prior treatment responses, potential benefits and risks of each medication option, and other factors with the treating clinician.
- Oral Medications
- Oral medications are convenient for many people because they can be administered at home.
- Oral concentrates and rapidly dissolving tablets are also available for anyone who has difficulty swallowing pills.
- Long-acting Injections (LAI)
- LAI formulations of antipsychotic medications can provide a number of benefits for patients, families, and clinicians, yet they are often underutilized.
- LAIs are often convenient for patients since they deliver the necessary dose of medicine over time, and there are fewer opportunities to forget or miss a medication dose.
- Clozapine is usually used in patients whose symptoms are not improving with other medications and/or those who are having thoughts of hurting themselves or others.
- Clozapine treatment requires close monitoring of blood work and side effects.
Managing Side Effects
- Patients may experience side effects while taking certain medications for schizophrenia. This is normal but should be shared with the treating clinician.
- Early in the course of treatment, common side effects include weight gain, being tired or drowsy, changes in blood pressure, restlessness, dry mouth, constipation, and difficulty with urination.
- Individuals taking an antipsychotic medication may also notice one or more of the following symptoms. It is important to talk to the clinician as soon as possible if any of these symptoms occur:
- Dystonia: uncontrollable contractions of muscles
- Parkinson-like symptoms: tremor and slowed movement
- Akathisia: a feeling of restlessness
- Tardive dyskinesia: uncontrollable movements that commonly occur in the face, neck, or tongue
- Sexual effects: changes in sexual desire or sexual functioning
- Antipsychotic medications can also have metabolic side effects such as weight gain and diabetes.
- If any of these side effects are severe or disabling, the treating clinician may:
- Lower the dosage of the current medication
- Switch to a different medication
- Provide additional medications to help reduce or eliminate the side effects
Adherence (following a treatment plan)
- Adherence to medications and other psychosocial approaches can be a big factor in predicting long-term success and quality of life.
- Some common issues that may influence adherence include:
- Lack of awareness of symptoms
- Difficulties managing complex tasks
- Difficulties due to other conditions
- Understanding need for treatment
- Understanding risks and side effects
- Forgetting medication or appointments
- Financial or insurance-related barriers
- Limited local services
- Lack of support from family or significant others
- If any of these common issues are present, it is important to discuss them with the treating clinician.
- Addressing these barriers as part of the treatment plan will require active collaboration and problem-solving between a patient and their care team.