What is schizophrenia?

Schizophrenia is a psychotic disorder that affects 0.6% - 1.9% of adults in the United States [11]. It can severely impact overall functioning, quality of life, [10] verbal communication, behaviors, emotions, social skills, and daily living. [1]

Symptoms of schizophrenia include hallucinations; the most common type is auditory hallucinations [1](when someone hears voices or sounds that are not there). Other symptoms include delusions, formal thought disorders, "poverty of speech" (refers to someone who speaks very little and needs to be prompted to speak), anhedonia (inability to find enjoyment in anything), and lack of motivation. [11]

So, is schizophrenia curable?

Schizophrenia is a complex psychotic disorder with a wide range of symptoms. Although there is no known cure for schizophrenia, research is ongoing. New antipsychotic drugs are being investigated with promising preliminary results. [11]Antipsychotic medications are critical therapeutic elements that can help you manage your symptoms, and most people can see improvements and live a more fulfilling life.

The ultimate goals for treatment are to reduce symptoms and increase social functioning (ability to maintain social relationships), cognitive functioning, and quality of life (e.g., happiness, ability to live independently or with less help from others). 

Although It is not typical and not well understood, some people (around 20%) [17] reach functional recovery. Functional recovery includes symptom remission (lack of symptoms), return to everyday independent living, social and occupational functioning, and improved quality of life for more than two years. [17]

How is schizophrenia treated?

Schizophrenia is associated with an increase in dopamine activity in the brain. Dopamine is a neurotransmitter produced by the brain that plays multiple roles in the body, including motor control, motivation, and cognitive functioning. [2] 

Medications used to treat schizophrenia lower dopamine levels, and they are referred to as first and second-generation antipsychotics. [2] Most patients need to take antipsychotic medications for life. [16]

Treatment typically consists of medication and therapy. One therapeutic modality that may be beneficial is cognitive behavioral therapy (CBT). Your primary care health provider, psychiatrists, and social services workers will collaborate with you and those close to you to create a treatment plan that is best for you based on your symptoms. [2]

Medications

The effectiveness of medications can vary from person to person. What works for one person may not work for another, and some medicines may be more effective for certain symptoms or a particular symptom's severity.

Schizophrenia symptoms are classified into two groups – positive symptoms and negative symptoms. [18]Positive symptoms are not beneficial; in fact, this term refers to schizophrenia symptoms that those without the mental health condition do not have. [18] Negative symptoms refer to an action that someone without schizophrenia has but that someone with schizophrenia is unable to do. [18] For instance, positive symptoms include hallucinations and delusions, whereas negative symptoms include lack of motivation and emotional expression. 

First-generation antipsychotic (typical) drugs decrease the risk of recurrent psychosis and control positive symptoms better than atypical antipsychotic drugs. [4] Second-generation antipsychotic medications (atypical) are the first line of treatment (SGA)[16] due to decreased risk of extrapyramidal effects compared to first-generation antipsychotics. Atypical antipsychotics can treat both positive and negative symptoms of schizophrenia, and they have a history of lowering relapse rates. [14]

Extrapyramidal side effects (EPS) are one of the more severe side effects of antipsychotic drugs and refer to a group of movement disorders with a long list of symptoms. EPS symptoms are severe and interfere with social functioning and daily living. Some symptoms include involuntary muscle contractions or tremors, slow motor skills, and problems talking and walking.[5]Less serious side effects of antipsychotic medications include weight gain, dry mouth, and sexual dysfunction.

