Treatment for schizophrenia

Schizophrenia is a serious mental illness characterized by breaks from reality (psychosis and delusions) and disorganized thinking. Schizophrenia usually appears during adolescence or early adulthood, but it can emerge during children. Schizophrenia in children is extremely rare, affecting less than 1 in 100 children. Schizophrenia can also "be dormant" and not display symptoms until later adulthood. Schizophrenia affects about 1% of adults worldwide.

Understanding schizophrenia

Schizophrenia can develop slowly or it can appear suddenly and develop quickly. It is a lifelong challenge that makes it difficult to hold a job or care for oneself. People with schizophrenia often have to depend on family members for their care. The burden of schizophrenia affects everyone in the individual's circle – family members, friends, and even society as a whole.

Schizophrenia displays as a variety of cognitive systems. People can have any or all of them, but it is important to rule out other mental illnesses before diagnosing schizophrenia. Contrary to media portrayals, people with schizophrenia are not usually violent.

Cognitive symptoms include disorganized thinking, poor concentration, difficulty following instructions or learning new things. A person with schizophrenia may be hard to communicate with because there is no logical connection between ideas. 

Negative symptoms include lack of motivation and drive. The individual may neglect basic tasks, like cooking and housecleaning, and personal hygiene. Negative symptoms also include lack of facial expressions, or blunted affect. People with schizophrenia may respond inappropriately to emotional events, for example, laughing during a funeral.Most people with schizophrenia have difficulty organizing their lives and planning ahead. Often they may start things and have trouble finishing them.

Positive symptoms include delusions and hallucinations. Many people with schizophrenia have paranoia, and withdraw from social contact because they think others are "out to get them." Delusions can take many forms. Some people may believe others are attempting to read their thoughts or control them remotely. Or, they may think they have super powers and a "mission to save the world."

Hallucinations include seeing, hearing, feeling, tasting, or smelling things that are not there. Hearing voices is the most common hallucination, but people with schizophrenia can experience any or all the different types.

Lack of insight and noncompliance

Many people with schizophrenia do not believe they are ill because their delusions and hallucinations seem so real. They may refuse medication because paranoia leads them to believe others are trying to poison them. Some may think the medication has side effects that aren't there. Even if a client is willing to take medication, a caretaker must often remind the individual to do so because they individual may forget or lose track of time. 

The role of stress in schizophrenia

People with schizophrenia are susceptible to stress. In some cases, a highly stressful event such as the death of a loved one triggers the first schizophrenic break from reality. For most patients, learning to manage stress is an important part of minimizing the symptoms of the disease. Psychotherapy is an invaluable tool that can help clients deal with stress in their lives and can guide them away from distorted thoughts. Psychotherapy also helps clients build social skills and deal with others more appropriately in social situations.

Types of schizophrenia

Former classifications

Until 2013, psychiatry broke down schizophrenia into different types. These included paranoid schizophrenia, catatonic schizophrenia, childhood schizophrenia, hebephrenic (disorganized) schizophrenia, and schizoaffective disorder, which combined the symptoms of schizophrenia with those of a mood disorder.

With the publication of the Diagnostic and Statistical Manual of Mental Disorder 5th edition (DSM-V), these sub-types were eliminated because they had low reliability and did not help provide clients with better treatment.

Changes in criteria

The DSM-V also changed the criteria for a diagnosis of schizophrenia. One change was the elimination of bizarre delusions as a requirement. A second change was that a diagnosis of schizophrenia no longer depended on the presence of hearing at least two voices during an auditory hallucination.

Further, to receive a diagnosis of schizophrenia it was necessary to have at least one of the following symptoms without another diagnosis (such as bipolar psychosis): auditory or visual hallucinations, delusional thinking, and disorganized speech.

Medications for schizophrenia

Many scientists think schizophrenia is many illnesses rather than just one. Certainly, it presents a variety of symptoms that must be treated.

Antipsychotic medications help mitigate delusions and hallucinations. First generation (typical or conventional) antipsychotics include drugs such as chlorpromazine (Thorazine), fluphenazine (Prolixin), Halperidol (Haldol), Perphenazine (Trilafon), Thiothixene (Navane) and others. Newer, second generation (atypical) antipsychotics include aripiprazole (Abilify), lurasidone (Latuda), olanzapine (Zyprexa), risperidone (Risperdal), ziprasidone (Geodon), quetiapine (Seroquel) and more.

Clozapine (Clozaril) is the only FDA-approved antipsychotic medication for treatment-resistant schizophrenia. A psychiatrist must be approved to prescribe clozapine and monthly blood work is required. The Centre for Counseling of Aventura is authorized to treat clients with clozapine.

Other medications involved in the treatment of schizophrenia might include antidepressants, anti-anxiety medications, and sleep aids.

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