Schizophrenia Treatments: Medication & Therapy

Is Schizophrenia Treatable?

Schizophrenia and related mental illnesses may be more common than you realize. About one in 100 people will be diagnosed with schizophrenia in their lifetime. The idea that there are treatments for schizophrenia can be a novel and even difficult concept for some individuals to understand due to the stigma surrounding mental health, and in particular schizophrenia. Because there is so much stigma surrounding schizophrenia, sometimes the more common message is that schizophrenia is not treatable. This is completely false. People with schizophrenia deserve fulfilling and joyful lives just like everybody else, and proper mental health treatment can help support that.

Starting treatment as early as possible is important. The sooner a person begins treatment after being diagnosed with schizophrenia, the better their outcomes are likely to be. Entering into treatment early can improve the likelihood of full remission for some people.¹

In order to start treatment, one must first be diagnosed through a psychiatrist, psychologist, or another medical or mental health provider with an appropriate credential to diagnose mental health conditions.(these can vary by state and country).² If an early intervention program is available, a referral to one of these may be a helpful next step to receive all related care in one location focused on schizophrenia-related concerns.

Antipsychotic Medications for Treating Schizophrenia

Medications are one of the most common and vital treatment options for individuals with schizophrenia. The American Psychiatric Association recommends antipsychotic medications as a first-line intervention for people with schizophrenia.² These medications can be taken either as a pill or as an injection (called a long-acting injectable or LAI).

Antipsychotic medications tend to work best for positive symptoms (hallucinations, delusions, disorganized speech), but people also see improvements in negative symptoms (apathy, flat affect, lack of motivation) as well as improvements in the ability to experience and express emotions; depression; quality of life; and social functioning.³ All antipsychotic medications have some side effects, and as a result, it is best to discuss medications and their side effects profile during the initial treatment consultation. It is also important to take note of any side effects and communicate these with the prescribing clinician.

The most recent review of evidence regarding antipsychotic medications indicates that one medication is not significantly better than another medication, but rather medications should be tailored to the individuals in terms of their presenting symptoms, and the presence of other medical conditions. You may need to try multiple medications until you find the best fit with the least amount of side effects.  Communicating with your doctor about your symptoms and side effects will help you find a medication or combination of medications that works best for you.

Typical Antipsychotics

Typical antipsychotic medications, or first-generation antipsychotic medications, were the first major type of medication to treat psychotic symptoms such as hallucinations and delusions (positive symptoms). They combine D2 blockade with anticholinergic and antihistamine mechanisms and have been found to be effective in treating positive symptoms.⁵

Despite their efficacy, antipsychotics are associated with cognitive side effects because of their anticholinergic and antihistamine pathways. These impacts include increased difficulties with thinking, speaking, and problem-solving, symptoms that are already present in many individuals with schizophrenia..⁴ Typical antipsychotic medications may also lead to extrapyramidal side effects or tardive dyskinesia, which are two types of involuntary bodily movements. Sometimes these side effects can be managed by additional medications ².

Examples of typical antipsychotic medications include:

• Chlorpromazine: one of the oldest antipsychotic medications. It is also sometimes used as a sedative or in hospital settings to calm anxious or agitated patients.
• Fluphenazine: typical antipsychotic that is available as a pill or long acting injection..
• Haloperidol: one of the oldest antipsychotic medications. It is also sometimes used as a sedative or in hospital settings to calm anxious or agitated patients.
• Perphenazine: typical antipsychotic.

Atypical Antipsychotics

Atypical antipsychotic medications, or second-generation antipsychotic medications, were developed in an effort to reduce unwanted extrapyramidal and cognitive side effects. They are different in their chemistry from typical antipsychotic medications, because they rely on a somewhat different D2 blockade with a serotonergic blockage.⁵

These medications are also effective in their ability to reduce hallucinations, delusions, and other symptoms of schizophrenia.³ Because of the different mechanisms they use, they do not tend to have cognitive side effects and may even improve cognitive functioning.⁵ However, they do have other notable side effects–most commonly, weight gain and metabolic disorders including diabetes. Extrapyramidal side effects or tardive dyskinesia are still possible, but significantly less likely.