Typical and atypical antipsychotics (except clozapine) can treat sudden and severe episodes of psychosis and offer long-term maintenance therapy. [4] Second-generation antipsychotic drugs may occasionally be used in conjunction with benzodiazepines, if necessary, which can help control anxiety and behavioral problems. [16] 

If there has been a poor response to at least two different antipsychotics, clozapine is prescribed to address treatment resistance. Due to the risk of agranulocytosis, clozapine requires initial weekly blood tests for six months, biweekly blood tests for six months, and then every four weeks thereafter to monitor white blood cell count. [15] Patients should be monitored for constipation and promptly treated because clozapine can cause a severe bowel problem that may require hospitalization and can be fatal. [6]

Electroconvulsive Therapy (ECT) 

Electroconvulsive Therapy (ECT) may be recommended when immediate results are needed, such as when someone is highly suicidal. [14]

Alternative Treatments 

  • Phytochemicals found in some plants and flowers show promise. They may lead to new protective treatments, but more research is necessary. [13]
  • Aromatherapy and aroma massage help relievedepression. [13]
  • Acupuncture activates different regions of the brain that controlsemotions. [13]

Lifestyle changes and self-management

  • Diet: A healthy diet is vital to general health, but research also shows that diet and supplements may be one component of treatment for schizophrenia. Certain vitamins and minerals, such as folic acid, vitamins C, E, and B (B12 and B6), may help relieve positive and negative symptoms, and vitamin D may help improve daily living. [7] 
  • Exercise: Regular aerobic exercise can help maintain better overall health and improve our thinking and feeling. A three-month study found that exercise increased the parts of the brain responsible for learning and memory (hippocampus) by 12% compared to the non-exercise control group, which showed no improvement. [9]
  • Yoga:Yoga helps with the practice of mindfulness, encourages the production of oxytocin (a feel-good hormone), and reduces stress and anxiety. Yoga treats positive and negative symptoms more effectively than antipsychotic medication alone. [7]
  • Sleep: Sleep plays vital functions for the central nervous system, including mood and cognitive functions [8](learning, comprehension, memory, recall). Sleep problems are common in people who experience delusions, hallucinations, and paranoia. [8] Establishing a healthy sleep schedule can improve symptoms and quality of life for those with schizophrenia. 

Psychosocial and Psychological Therapies 

Studies show that family interventions, family psychoeducation, and cognitive behavior therapy (CBT) are often the most effective forms of therapy. They are associated with relapse prevention, a reduction of symptoms, and better medication and therapy compliance. [3]

  • Cognitive behavioral therapy (CBT): CBT is effective in reducing relapse and improving many positive and negative symptoms, overall symptoms, medical plan adherence, and general functioning. [3] Some research has shown that CBT can reduce recurring symptoms. [12] CBT uses a collaborative goal approach with the patient and focuses on improving the patient’s current coping strategies and working to create and practice new strategies. CBT also words toward helping patients improve negative self-image. [3] 
  • Family interventions:This involves the patient's family members and can focus on multiple goals, such as developing an alliance with family members who care for the person with schizophrenia, improving the family's ability to anticipate and solve issues, helping the family learn what expectations are reasonable for their loved one's performance, and attainment of desired changes in family member's behavior and belief systems. [3]
  • Family psychoeducation: Family psychoeducation focuses on educating the patient's family on schizophrenia, its symptoms, medications, psychosocial treatments, relapse prevention, and the role family plays in managing their loved one’s mental health condition. [3] 

Studies show that family members or relatives who are hostile or highly critical toward a person with schizophrenia can significantly impact their emotional health, well-being, and relapse rates. [12]

One study showed that unmedicated people with schizophrenia who were around hostile family members had a 92% relapse rate over nine months, and medicated people with schizophrenia who spent time around hostile family members had a 53% relapse rate. Unmedicated schizophrenic patients with less contact with hostile family members showed much lower relapse rates (15%). [12] This demonstrates that the environment has an effect on wellbeing for individuals who live with schizophrenia. 

In summary, there isn’t an established cure for schizophrenia, but effective treatment, combined with family support, can reduce the impact of symptoms on daily life and help a person to function more independently.

