Schizophrenia - Treatment
If there's a risk of future acute episodes, you may want to write an advance statement. This is instructions about what you would like your family or friends to do if you have another episode. You may also want to include contact details for your care coordinator.
Community mental health teams
Most people with schizophrenia are treated by community mental health teams.
The team provides day-to-day support and treatment. They will also try to ensure you have as much independence as possible.
The team can have:
- social workers
- community mental health nurses – who have specialist training in mental health conditions
- occupational therapists
- counsellors and psychotherapists
- psychologists and psychiatrists
Care plan approach (CPA)
You may have complex mental health conditions. If so, you will usually get treatment with the community mental health team.
A care plan is a way of making sure you receive the right treatment for your needs.
You'll work together with your healthcare team to develop a care plan. The care plan may involve a crisis plan. This is for an emergency.
Your care plan should include a healthy eating and physical activity programme. If you smoke, you should also get support to quit.
Your care coordinator will make sure all members of your healthcare team have a copy of your care plan.
People who have serious psychotic symptoms may need a more intensive level of care.
These episodes are usually dealt with by antipsychotic medication and special care.
Antipsychotics are usually recommended as the first treatment for an acute schizophrenic episode. They work by blocking the effect of the chemical dopamine on the brain.
They can usually reduce feelings of anxiety or aggression within a few hours of use. They may take several days or weeks to reduce other symptoms. For example, hallucinations or delusional thoughts.
Your doctor should give you a physical examination before you start antipsychotics. You should talk to your psychiatrist to find the right antipsychotic for you.
You can take antipsychotics orally, or they can be given to you as a slow-release injection. This is a depot. Several slow-release antipsychotics are available. With these, you only need one injection every 2 to 4 weeks.
Most people take medication for 1 or 2 years after their first psychotic episode. This is to prevent further acute schizophrenic episodes occurring. They can take medication for longer if the illness returns.
There are 2 main types of antipsychotics:
- typical antipsychotics – the first generation of antipsychotics developed in the 1950s
- atypical antipsychotics – newer-generation antipsychotics developed in the 1990s
You and your psychiatrist should discuss the best antipsychotic for you. They can tell you about the likely benefits and side effects.
Both typical and atypical antipsychotics can cause side effects. But not everyone will experience them, and the severity will differ from person to person.
The side effects of typical antipsychotics include:
- muscle twitches
- muscle spasms
Side effects of both typical and atypical antipsychotics include:
- weight gain, particularly with some atypical antipsychotics
- blurred vision
- lack of sex drive
- dry mouth
Tell your care coordinator, psychiatrist or GP if your side effects become severe. There may be an alternative antipsychotic you can take. There may also be other medicines that will help you deal with the side effects.
If one antipsychotic medication is not working for you, you can try a different one. It's important to work with your treatment team to find the right one for you.
Don't stop taking antipsychotics without consulting your care coordinator, psychiatrist or GP. If you stop taking them, you could have a relapse of symptoms. They will review your medication at least once a year.
Psychological treatment can help you cope with the symptoms. For example, hallucinations or delusions.
They can also help treat some of the negative symptoms of schizophrenia. For example, apathy or a lack of enjoyment.
Psychological treatments for schizophrenia work best when they're combined with antipsychotic medication.
Common psychological treatments include:
- cognitive behavioural therapy (CBT)
- behaviour family therapy
- compassion focused therapy
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) helps you manage problems by thinking more positively. It frees you from unhelpful patterns of behaviour.
Behaviour family therapy
Many people with schizophrenia rely on family members for their care and support. Most are happy to help, but caring for somebody with schizophrenia can put a strain on a family.
Family therapy is a way of helping you and your family cope better with your condition. It involves a series of informal meetings over a period of around 6 months.
Meetings may include:
- discussing information about schizophrenia
- exploring ways of supporting somebody with schizophrenia
- deciding how to solve practical problems caused by symptoms of schizophrenia
Talk to your care coordinator or GP about family therapy, if you think it would be helpful.
In certain circumstances, you may have to be admitted to hospital against your will. This is an ‘involuntary admission.’