Examples of atypical antipsychotic medications include:

• Aripiprazole: can be used on its own, and is sometimes also used to supplement antidepressant medications for people with depression or combined mood and psychotic disorders.
• Asenapine: somewhat less likely to cause weight gain and metabolic disorders than some other atypical antipsychotic medications.
• Olanzapine: somewhat more likely to cause weight gain, metabolic disorders, and diabetes than some other atypical antipsychotic medications.
• Quetiapine: somewhat less likely to cause weight gain and metabolic disorders than some other atypical antipsychotic medications.
• Risperidone: common atypical antipsychotic that can be used similarly to aripiprazole.
• Ziprasidone: somewhat less likely to cause weight gain and metabolic disorders than some other atypical antipsychotic medications.

Clozapine

Clozapine is also an atypical antipsychotic. The American Psychiatric Association recommends clozapine only when people have not experienced symptom improvements on other antipsychotic medications. This is especially true for people who continue to experience significant risk of suicide or aggression.²  is particularly effective, but it’s also associated with a great risk of a range of side effects compared to other antipsychotics.² Typically, this means that if a person is prescribed clozapine, they will require closer monitoring.

Long-Acting Antipsychotic Injectables

Several typical and atypical antipsychotics can be taken as long-acting injectables or LAIs.² These are injections that are given sometime between once a month and once every four months. People on LAIs come into a clinic to receive their LAI from their doctor, nurse, or another provider. These can be helpful for people who have trouble remembering to take their medication on a daily basis. This ensures that they continue to receive the benefit of their medication consistently. Research has shown that people on LAIs tend to receive more benefit than those on pill versions of the same medication, probably because they get a more consistent dose.

Therapy Options for Schizophrenia

Individual and group therapy is an important part of treatment for most people with schizophrenia. There are a range of therapeutic options that target hallucinations and delusions, as well as other issues people with schizophrenia face like mood symptoms, cognitive symptoms, and social functioning.⁶

One of the most meaningful aspects of therapy is that each person can set their own treatment goals based on their individual values, and cultural practices. That means that two people can have the same diagnosis of schizophrenia, but have different treatment goals; one might be focused on improving their social relationships and feelings of belonging in their chosen community, while the other might be focused on reducing hallucinations and paranoia.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) has been specifically tailored to people with schizophrenia. This approach is most typically called CBT for Psychosis or CBTp, and can be provided individually or in a group format. CBTp uses the same overall structure and goals of CBT, and focuses on symptoms of schizophrenia, particularly hallucinations and delusions. Recent efforts to use CBTp to target negative symptoms have also been effective, too.⁶

Cognitive Rehabilitation

Cognitive rehabilitation therapies help support people who have difficulties with different aspects of thinking, including memory, attention, auditory processing, problem-solving, and social communication. These therapies can be done with a therapist like other kinds of therapies, but might also be done using computer games or virtual reality components. Cognitive rehabilitation tends to be most helpful when combined with other therapies, like CBT or supported education and employment .

Psychosocial Therapies

Effectively treating schizophrenia often includes engaging in psychosocial therapies beyond what people most often think of as traditional mental health care. These therapies might be in groups with other people with similar diagnoses, or they might be provided by peer support workers or in non-traditional settings (like out in the community or in your home). These approaches can help make sure that your care works towards all of your recovery goals–from your symptoms to your relationships, or from staying out of the hospital to engaging in important hobbies or spiritual activities. Combining a set of therapies helps people with schizophrenia gain support on all the things that are important to them.

Social Skills Training

Some people with schizophrenia have difficulty with social interactions, such as feeling confident getting their needs met with family, friends, romantic relationships, at work, and at school. Social Skills Training (SST) is a group intervention that helps people gain general and specific skills related to those needs.