Resources:

  1. American Psychiatric Association. (2013). Schizophrenia. In Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  2. Bhatia, A., Lenchner, J.R., & Saadabadi, A. (2022). Biochemistry, dopamine receptors. NCBI. Retrieved December 27, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK538242/
  3. Bighelli, I., Rodolico, A., García-Mieres, H., Pitschel-Walz, G., Hansen, W. P., Schneider-Thoma, J., Siafis, S., Wu, H., Wang, D., Salanti, G., Furukawa, T. A., Barbui, C., & Leucht, S. (2021). Psychosocial and psychological interventions for relapse prevention in schizophrenia: A systematic review and network meta-analysis. The Lancet. Psychiatry, 8(11), 969–980. https://doi.org/10.1016/S2215-0366(21)00243-1
  4. Chokhawala, K., & Stevens, L. (2022). Antipsychotic medications. NCBI. Retrieved December 27, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK519503/
  5. D’Souza, R.S., & Hooten, W.M.(2022). Extrapyramidal symptoms. NCBI. Retrieved December 27, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK534115
  6. U.S. Food and Drug Administration. (2022). FDA strengthens warning that untreated constipation caused by schizophrenia medicine clozapine (Clozaril) can lead to serious bowel problems. Retrieved December 27, 2022 from https://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-strengthens-warning-untreated-constipation-caused-schizophrenia-medicine-clozapine-clozaril-can
  7. Ganguly, P., Soliman, A., & Moustafa, A. A. (2018). Holistic management of schizophrenia symptoms using pharmacological and non-pharmacological treatment. Frontiers in Public Health, 6, 166. https://doi.org/10.3389/fpubh.2018.00166
  8. Gica, Ş., & Selvı, Y. (2021). Sleep interventions in the treatment of schizophrenia and bipolar disorder. Noro psikiyatri arsivi, 58(Suppl 1), S53–S60. https://doi.org/10.29399/npa.27467
  9. Girdler, S. J., Confino, J. E., & Woesner, M. E. (2019). Exercise as a treatment for schizophrenia: A review. Psychopharmacology Bulletin, 49(1), 56–69.
  10. Gutiérrez-Rojas, L., González-Domenech, P.J., Junquera, G., Halverson, T.F., & Lahera, G. (2021). Functioning and happiness in people with schizophrenia: Analyzing the role of cognitive impairment. Int J Environ Res Public Health,18(14), 7706. doi: 10.3390/ijerph18147706. PMID: 34300155; PMCID: PMC8303973.
  11. Hany, M., Rehman, B., Azhar, Y., et al. (2022). Schizophrenia. NCBI. Retrieved December 27, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK539864/
  12. Haddock, G., & Lewis, S. (1996). New psychological treatments in schizophrenia. Advances in Psychiatric Treatment, 2(3), 110-116. doi:10.1192/apt.2.3.110
  13. Saleem, A., Qurat-Ul-Ain, & Akhtar, M. F. (2022). Alternative therapy of psychosis: Potential phytochemicals and drug targets in the management of schizophrenia. Frontiers in Pharmacology, 13, 895668. https://doi.org/10.3389/fphar.2022.895668
  14. Salik I., & Marwaha, R. (2022). Electroconvulsive therapy. NCBI. Retrieved December 27, 2922 from https://www.ncbi.nlm.nih.gov/books/NBK538266/
  15. Sedhai Y.R., Lamichhane, A., & Gupta, V. (2022). Agranulocytosis. NCBI. Retrieved December 27, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK559275/
  16. Stępnicki, P., Kondej, M., & Kaczor, A. A. (2018). Current concepts and treatments of schizophrenia. Molecules (Basel, Switzerland), 23(8), 2087. https://doi.org/10.3390/molecules23082087
  17. Volavka, J., & Vevera, J. (2018). Very long-term outcome of schizophrenia. International Journal of Clinical Practice, 72(7), e13094. https://doi.org/10.1111/ijcp.13094
  18. American Psychiatric Association. (2020). What is schizophrenia. Retrieved December 27, 2022 from https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia