Rehabilitation and recovery from schizophrenia

Can you recover from schizophrenia?

Although there is no cure for schizophrenia, studies indicate that up to half of those with schizophrenia are able to control their symptoms and experience adequate social, professional, and cognitive functioning, suggesting that some level of recovery is possible ^[1][2].

Outcomes for schizophrenia typically depend on the severity of the condition and the stage at which treatment is commenced. More positive outcomes are possible for those who receive early intervention, social support, and ongoing professional treatment ^[3][4].

However, for many, treatment is likely to be a life-long requirement, whether to maintain mental and functional stability and prevent relapse, or to reduce the impact of chronic and severe symptoms ^[1][5].

Progression of schizophrenia

It is unclear what causes schizophrenia, but it is thought that the development of the condition has a neurodevelopmental element. Development of schizophrenia appears to be related to brain chemistry, genetic heritability, and social or environmental factors. As such, some people may be at a higher risk of developing the mental disorder^[4][6].

Schizophrenia typically progresses in three stages, known as the prodromal phase, the acute or active phase, and the residual or chronic phase ^[4].

Prodromal

The prodromal phase of schizophrenia involves the presence of early warning signs, including changes in thoughts and behavior that may appear bizarre or unusual, but are not yet symptoms of a full psychotic episode ^[7].

This could include:

• Odd beliefs or perceptions
• Reduced social engagement and functioning
• Mood changes
• Impaired cognitive abilities
• Impaired personal care and hygiene
• Changes in speech and emotional affect
• Unusual or uncharacteristic behavior

The prodromal phase may be present for up to one year prior to the development of a full psychotic episode or disorder ^[4].

Acute or active phase

The acute or active phase of schizophrenia includes the first episode of psychosis and the initial years of the illness. In this phase, full psychotic symptoms emerge. Psychotic symptoms can develop or worsen, potentially having a significant impact on social, professional, and cognitive functioning ^[4][6].

This can include:

• Hallucinations
• Delusions
• Disordered and disorganized thinking
• Bizarre behavior and speech
• Social withdrawal
• Impairments in personal, professional, and social functioning

It is during this phase that an official diagnosis of schizophrenia can be reached. Depending on the severity of symptoms, hospitalization may be required during this period of time to ensure the individuals safety and stabilize their condition ^[1].

Residual or chronic

The residual or chronic phase of schizophrenia involves a reduction in symptoms. The reduction of symptoms is typically due to effective treatment that controls and reduces the impact of the condition. In this phase, psychotic symptoms may still be present but have become less severe, although relapse can still occur in this time ^[4][8].

Depending on the severity of the ongoing symptoms, this stage may be considered functional recovery if the individual is able to regain a level of cognitive, professional, and social functioning ^[3].

However, for some, symptoms during this stage may be improved from the active phase but still be causing impairments in functioning, thus requiring careful maintenance of treatment to prevent a worsening of symptoms ^[1][3].

How to treat schizophrenia

The most effective treatment plan for schizophrenia has been shown to be a combination of medication, psychotherapy, and social support. Without treatment, symptoms of schizophrenia are likely to worsen with time, causing increased impairments in physical and mental wellbeing and functioning ^[6][9].

Medication

Antipsychotic medication is typically prescribed immediately upon presenting with or being diagnosed with schizophrenia. The aim of medication is to stabilize psychotic symptoms quickly. Medication will usually be a second generation (or atypical) antipsychotic, as they are thought to be more effective and tend to have fewer severe side effects than first generation (or typical) antipsychotics ^[3].

Typically, only one antipsychotic medication will be prescribed. However, in some cases, a combination of medications may be prescribed, such as a second antipsychotic, an antidepressant, or a mood stabilizer, to better manage symptoms. All medications will require close physical health monitoring to mitigate and manage any side effects or reactions ^[5].

If two or more antipsychotic medications have been tried with no success, clozapine may be prescribed. Although clozapine is very effective at managing symptoms of the condition, particularly treatment-resistant schizophrenia, it carries a high risk of severe physical health complications, so is not a first-line medication ^[5][6].

Long-acting injectable medications (also known as depot injections) may be used in maintenance treatment or for those who are noncompliant with medication ^[4][5].

Psychotherapy

Some types of psychotherapy may not be as effective during the acute phase of schizophrenia, due to impaired cognition, psychotic symptoms, or treatment noncompliance that occur in this stage. However, psychotherapy and other therapeutic interventions can be very beneficial throughout the illness, in helping to prevent progression to an acute psychotic episode or relapse ^[6][9].

Various types of therapy can provide emotional support, guidance and advice with social and professional functioning, education and understanding of the condition and the importance of treatment, and the involvement of family members or carers in the recovery process ^[1][5].

Effective therapy for schizophrenia may include:

• Cognitive behavioral therapy (CBT)
• Individual and group therapies
• Skills and compliance therapy
• Family therapy

Top tips for a successful recovery

Alongside medication and therapy, there are several other ways in which to improve chances of positive outcomes and recovery in patients with schizophrenia, including early intervention and self-care techniques.

Early intervention

Research shows that recovery outcomes are greatly improved with early intervention. Early intervention helps to reduce the progression of psychotic disorders and prevent relapse. Treatment in the prodromal phase is often very effective and can improve future functioning and help to prevent the development of a full psychotic episode or disorder ^[4][7].

Treatment during the first episode of psychosis can also help to prevent relapse or a worsening of the condition. Intervention with medication and psychotherapy in the first few weeks of psychosis have been shown to greatly reduce the impact of psychotic symptoms, develop positive therapeutic relationships with professionals, and improve interpersonal relationships and professional functioning ^[1][8].

Self-care

Improving or maintaining physical and mental wellbeing can help to reduce the impact of schizophrenia symptoms and prevent physical health complications from occurring. This could include ^[3][5][6][9]:

• Avoiding or limiting drug and alcohol use, as substances can worsen symptoms or cause unpleasant or dangerous interactions with medications.
• Healthy eating and exercising, as this can help prevent weight gain caused by antipsychotic medications. Healthy eating and exercise can alsoprevent physical health complications that commonly occur within the context of schizophrenia, such as obesity, diabetes, and dental issues.
• Attending groups or training programs, as these can help improve social functioning, prevent isolation, and make it easier to begin or restart employment, thereby improving overall wellbeing and functioning.
• Attending all appointments and taking prescribed medications, as this will provide the most effective treatment and chance of recovery, helping to prevent relapse.