Group Therapy

Aside from Social Skills Training, there are many other group therapies available to people with schizophrenia. For example, Illness Management and Recovery (IMR) helps people understand their symptoms, and identify coping skills that work for them. Wellness and Recovery Action Planning (WRAP) helps clients create a very detailed WRAP plan to identify potential triggers for symptom relapse and take action to prevent this, as well as continue their recovery through positive action.

Family Therapy

Having family support is important for many people with schizophrenia, but lots of families aren’t sure how to help. Many people don’t know much about schizophrenia before their loved one is diagnosed, beyond the stigmatizing (and inaccurate) things they see in the media. Family therapy provides helpful education about what schizophrenia is, what their loved one specifically is going through, and identifies specific ways for the family to support their loved one.

Peer Support

Peers are people with lived experience of a given mental health concern. In this case, a peer would be someone who has or has had schizophrenia or a related mental illness (like schizoaffective disorder). Peers work in many different capacities, and can provide individual support, facilitate different types of group therapies, share their recovery journeys, and work with you in the community to support your recovery. Peers can be helpful, because they have been in similar shoes to yours, and have expertise in the mental health system from both sides.

Supported Employment and Education

Engaging in structured activity that is meaningful to you can help with quality of life and recovery. For some, that activity is work and/or school. Some folks with schizophrenia need additional support or accommodations in order to work or go to school. Supported employment and education provides that additional support and accommodation. One evidence-based approach is called Individual Placement and Support (IPS), where people are placed into the kinds of jobs they most want, and provided day-to-day support and accommodation to help them succeed.

Support Groups

Connecting with other people who have schizophrenia or similar symptoms can be really helpful. One option for these groups is the Hearing Voices Network, a group that views their voices outside of an illness framework. This can help people who see their own voices as something positive or meaningful, or would like to hear from others who understand their voices that way. The National Alliance for the Mentally Ill (NAMI) also has support groups that can help create community and connection.

Medical Procedures

For people who don’t experience significant enough benefits from medications or therapy, ECT and TMS can sometimes be helpful.

ECT

ECT, or electroconvulsive therapy, uses brief electrical stimulations of the brain while a patient is under anesthesia. Usually, patients receive two or three treatments per week for eight weeks. Patients may do ECT on an outpatient basis, or stay in the hospital during the treatment period. ECT tends to be most helpful when used in combination with antipsychotic medication. ECT is tagreted for  people with schizophrenia who have not responded well to medication and therapy alone; have not been able to tolerate antipsychotic medications at all; those with catatonic schizophrenic symptoms; and those at risk of suicide, among others.⁷ However, ECT does have side effects including increased rates of headache and memory impairment, so it’s important to weigh the benefits and risks of this intensive treatment.³

TMS

TMS, or transmagnetic stimulation, is a similar medical treatment that uses a magnetic field to stimulate electric currents in specific parts of the brain. Evidence for TMS is still in process. There is some evidence that TMS improves hallucinations and negative symptoms (like low motivation and difficulty feeling or expressing emotions), but more research needs to be done in order to fully understand this treatment procedure. The techniques behind how TMS is performed varies widely across different studies and practicing clinics. As a result, the American Psychiatric Association does not yet include TMS in its formal recommendations.² Research is ongoing, and it is available in some clinics after discussing the specific benefits and side effects with your treatment team.

Hospitalization for Schizophrenia

Sometimes people with schizophrenia are hospitalized due to their symptoms. This might be for a short time (two or three days), or it could be a longer period (weeks or months). Hospitalization could be a choice you make if you feel unsafe and would like support keeping yourself or others safe. Hospitalization can also occur if your provider believes you are at imminent risk of harm to yourself or another person.

In inpatient treatment (hospitalization), there are often group therapy and other activities offered, and you might have the option to meet with a therapist individually. You should also have access to medication, and might be able to consider other options like ECT during inpatient treatment.

