Dealing with schizophrenia-part 3

Today we will explore the various treatment options you have if you suffer from schizophrenia. These options fall under these main categories:

  • Medication
  • Electroconvulsive therapy
  • Psychotherapy

It is important to bare in mind that these treatments can only give lasting benefit alongside a good healthy and happy lifestyle. Without utilising your personal resources and seeking out appropriate moral support and making active changes to your lifestyle, not much progress can be made.

So let’s start with the basics. As mentioned in earlier blogs, a lot of healthcare professionals prefer to treat schizophrenia as a disease of the brain when evaluating treatment options. Therefore, you could say there is a bias towards prescribing medication particularly from what I have seen from the NHS in the past. So firstly lets explore the different types of medication out there…

So essentially, drugs used to treat schizophrenia are called antipsychotics and are either “typical” or “atypical”. In the beginning a high dosage of typical drugs were used in the “acute phase” to treat very severe psychotic symptoms. Following on from this, is the maintenance phase. This is where drug dosage is gradually reduced to the very minimum needed to keep the symptoms at bay during psychotic episodes and also between each incident. Generally antipsychotics work through blocking the effect of dopamine (neurotransmitter associated with pleasure) in your brain. Hence, when administering these drugs the strategy here is to prescribe medication only when deemed necessary to do so, so that the client does not overdose on these drugs and create a chemical/hormonal imbalance in themselves. At the same time, medication is never completely taken out of a patient’s treatment plan since it is believed that the major cause of relapses is stopping medication.

Examples of typical drugs include:

  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Loxapine
  • Perphenazine
  • Thioridazine
  • Thiothixene
  • Trifluoperazine

These drugs were effective in treating positive symptoms such as hallucinations and delusions; however, this came with a cost of various side effects, such as cognitive dulling (slowed thinking or perceptions). These older medications were not effective in treating negative symptoms (e.g. apathy) and therefore there was a demand for continual drug trials.

Further into the advancement of drug testing, came the atypical drugs. These included:

  • Clozapine
  • Aripiprazole lauroxil
  • Asenapine
  • Brexpiprazole (Rexulti)
  • Cariprazine (Vraylar)
  • Lurasidone (Latuda)
  • Paliperidone (InvegaInvega Sustenna, Invega Trinza)
  • Paliperidone palmitate (Invega Trinza)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal or Risperdal Consta)
  • Olanzapine (Zyprexa)
  • Ziprasidone (Geodon)

When prescribing the correct level of dosage, these drugs had fewer neurological side effects. However, these drugs (mostly clozapine) did have other side effects such as: weight gain, changes in blood sugar, changes in cholesterol and a potential decrease in white blood cells. Therefore, healthcare professionals had to exact a level of caution and also ensure they carry out routine checks to ensure physiological factors (such as blood sugar levels) were kept relatively stable. Generally with any antipsychotic drug it is recommended the patient has to take them for two to four weeks (depending on the drug) to actually verify that the drug is having a positive effect.

Bearing this in mind, it is clear that during this period the patient may seek out other treatment especially if they experience strong side effects. Electroconvulsive therapy although considered an old-fashioned method to treating mental illness, is still an option today. This involves getting general anesthesia and a drug that relaxes your muscles. Then, you get electrodes placed on your scalp. The doctor will send a small electric current through those electrodes for a short time period. This will cause a brief seizure in your brain. You’ll “wake up” minutes later, with a short episode of short-term memory loss (this usually wears off a few weeks after treatment is finished). This treatment may need to be repeated for two to three times a week for two to four weeks. Often people dismiss this treatment due to misconceptions that it is a “quick fix” and not beneficial in the long run. Although this treatment has been going on since the 1940’s, the way it is implemented now is in a more precautionary fashion. Doctors make sure you take medical examinations to assess your medical history to ensure you are suitable for this treatment. So if you or a close-relative have been through many options of treatment, I recommend you ask your doctor to test your eligibility for electroconvulsive therapy and give it a try.

