Getting Help for Schizophrenia

Diagnosing schizophrenia

The first step to schizophrenia treatment is getting a correct diagnosis. This isn’t always easy, since the symptoms of schizophrenia can resemble those caused by other mental and physical health problems. Furthermore, people with schizophrenia may believe nothing is wrong with them and resist going to the doctor. Because of these issues, it is best to see a psychiatrist with experience identifying and treating schizophrenia, rather than a family doctor.

A diagnosis of schizophrenia is made based on a full psychiatric evaluation, medical history, physical exam, and lab tests.

• Psychiatric evaluation — The doctor or psychiatrist will ask a series of questions about you or your loved one’s symptoms, psychiatric history, and family history of mental health problems. 
• Medical history and exam — Your doctor will ask about your personal and family health history. He or she will also perform a complete physical examination to check for medical issues that could be causing or contributing to the problem.
• Laboratory tests — While there are no laboratory tests that can diagnose schizophrenia, simple blood and urine tests can rule out other medical causes of symptoms. The doctor may also order brain imaging studies, such as an MRI or a CT scan, in order to look for brain abnormalities associated with schizophrenia.

Conditions that can look like schizophrenia

The medical and psychological conditions the doctor must rule out before diagnosing schizophrenia include:

• Other psychotic disorders - Schizophrenia is a type of psychotic disorder, meaning it involves a significant loss of contact with reality. But there are other psychotic disorders that cause similar symptoms of psychosis, including schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder. Because of the difficulty in differentiating between the psychotic disorders, it may take six months or longer to arrive at a correct diagnosis.
• Substance abuse – Psychotic symptoms can be triggered by many drugs, including alcohol, PCP, heroin, amphetamines, and cocaine. Some over-the-counter and prescription drugs can also trigger psychotic reactions. A toxicology screen can rule out drug-induced psychosis. If substance abuse is involved, the physician will determine whether the drug is the source of the symptoms or merely an aggravating factor.
• Medical conditions – Schizophrenia-like symptoms can also result from certain neurological disorders (such as epilepsy, brain tumors, and encephalitis), endocrine and metabolic disturbances, and autoimmune conditions involving the central nervous system.
• Mood disorders – Schizophrenia often involves changes in mood, including mania and depression. While these mood changes are typically less severe than those seen in bipolar disorder and major depressive disorder, they can make diagnosis tricky. Schizophrenia is particularly difficult to distinguish from bipolar disorder. The positive symptoms of schizophrenia (delusions, hallucinations, and disorganized speech) can look like a manic episode of bipolar disorder, while the negative symptoms of schizophrenia (apathy, social withdrawal, and low energy) can look like a depressive episode.

• Post-traumatic stress disorder (PTSD) — PTSD is an anxiety disorder that can develop after exposure to a traumatic event, such as military combat, an accident, or a violent assault. People with PTSD experience symptoms that are similar to schizophrenia. The images, sounds, and smells of PTSD flashbacks can look like psychotic hallucinations. The PTSD symptoms of emotional numbness and avoidance can look like the negative symptoms of schizophrenia.

Treatment for schizophrenia

Despite the widespread misconception that people with schizophrenia have no chance of recovery or improvement, the reality is much more hopeful. Think of schizophrenia as similar to a chronic medical condition like diabetes: although currently there is no cure, it can be treated and managed with medication and supportive therapies. When schizophrenia is stabilized with proper treatment, a person is:

• Less likely to have frequent or lengthy hospitalizations
• Less likely to require intensive support at home
• Less likely to abuse alcohol or drugs
• Less likely to commit suicide
• More likely to live and work independently
• More likely to enjoy satisfying relationships

Effective treatment also makes the challenges of schizophrenia less stressful and frightening for both the individual with the disorder and his or her family members and loved ones.

Successful treatment for schizophrenia aims to relieve current symptoms, prevent future psychotic episodes, and reintegrate the person into society. A treatment plan that combines medication with supportive services and therapy is the most effective approach.

Stages of schizophrenia recovery

There are two phases of schizophrenia treatment and recovery: one addresses the severe symptoms of an acute psychotic episode and the other focuses on improving functioning and preventing relapse during the maintenance or recovery phase of the illness.

