The treatment goals for schizophrenia are to reduce symptoms and promote social and professional integration of the patient. It spans several years (at least five years) and includes various essential and complementary components.
The treatment of schizophrenia has evolved considerably in recent years so that people with schizophrenia can expect a satisfying life and face different challenges. Early intervention, changes in medication, and rehabilitation programs help to maintain the person’s functional abilities and prevent a worsening of symptoms or the disease itself.
Despite their urgent need for help, many sufferers refuse to collaborate because they fear being rejected, stigmatized and suffer from a lack of self-criticism, a symptom inherent in the disease that prevents them from recognizing that ‘They are sick.
Based on inseparable principles, the bio-psycho-social approach in the treatment of schizophrenia involves various therapeutic modalities. Those new treatment goals for schizophrenia allow the person affected not only to become functional but also to find a life rewarding, both personally and socially.
Establishing an alliance between the person and his treatment team is essential, but can take time. It is important for stakeholders to be flexible in their approach and responsive to the needs of the client.
*** The Modalities of the Bio-Psycho-Social Approach
– Taking antipsychotic medication, a major element;
– Psychological and social therapies. For example, cognitive therapies or psycho-educational approaches that include, among other things, information about the illness, symptom management, medication, and relapse;
– Social rehabilitation to develop or maintain skills and abilities;
– Reintegration, for example, integration programs at work and studies.
*** Early Intervention Is the Best Way to Recover
Early detection of the disease, accompanied by adequate treatment, promotes a better prognosis. The period of 2 to 5 years following a first psychosis is decisive in the evolution of the disease. During this time, intensive rehabilitation services, often offered by specialized clinics (for example, clinics of early psychotic episodes) or support organizations, are essential.
Early treatment allows:
– Decrease the severity of the disease;
– Maximize the quality of life of people with cancer and their loved ones;
– Avoid self-stigma, depreciation or guilt; maintain hope;
– Avoid a prolonged interruption of school, professional or other activities;
– Establish a relationship of trust with the care team and reduce calls for legal remedies;
– shorten the duration of treatments;
– Reduce the risk of legal problems, drug use, depression, and suicide.
Patients and their relatives are often worried about treatment with neuroleptics and wonder if the drugs will not “knock out” the patient. Of course, this isn’t the treatment goal for schizophrenia. Neuroleptics, when prescribed at a dosage appropriate to the patient, do not deprive schizophrenics of their personality or decision-making ability. Although they may have sedative effects (soothing, these effects are often sought at the beginning of treatment), they act by reducing the frequency of delusions and allowing the patient to have a more logical and better-organized thought. Neuroleptics help the schizophrenic person to act rationally and communicate better with the outside world. They are not addictive and can be taken for years.
Note: In case of pregnancy or breastfeeding – The use of certain neuroleptics is possible in case of pregnancy. It is done according to the ratio between the expected benefits and the risks incurred. The medical supervision of the future mother is then increased. In the absence of scientific data on the passage of neuroleptics in breast milk, it is not recommended to breastfeed when taking this type of medication.
*** The Different Antipsychotics Used in Schizophrenia
The drugs used against schizophrenia and psychoses are antipsychotic drugs. The first ones that were developed in the fifties are part of the family of so-called classical neuroleptics. They would basically have an action on one of the brain’s chemical messengers, dopamine. They are mostly active against so-called positive symptoms of schizophrenia, such as delusions or hallucinations, and often result in many adverse effects, some of which are disabling.
More recently, new neuroleptics have appeared. These so-called atypical neuroleptics act simultaneously on two chemical messengers of the brain (neurotransmitters), serotonin and dopamine. They show greater efficacy on the negative symptoms of the disease (demotivation, mood disorders, apathy) than so-called conventional antipsychotics.
Atypical antipsychotics containing clozapine (Leponex and its generics) are likely to cause a significant decrease in the number of white blood cells in the blood (agranulocytosis, a decrease in immune defenses). They are reserved for patients whose disease has resisted other treatments or does not tolerate their side effects. In addition, blood tests should be taken regularly during treatment with clozapine. Each month, the pharmacist will only deliver the treatment after checking the recent blood test results on a logbook.
Beyond the distinction between classics on the one hand and atypical, on the other hand, neuroleptics can be classified according to their effects. They can have:
– a sedative action that relieves anxiety and agitation;
– a so-called anti-productive action that treats delusions and hallucinations;
– a disinhibitory action that combats apathy and demotivation.
