Treatment and outcome

Schizophrenia is treated using a combination of medical treatments such as anti-psychotic medicines, and psychological interventions such as cognitive behavioral therapy. Some people respond very well to treatment, while others are more challenging to treat.

Research has shown that out of 100 people with schizophrenia:

• 20 people will never have another acute schizophrenic episode,
• 50 people will experience a relapse of symptoms within two years,
• 30 people will never be free of symptoms, though the severity of symptoms can fluctuate over time, and
• 20 people will remain resistant to treatment and will require constant support and supervision.

Community mental health teams

Most people with schizophrenia are treated by community mental health teams (CMHT). The goal of the CMHT is to provide you with day-to-day support and treatment while trying to ensure that you have as much independence as possible.

A CMHT can be made up of:

• social workers,
• community mental health nurses (a nurse who has had specialist training in mental health conditions),
• pharmacists,
• counsellors and psychotherapists, and
• psychologists and psychiatrists - the psychiatrist is usually the senior clinician in the team.

The care plan approach (CPA)

People with complex mental health conditions, such as schizophrenia, are usually entered into a treatment process, known as a care plan approach (CPA). A CPA is essentially a way of ensuring that you receive the right treatment for your needs.

There are four stages to a CPA.

• Assessment - where your health and social needs are assessed.
• Care plan - a care plan is created in order to meet your health and social needs.
• Appointment of a care coordinator - a care coordinator - sometimes known as a keyworker - is usually a social worker, or nurse, and is your first point of contact with other members of the CMHT.
• Reviews - your treatment will be regularly reviewed and, if needed, changes to the care plan can be agreed.

Treatment for schizophrenia

Treatment for schizophrenia usually involves using a combination of antipsychotic medicines and psychological therapies.

Treating an acute schizophrenic episode

People who are experiencing serious psychotic symptoms, as a result of an acute schizophrenic episode, may require a more intensive level of care than a CMHT can provide.

Crisis resolution teams (CRT)

One treatment option is to contact a crisis resolution team (CRT). Crisis resolution teams treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis. Without the involvement of the CRT these people would require treatment in hospital.

The CRT will aim to treat a person in the least restrictive environment possible, ideally near the person's home. This can be in your own home, in a dedicated crisis residential home or hostel or in a day care centre.

CRTs are also responsible for planning after care once the crisis has passed in order to prevent a further crisis from occurring.

Your care coordinator should be able to provide you and your friends or family with contact information so that you can contact your CRT in the event of a crisis.

Voluntary and compulsory detention

More serious, acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees that it is necessary.

People can also be compulsorily detained at a hospital under the Mental Health Act (1983). However, it is only possible for someone to be compulsorily detained at a hospital if they are suffering from a severe mental disorder such as schizophrenia and if detention is necessary:

• in the interests of the person's own health,
• in the interests of the person's own safety, and/or
• for protecting others.

People with schizophrenia who are compulsorily detained may need to be kept in locked wards.

All people being treated in hospital will stay only as long as absolutely necessary for treatment.

An independent panel will regularly review your case and your progress. Once they feel that you are no longer a danger to yourself and others you will be able to leave the hospital. However, your care team may recommend that you remain in hospital on a voluntary basis.

Advance directives

If it is felt that there is a significant risk of future acute schizophrenic episodes occurring, you may want to write an advanced directive.

An advanced directive is a series of written instructions about what you would like your family or friends to do in case you do experience another acute schizophrenic episode. You may want to also include the contact details of your care coordinator.

Antipsychotics

Antipsychotics are usually recommend as the first-line treatment for treating the symptoms of an acute schizophrenic episode. Antipsychotics work by blocking the effect that dopamine has on the brain.

Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but they may take several days or weeks to reduce other symptoms, such as hallucinations or delusional thoughts.

Antipsychotics can be taken orally (as a pill) or given as an injection. Several 'slow release' antipsychotics are available whereby you only need to have one injection every two to six weeks.

You may only need to take antipsychotics until your acute schizophrenic episode has passed. However, their long-term use is usually recommended in order to prevent further acute schizophrenic episodes occurring.

There are two main types of antipsychotics:

• typical antipsychotics - the first generation of antipsychotics that were developed during the 1950s, and
• atypical antipsychotics - a newer generation of antipsychotics that were developed during the 1990s.

Atypical antipsychotics are usually recommended because they are less likely to cause side effects. However, they are not suitable or effective for everyone.

Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them and their severity will differ from person to person.

The side effects of typical antipsychotics can include:

• drowsiness,
• shaking,
• trembling,
• muscle twitches, and
• spasms.

Side effects of both typical and atypical antipsychotics can include:

• weight gain,
• blurred vision,
• constipation,
• lack of sex drive, and
• dry mouth.

You should tell your care coordinator or GP if your side effects are becoming severe. There may be an alternative antipsychotic that you can take or additional medicines that will help you to deal with the side effects.

You should not stop taking your antipsychotics without first consulting your CMHT because, if you do, it is possible that you may experience a relapse of symptoms.

Psychological treatment

Psychological treatment, such as counselling or cognitive behavioural therapy (CBT), can help people with schizophrenia to cope better with the symptoms of hallucinations or delusions.

Psychological treatments can also help to treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment.

Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is based on the idea that most unwanted thinking patterns, and emotional and behavioural reactions are learnt over a long period of time.

The aim of CBT is to identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and to learn to replace this thinking with more realistic and useful thoughts.

For example, you may be taught to recognise examples of delusional thinking in yourself. You may then receive help and advice about how you can avoid acting on these thoughts.

Most people will require between eight to 20 sessions of CBT over the space of six to 12 months. CBT sessions usually last for about an hour.

Your GP or CMHT should be able to arrange a referral to a CBT therapist.

Family therapy

Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, the stress of caring for somebody with schizophrenia can place a strain on any family.

Family therapy is a way of helping both you and your family to cope better with your condition.

Family therapy involves a series of informal meetings that take place over a period of six months. Meetings may include:

• discussing information about schizophrenia,
• exploring ways of supporting somebody with schizophrenia, and
• deciding how to solve practical problems that can be caused by the symptoms of schizophrenia.

If you think that you and your family could benefit from family therapy you should contact your care coordinator.

Occupational therapy

Many people with schizophrenia find that they benefit from meeting with an occupational therapist. An occupational therapist provides training, support and advice in order to help people with mental health conditions, such as schizophrenia, to develop the skills that they need for day-to-day living.

Occupational therapists can:

• help you to identify both your weaknesses and strengths,
• help you to improve your social and communication skills, and
• provide practical help and training that will allow you to get back to work.

Most CMHTs will have an occupational therapist working as part of the team.