Treating Schizophrenia: How to treat Schizophrenia

Treating Schizophrenia: How to treat Schizophrenia 

Pharmacotherapy

An acute episode of schizophrenia typically responds to treatment with

classic antipsychotic agents, which are most effective in its treatment. Some

commonly used drugs include:

Chlorpromazine: 300-1500 mg/day PO; 50-100 mg/day IM

Fluphenazine decanoate: 25-50 mg IM every 1-3 weeks

Haloperidol: 5-100 mg/day PO; 5-20 mg/day IM

Trifluoperazine: 15-60 mg/day PO; 1-5 mg/day IM

Clozapine: 25-450 mg/day PO

Risperidone: 2-10mg/day PO

Electroconvulsive Therapy (ECT)

Indications for ECT in schizophrenia include:

· Catatonic stupor

· Uncontrolled catatonic excitement

· Severe side-effects with drugs

· Schizophrenia refractory to all other forms of treatment

Usually 8-12 ECTs are needed 

Psychological Therapies

Group therapy: The social interaction, sense of cohesiveness, identification and reality testing achieved within the group setting have proven to be highly therapeutic for these individuals.

Behaviour therapy: Behaviour therapy is useful in reducing the frequency of bizarre, disturbing and deviant behaviour and increasing appropriate Social skills training: Social skills training addresses behaviours such as poor eye contact, odd facial expressions and lack of spontaneity in social situations through the use of videotapes, role playing and homework

Cognitive therapy: Used to improve cognitive distortions like reducing distractibility and correcting judgment.

Family therapy: Family therapy typically consists of a brief program of family education about schizophrenia. It has been found that relapse rates of schizophrenia are higher in families with high expressed emotions (EE), where significant others make critical comments, express hostility or show emotional over-involvement. The significant others are, therefore, taught to decrease expectations and family tensions, apart from being given social skills training to enhance communication and problem solving.

Psychosocial Rehabilitation

This includes activity therapy to develop the work habit, training in a new vocation or retraining in a previous skill, vocational guidance and independent job placement.

Course and Prognosis

The classic course is one of exacerbations and remissions. In general, schizophrenia has been described as the most crippling and devastating of all psychiatric illnesses. Several studies have found that over the 5-10 years period after the first psychiatric hospitalization for schizophrenia, only about 10 to 20 percent of patients can be described as having a good outcome.More than 50 percent of patients have a poor outcome, with repeated hospitalizations.

Prognostic Factors in Schizophrenia

Good prognostic factors Poor prognostic factors

1. Abrupt or acute onset Insidious onset

2. Later onset Younger onset

3. Presence of precipitating factor Absence of precipitating factor

4. Good premorbid personality Poor premorbid personality

5. Paranoid and catatonic subtypes Simple, undifferentiated subtypes

6. Short duration: (<6 months) Long duration:(>2 years)

7. Predominance of positive symptoms Predominance of negative symptoms

8. Family history of mood disorders Family history of schizophrenia

9. Good social support Poor social support

10. Female sex Male sex

11. Married Single, divorced or widowed

12. Out-patient treatment Institutionalization