Some neuroleptics produce essentially one of these effects, but these three types of action can be found for the same substance depending on the dose used: low dose disinhibition, medium-dose anti-production, high dose sedation.
*** Precaution and Good Use of Drugs Against Schizophrenia
Before the implementation of neuroleptic treatment, it is necessary to practice additional tests to avoid certain complications. Except in the case of acute psychosis, treatment with a neuroleptic is implemented gradually. Each patient responds differently to these substances and it takes time to identify the lowest effective dose that will cause the least adverse effects in the long term. During this period of adjustment, the support of the entourage is important. The associations of several neuroleptics are rare and reserved for cases most resistant to treatment.
Neuroleptics should be taken preferably during meals to avoid certain digestive disorders, including nausea. When taking a neuroleptic, you should never drink alcohol. The combined effects of these two substances can lead to serious behavioral problems. Driving a vehicle or using potentially dangerous tools is strongly discouraged throughout the treatment. The risks of interactions between neuroleptics and other drugs (anxiolytics, hypnotics, allergy or high blood pressure medications, certain treatments for Parkinson’s disease and erectile dysfunction, etc.) are important. It is essential to report taking neuroleptics to your pharmacist and any new doctor consulted.
In people treated with neuroleptics, the appearance of an unexplained fever (temperature above 38 ° C) requires an emergency medical consultation. These substances can indeed cause a very serious adverse effect that appears gradually, the malignant syndrome.
Drugs in the family of neuroleptics may also be responsible for abnormal movements called dyskinesias. This phenomenon can occur in the first days of treatment (early dyskinesia) or after several months (tardive dyskinesia). Late dyskinesia is also observed when stopping long-term treatment (withdrawal reactions).
*** Adverse Effects of Antipsychotics
Antipsychotics, and in particular those known as classic, have many adverse effects: constipation, drowsiness (more marked at the beginning of treatment), accommodation problems, blurred vision, dry mouth, orthostatic hypotension, retention of urine, irregularity of the rules, sexual disorders, neurological disorders such as abnormal movements, tremors, muscular stiffness. Some of these effects sometimes need to be corrected by other drugs.
A particular side effect, tardive dyskinesia, occurs during long-term treatments. It is manifested by involuntary movements of the mouth, lips, tongue (chewing), arms or legs. It appears in 15 to 20% of patients treated for several years with so-called conventional antipsychotics.
A frequent problem with antipsychotic medication is the appearance of overweight (especially at the abdomen) associated with high blood levels of sugar, cholesterol, and triglycerides (blood fats). For this reason, it is important that treated patients be followed by a general practitioner, endocrinologist or nutritionist who will prescribe regular blood tests and give advice for a balanced diet.
In addition to these undesirable effects, these are extremely rare events that constitute medical emergencies:
– The malignant syndrome which results in high fever, sweating, disturbances of consciousness, excessive salivation, etc.
– Agranulocytosis, which is characterized by a drop in white blood cells, a sore throat, canker sores or an abnormal fever.
When taking antipsychotic medication, this type of symptoms requires emergency medical consultation.
Treatment includes medication and therapy. The treatment is usually for life and involves a combination of drugs, psychotherapy, and coordinated specialty care services.
*** The Drugs for the Treatment of Schizophrenia Are of Types:
– Neuroleptic: Attenuates or improves the symptoms of certain psychiatric disorders.
– Anti-shake: Helps control tremors and instability.
*** For Treatment with Therapies, We Have:
– Speech group: Forum of advice and sharing of experiences between people with a similar illness or goal, such as depression or weight loss.
– Neuropsychological rehabilitation: Re-learning neural pathways to improve mental and physical functioning after illness or injury, for example after a stroke on the head (concussion).
– Cognitive Therapy: Speech-based therapy focuses on the desire to replace erroneous and negative thoughts with real, positive thoughts.
– Psychoeducation: Mental health education that also helps to support, comfort and value patients.
– Family Therapy: Psychological support that helps families resolve their conflicts and communicate more effectively.
– Behavioral Therapy: A therapy focused on modifying the dangerous behaviors associated with psychological distress.
– Group therapy: Speech therapy where the therapist views patients in groups rather than individually.
*** For the Treatment of Ka Schizophrenia, We Have the Following Specialists:
– Psychiatrist: Treatment of mental disorders, mainly with drugs.
– Clinical Psychologist: Treatment of mental disorders, mainly through speech therapy.