How to Find Treatment for Schizophrenia

For most people with schizophrenia, finding providers who have specialized expertise or training will be helpful to ensure you get the best possible care. Sometimes these providers will be at specialty programs, but they may also be in private practice or other clinics. It’s okay to try more than one provider or clinic as you look for someone that makes you feel comfortable and understands your needs, goals, and values.

Specialty Programs for Schizophrenia

For people experiencing their first episode of psychosis, as well as for other people who have only been experiencing symptoms for a few months to a year, there are coordinated specialty care (CSC) clinics for first episode and early intervention for schizophrenia. These programs usually package psychiatric treatment, individual therapy, family therapy, supported education and employment, and peer support into one coordinated program to help you get the care you need. For people who have been experiencing symptoms longer, psychiatric rehabilitation and psychosocial rehabilitation programs also provide a combination of services like psychiatry, individual, group and family therapy, peer support, and supported education and employment to help you work towards your recovery goals.

For those who would benefit from support in their homes rather than at a clinic, assertive community treatment programs and other intensive case management programs can help. Typically, these programs can provide services like a case manager or social worker who visits your home between twice a week and twice a month, and might bring you medication refills; take you to appointments or help you run errands; and support you in the community. These programs may also include other services like psychiatry and peer support.

How to Prepare for a First Appointment

It’s understandable if you feel worried or anxious about going to your doctor about schizophrenia symptoms. If you’d like, you can bring along a family member or friend to help support you.

Your doctor may have many questions for you. One option is to write down the questions and concerns you want to make sure are addressed during your appointment, along with your primary symptoms, current medications, most important medical and mental health history, and anything else you think might be important. This can help you remember, and if you’d like, you can have a copy to give to your doctor.

Some questions you might want to ask your doctor include:

• What could possibly be causing these symptoms?
• What kind of diagnostic assessment or evaluation could be done?
• What kind of resources or materials do they recommend or are available to learn more?
• What medication options are there? What are the pros and cons of the different options? How likely am I to benefit from these options?
• What non-medication options are there? What are the pros and cons of the different options? How likely am I to benefit from these options?
• Why does the doctor recommend a particular treatment or test?
• Is there a specialty program or provider available?
• Are there support groups available?

8 Ways to Cope With Schizophrenia Symptoms

There is no “one size fits all” coping mechanism that works for everyone. Individual symptoms are specific to the individual and as a result, there are a vast array of healthy coping tools that may work differently for each person. The same healthy living strategies that help with other mental health and physical health issues can also help with symptoms of schizophrenia.

Here are eight ways to help manage symptoms of schizophrenia:

1. Maintaining a consistent sleep schedule of about 7-9 hours per night (talk to your doctor if this is hard for you)
2. Eat regularly, including a combination of carbohydrates, fats, and protein in your diet
3. Drink enough water
4. Include physical activity in your daily routine
5. Monitor your alcohol and substance use, and consider reducing if needed, especially if it interacts with your medications or negatively impacts your life or health
6. Include social interactions that makes you feel good in your routine
7. Include activities that are meaningful and enjoyable
8. Take care of your basic physical needs (brushing teeth, washing face and body)

Although these activities are not “cures,” it’s really hard to feel good or interested in your recovery journey when you are exhausted, hungry, and haven’t had an enjoyable interaction with another person in weeks or months. Taking care of some of these “basics” can go a long way to helping make it easier to have the energy and motivation to engage in other aspects of your treatment plan.

Final Thoughts

It can be overwhelming and even scary to realize you might be experiencing symptoms of schizophrenia. Treatment that helps improve your symptoms is possible. Talking to people about what’s going on can be hard, but finding a provider, support group, and program you trust can make a world of difference. Start with just one step–whether it’s an appointment with your current provider to get a diagnosis, looking for a specialty program, or connecting with a support group. You are not alone.