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Medication, stress management, education and information are integral in improving the treatment of schizophrenia.
There is no reason why a person with schizophrenia could not be working and functioning as a productive member of the community. That is of course, once the acute symptoms have been treated successfully.
There are several ways to optimise the treatment of this disease. The role of family members and other loved ones should not be underestimated in improving the patient’s quality of life and the outcome of the treatment.
Role of psycho-education
As soon as the patient has responded to medication and the abnormal thoughts are under control, it’s important to start psycho-education.
The goal of psycho-education is to fully inform the patient and his or her family members about the disease and all other aspects of treatment. This information is essential for a patient to understand why he or she needs the medication and that it will have to be taken for life
Topics that should be addressed during psycho-education include:
- Recognising schizophrenia symptoms early
- Preventing recurrence of the psychotic episodes
- Highlighting the role of medication and side effects
If patients are not adequately informed about potential side effects, they may stop using the medication without consulting a psychiatrist for advice.
Unfortunately people suffering from schizophrenia often have poor insight into their own condition and may believe they are not ill and do not need to take medication. Discontinuation of medication is one of the most common reasons for relapse and reappearance of symptoms.
Family intervention
Relatives need to be well informed about the disease to improve compliance to treatment. In this way, they will understand the patient better and therefore be able and willing to help in the patient’s long-term encouragement and treatment. Family education remains one of the most effective therapies in improving long-term outcome and quality of life of people with schizophrenia.
Medication
The treatment with medication consists of antipsychotic drugs. The antipsychotic drugs initially bring the acute psychosis under control and thereafter, prevent further episodes from occurring.
Medications that have been used regularly in the past include haloperidol and chlorpromazine.
While these older medications are effective in treating the positive symptoms, they are less successful in addressing the negative symptoms. They also have undesirable side effects. These include uncontrollable movements, tremors, lethargy, blunted emotions, shuffling gait and staring eyes.
Using the correct dosage and taking the medication regularly can minimise the side effects. Additional medication can also be prescribed to offset certain side effects.
More recently however, there has been a development in so called "new generation" antipsychotic drugs. These drugs seem to be more effective in reducing social isolation and withdrawal of patients and have been proven to cause significantly fewer movement side effects than their predecessors.
They include Risperidone, Quetiapine, Olanzapine, Aripiprazole, Amisulpride, Paliperidone, Ziprasidone and Clozapine.
Although they are more expensive, this is offset by their improved efficacy, which means less hospitalisation and better functioning of the individual. There are, however, still some problematic side effects with the newer medications, including weight gain and a change in glucose and lipid metabolism.
Research continues to produce better medications with fewer side effects and researchers hope that they will be able to treat the disorder more successfully in the future.
In addition to antipsychotic drugs, people with schizophrenia can also take Omega 3 fatty acids (fish oils) as these have been shown to improve the outcome of the illness.
Outcome
Earlier treatment usually results in a better outcome. Treatment delays may worsen the condition, cause a patient to be less responsive to treatment, and increase the time it take to go into remission. The lesser the degree of remission, the greater chance of early relapse.
Although schizophrenia has received much negative media attention, it often has a favourable outcome. There have recently been major advances in the treatment of the disorder with the development of the new generation antipsychotics. This gives even more hope for a successful outcome in the treatment of schizophrenia.
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Reviewed by Dr Tasneem Mahomed, MBBCh (Wits), FC Psych (SA), Mmed (Psych) (Wits), Psychiatrist in private practice, Cape Town. (March 2015)