Now I can begin to explain where talking therapy/psychotherapy fits into all of this. Well in order to help a person suffering from schizophrenia to cope with the symptoms and to build their self-awareness and tolerance, they need to be taught how to identify the neurotic thoughts from the more rational thoughts. Their self-awareness needs to be facilitated, so that they can accurately know and detect the source of their own hallucinations/delusions and their own trauma. Therefore, various types of psychotherapy help to build the patient’s mental and emotional capacity to progress through treatment. Achieving the right mindset as a result. Mind over matter, is the key phrase in this stage.

The different forms of psychotherapy for schizophrenia are as follows:

  • CBT (cognitive behavioural therapy)
  • Family therapy
  • Arts therapy
  • Mindfulness (with caution and if they have mental capacity)

CBT (cognitive behavioural therapy) is the most popular form of psychotherapy typically used for treating most mental illnesses. It is different from conventional counselling which essentially involves talking through your problems. CBT is more goal-orientated using SMART goals to direct a clients recovery. Clients receive “homework” to work on in between sessions. It also involves more use of diagrams such as formulation charts which show your recent thoughts, feelings, physical sensations and behaviour; whilst depicting the link between these four factors. Most people require between 8 and 20 sessions of CBT over the space of 6 to 12 months. CBT sessions usually last for about an hour. In terms of  schizophrenia a CBT session would start with collating all known symptoms (hallucinations, delusions etc). Then the next goal will be to fill in all the thoughts, behaviours and physical sensations that trigger or are triggered by these psychotic episodes. Once the client is aware of this, they can then try and replace these unwanted thoughts, feelings and behaviours with healthier alternatives gradually. Smart goals will be agreed between client and therapist to initiate these changes in a realistic and practical way. Essentially what we see here is a more logical and pragmatic approach to therapy. It focuses on problem solving, and setting goals. Some have argued CBT lacks real core empathy and can be quite mechanistic, however this depends on the exact therapist you receive.

Family therapy is very crucial because family support is needed to overcome the hardest parts of recovery. When a patient is undergoing treatment and loses motivation and needs emotional support, nothing can replace the impact that family and friends have. In order to strengthen this bond and make the most out of it, family therapy sessions are done to teach the relatives of the client how to effectively support him or her. Supporting someone with schizophrenia can also be mentally and emotionally draining for the caregiver. Therefore, it is important for these people to learn how to look after themselves before they can continue to care for their relative.

Due to the abstract nature of schizophrenia, sometimes it is hard for people who experience it, to fully express themselves in words. Therefore, this is where art therapy comes in. It offers the chance for schizophrenic individuals particularly those that experience the negative symptoms (e.g. low cognitive function and energy) to express themselves creatively. This has the added benefit of re-activating parts of their brain that may originally be low in function. It can also act as a social activity when done in a group with other people. Not all therapy should be strictly implemented. This form of therapy would be effective as a complementary activity to the conventional treatment plan (medication and CBT).

Mindfulness based therapy is not typically used for schizophrenia. However, theoretically if you adopt mindful anchors that divert your attention away from the gravity of your hallucinations onto another stimulus, this could provide an effective way to cope with psychotic episodes in between treatment periods. For example, focusing on the weight of the breath in your body to divert your attention away from the voices in your head.  It is important to bear in mind that mindfulness and meditation could potentially exaggerate some schizophrenia symptoms; since the individual becomes hyper attuned to their senses and may experience hallucinations more vividly (when attention is lost from the anchor) which may cause more suffering in the short-term. Therefore, to be on the safe-side I would recommend that mindfulness be used more for the treatment of negative symptoms (depressive symptoms) rather than positive symptoms.

Upon reviewing all the treatments I have mentioned. My conclusion is that there is no one-size fits all for treatment. What is needed to recover from schizophrenia is an open mind to try any method of treatment, a great support network of family/friends and a strong sense of self-belief. I apologise if this may not provide the closure you seek. However in my next blog, I will share my personal story which I hope will empower those with schizophrenia to never give up and to live on and prosper.

Take care,

Azeem.

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