Treatment

There are many ways to manage schizophrenia, treatment ranges from antipsychotic medication to psychotherapy, meeting the various needs of the patients. 

Antipsychotic medication forms the core of schizophrenia treatment. On one hand, these medications can effectively reduce symptoms and the anxiety and distress that comes with it; on the other hand, it also prevents relapse. The medication works by acting on the neurotransmitter dopamine in the brain. 

Anti-psychotics have been available since the 1950s, known as the ‘typical’ antipsychotics; in the 1990s, new antipsychotic medications were developed, known as the ‘atypical’ antipsychotics. Recent studies found that there are less severe side-effects in the newer medication; nonetheless, the drug efficacy is relatively similar in both the ‘typical’ and ‘atypical’ antipsychotics. Antibiotics are available in tablets, capsules, liquid form or ‘depot’ injections; oral medications are easier to use, though injections are slow-release medication which targets those who have difficulty taking pills, and are easier to remember.  

Doctors may alter the drug prescribed if the side effects brought on are too severe; Benzhexol and benztropine are normally prescribed to manage facial and limbs stiffness, tremour of the hands and feet. Nonetheless, these drugs also have side effects which are less debilitating, such as dry mouth, decrease in memory and constipation. If the drug dosage is too high, patient could be in hysteria. 
 

Side effects from medication are commonly appear during the early phase of treatment, though the side effects and its severity experienced varies from person-to-person. Shortly after medication, anxiety and sleep problem caused by the illness will be alleviated. Within a few days or weeks, other symptoms such as hallucination and delusion will gradually improve. Some other symptoms, such as lack of motivation, flat expressions, etc, may take 1 to 2 years to improve. It requires patience from patients and their families during treatment. About 80% of the patients can gradually recover. Moreover, medication dosage and type are adjusted according to the patient’s symptoms and side effects. 

Apart from medication, psychosocial therapy plays a significant role in treating psychosis. Psychosocial therapy can be given in the form of individual or group. Based on personal needs, professionals design ample intervention methods, to enhance patients’ psychological qualities and abilities in social life, handling the illness, etc. Methods such as counselling, psycho-education and cognitive behavioral therapy ameliorates the situation.

In general, there is no need to isolate the patients in hospital and hostel. Majority of the patients can receive treatments in the society. In fact, family members and friends around the patients can help a great deal by understanding their feelings, supporting and encouraging them so as to strengthen their motivation to recover.

The human brain is a mysterious and complex organ. We rely on our brains for many sophisticated functions of human kind including sensory experiences, emotions, impulse-control, language and thinking. These complex functions all depend on the activities of different neurons, and neurons communicate with each other via a chemical substance called neurotransmitters, dopamine being one of them.

The Central Nervous System is composed of about 100 billion neurons, and the neurons are connected by the synapses. Neurons are able to communicate with each other through the passing of neurotransmitters across synapses.

The biochemical approach suggests that psychosis is caused by excess dopaminergic activities, which leads to development of psychotic symptoms such delusions and hallucinations. Psychoactive drugs can intervene with the activities of dopamine, helping patients to reorganise their thoughts and get back in touch with reality.

Psychosis-related symptoms such as emotional disturbances and sleeping problems can usually be alleviated shortly after starting medication. Symptoms such as delusions and auditory hallucinations can usually be improved within a few weeks, with about 80% of the patients being able to recover gradually.

If you would like to learn more about the functions and side effects of each drug, please click here.

Although medication can help alleviate psychotic symptoms, patients also need a lot of mental support to help with their process of healing. Depending on different situations, patients have their own unique needs. Many patients lose confidence in themselves or worry about the future; some also feel anxious about interacting with other people, or even refuse to face their situation because of societal labels and prejudices. Other than medication, psychosocial therapy can also help patients to overcome these difficulties.

Psychosocial therapy can provide help to patients in the following aspects:

• Gain knowledge about psychosis and relevant therapies
• Learn to think positively and manage stress
• Increase awareness and learn to manage possible relapses
• Enhance social skills and learn to manage social anxiety
• Establish communities and receive emotional support
• Discover talents and boost self-confidence
• Re-evaluate self-expectations and needs
• Learn to prevent relapses
• Rebuild and adapt to patterns of life

Psychosocial therapy can be divided into individual or group therapy. Different professionals, such as social workers, nurses, professional therapist or clinical psychologists can help plan the period and details of the therapy of the patient according to their stage of onset and situation. Therapy methods include counseling, psychological education, cognitive behavioral therapy and life navigation etc. These therapeutical methods can help integrate these ideas into patients’ daily lives, and hopefully help the patients regain confidence to return to work or school.

For information on organisations which provide the above services, click here.

Antipsychotic medications are mainly divided into typical (the older type) and atypical (the newer type). The two types of medication are similar in their effectiveness at alleviating positive symptoms. Some of the side effects (eg. Drowsiness, dizzy etc) will appear when the patient first started taking medication, but will disappear gradually; other side effects (eg hand tremor, increase muscle tone, increase body weight etc) may appear later in the course of medication.

There are oral and depot medications. The effectiveness of medications can vary from person to person; the side effects experienced by individuals differ too. Therefore it usually takes some time to adjust dosage and types of medication. Medications often take effects from few weeks to few months (for alleviation of delusions and hallucinations), but the side effects can be apparent soon after starting the medication.

Older Medication (Typical Antipsychotic Drugs): General Uses and Side Effects

Newer Medication (Atypical Antipsychotic Drugs): General Uses and Sides Effects

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Extrapyramidal symptoms include muscular spasms of the mouth, tongue or other body parts, stiffened face and limbs, tremor of hands and legs, impatience, motor restlessness, and acute dystonic reactions (i.e. eyes rolling back, neck bending backward).

If you would like to learn how to handle deal with side effects, please click here.

Doctors may prescribe other medicines to alleviate the side effects. Most common ones are Benzhexol and Benztropine, which mainly improves tremour and abnormal muscle contraction. However, they have their own adverse effects which are generally lighter, for example, dry mouth, cognitive changes and constipation. If it is in overdose, patients may appear psychotic.

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Postural hypotension is a sudden drop in blood pressure when standing up or stretching, it causes symptoms such as head rush, dizzy spells, blurred vision, weakness and in rare cases fainting/ syncope. 

Some patients may not want to be medicated due to various reasons; the most common reasons include the fear of being discriminated against if others found out, worrying about the side effects, or thinking that getting medicated means that they have not recovered etc. Medication has different uses for the patient during different stages of the disorder. In the early stage, the main purpose of medication is to alleviate and get rid of the symptoms. It usually takes approximately half a year to a year, but it varies from person to person. When the symptoms are under complete control, the patient would enter a stable stage, in which the purpose of the medication becomes the prevention of relapse.

Although the relapse rate is not low, it does not mean that all patients experience it. Therefore, psychiatrists will adjust the dosage medication according to the patient’s condition, environment and personal factors. Stopping or decreasing the dosage of medication too early may lead to a higher likelihood of relapse. Some patients can stop medication without any problems, however some may need to stay on medication for a longer period of time.

Some patients worry about being addicted to psychiatric medications, but antipsychotic drugs are not addictive.

Each patient experiences a unique journey of recovery, and it is our responsibility to observe and understand the effectiveness of medications, but it is important to avoid comparisons with other people. Every individual in this world possesses different characteristics and faces different problems in their lives, and it would be very difficult to measure these differences; the most essential thing is that the patients are getting supported throughout the journey by their close family members and friends.