• Acute phase — An acute episode of schizophrenia involves intense psychotic symptoms such as hallucinations, delusions, paranoia, and confused thinking. The aim of treatment in the acute phase is to get the psychotic symptoms under control so the patient isn’t a danger to self or to others. Hospitalization may be required during this time. Medication is the primary treatment. Given the right drug and dose, schizophrenia medication can greatly reduce psychotic symptoms within six weeks.
• Stabilization phase — Once the acute psychotic symptoms have been controlled, most people go through a stabilization phase in which they continue to experience bothersome, yet milder symptoms of schizophrenia. During this phase, patients are particularly vulnerable to relapse. The aim of treatment in the stabilization phase is to prevent relapse, reduce symptoms even more, and move the patient forward into a more stable recovery phase.
• Maintenance phase — The long-term recovery phase of schizophrenia is known as the maintenance phase of treatment. During the maintenance phase of treatment, the goal is to sustain symptom remission or control, reduce the risk of relapse and hospitalization, and teach skills for daily living. Maintenance treatment typically involves medication, supportive therapy, family education and counseling, and vocational and social rehabilitation.

Medications for schizophrenia

The medications used in the treatment of schizophrenia are known as antipsychotics. These medications for schizophrenia don’t provide a cure; rather they work by reducing the psychotic symptoms of the illness. The antipsychotic medications are particularly effective at controlling the positive symptoms of schizophrenia, including hallucinations, delusions, paranoia, and disordered thinking. They are less helpful for treating the negative symptoms of schizophrenia, such as social withdrawal, lack of motivation, and lack of emotional expressiveness.

As with all medications, the antipsychotics affect people differently. It’s impossible to know ahead of time how helpful a particular antipsychotic will be, what dose will be most effective, and what side effects will occur. Finding the right drug and dosage for schizophrenia treatment is a trial and error process. It also takes time for the antipsychotic medications to take full effect.

Some symptoms of schizophrenia may respond to medication within a few days, but others take weeks or months to improve. In general, most people see a significant improvement in their schizophrenia within six weeks of starting medication. If, after six weeks, an antipsychotic medication doesn’t seem to be working, the doctor may increase the dose or try another medication.

Since most people with schizophrenia require medication for extended periods of time—often for life—the goal is to find a medication regimen that keeps the symptoms of the illness under control with the fewest side effects. Antipsychotic medication should never be discontinued without first consulting the doctor. Sudden or unsupervised dosage changes are dangerous, and can trigger a schizophrenia relapse or other complications.

The two main groups of medications used for the treatment of schizophrenia are the older or “typical” antipsychotic medications and the newer “atypical” antipsychotic medications.

Typical antipsychotic medications for schizophrenia treatment

The oldest antipsychotic medications are known as conventional or typical antipsychotics. They are believed to work by blocking dopamine receptors in the brain. While these first-generation schizophrenia medications effectively reduce the positive symptoms of the illness, they are prescribed less frequently today because of the neurological side effects—known as extrapyramidal symptoms­—they often cause.

Common extrapyramidal side effects of the typical antipsychotics include:

• Restlessness and pacing
• Extremely slow movements
• Tremors
• Painful muscle stiffness
• Temporary paralysis
• Muscle spasms (usually of the neck, eyes, or trunk)
• Changes in breathing and heart rate

When the typical antipsychotics are taken long-term for the treatment of schizophrenia, there is a risk that tardive dyskinesia will develop. Tardive dyskinesia is characterized by involuntary muscle movements, usually of the tongue or mouth. In addition to facial tics, tardive dyskinesia may also involve random, uncontrolled movements of the hands, feet, trunk, or other limbs. According to the National Alliance on Mental Illness, the risk of developing tardive dyskinesia is 5 percent per year with the typical antipsychotics. The risk is less with the newer medications for schizophrenia.

Atypical antipsychotic medications for schizophrenia treatment

In recent years, newer drugs for schizophrenia have become available. These drugs are known as atypical antipsychotics because they work differently than the older antipsychotic medications. In addition to acting on dopamine, they also affect other neurotransmitters such as serotonin. Since the atypical antipsychotics produce fewer extrapyramidal side effects than the typical antipsychotics, they are recommended as the first-line treatment for schizophrenia.

The most common side effects of the atypical antipsychotic medications are:

Stiffness in the neck and jaw Drowsiness Faintness Dry mouth Blurred vision

Constipation Weight gain Loss of sex drive Sun sensitivity Skin rashes

In addition to their superior side effects profile, the atypical antipsychotics have other benefits over the typical antipsychotics. Most importantly, they have the potential to reduce the negative as well as the positive symptoms of schizophrenia. Schizophrenia’s negative symptoms are notoriously difficult to treat and show little response to the older antipsychotic medications. Some of the newer atypical antipsychotics may also improve memory and cognitive functioning.

Psychosocial treatment for schizophrenia

While medication is almost always a necessary component of schizophrenia treatment, it doesn’t offer a complete solution. People with schizophrenia also need psychosocial treatments to help them cope with their illness, obtain services, and become more independent. People who receive psychosocial treatment for schizophrenia are more likely to take their medication regularly and avoid relapse and hospitalization.

Supportive therapy

The goal of supportive therapy for schizophrenia is to help people adjust to their illness and navigate the challenges of daily living. Individual and group therapy provide much-needed emotional support for people with schizophrenia, while simultaneously teaching them how to solve problems in their daily lives, improve their relationships, and participate in their own recovery.

• Illness management — A primary focus of supportive therapy is patient education. Patients learn about common schizophrenia symptoms and problems, treatment options, and the importance of medication. This knowledge helps them take an active role in treatment and better manage their illness. People with schizophrenia can learn to monitor their progress, watch for signs of relapse, take their medication regularly, and deal with side effects.
• Coping with symptoms — Supportive therapy can also teach people how to cope with symptoms of schizophrenia that persist despite medication and treatment. Using cognitive-behavioral techniques, patients learn to challenge delusional beliefs, ignore the voices in their heads, or motivate themselves.

Rehabilitation

Vocational and social rehabilitation teaches basic life skills to people with schizophrenia so they can function in their families or communities. There are many different types of rehabilitation programs, but the shared focus is on helping patients take care of themselves and make the most of their capabilities. Depending on the individual’s personal goals and degree of illness, rehabilitation may include training in handling finances, using public transportation, communicating with others, and finding living arrangements. For those who want to work, vocational rehabilitation includes work assessment, job skills training, and assistance finding full or part-time employment.

Family education and support

Family support makes a difference in the outlook for people with schizophrenia. When family members are involved in treatment, patients are more likely to avoid relapse and achieve a higher level of functioning. If you have a family member with schizophrenia, educating yourself about the illness will give you a clearer understanding of your loved one and the challenges of treatment and recovery.

 

Related links for schizophrenia diagnosis and treatment

Schizophrenia diagnosis and treatment

Expert Consensus Treatment Guidelines for Schizophrenia: A Guide for Patients and Families (PDF) – Overview of the treatment options for schizophrenia, including effective medications, supportive therapy, and psychosocial rehabilitation programs. (Journal of Clinical Psychiatry)

Schizophrenia: An Information Guide – Covers common concerns about schizophrenia and its treatment, including treatment options and relapse prevention. (Centre for Addiction and Mental Health)

Antipsychotic medications and side effects

Medications – A thorough guide to the safe use of medications for mental illness, including the antipsychotics prescribed for schizophrenia. (National Institute of Mental Health)

Antipsychotic Drugs: Summary of Affordable Alternatives – Offers drug recommendations for schizophrenia treatment, based on safety, side effects, dosing convenience, and cost. (Consumer Reports Health)

Antipsychotic Side Effects Checklist (PDF) – Printable screening checklist for monitoring the common side effects of the antipsychotic medications for schizophrenia. (National Mental Health Association)

Tardive Dyskinesia – Learn about tardive dyskinesia, an involuntary movement disorder caused by long-term antipsychotic treatment. (Natioinal Alliance on Mental Illness)

Psychosocial treatment and rehabilitation for schizophrenia

Assertive Community Treatment (ACT) -  Learn about ACT, a community-based program that helps people with serious mental illness such as schizophrenia get the treatment and supportive services they need. (National Alliance on Mental Illness)

Assertive Community Treatment: Information for Consumers – More information about the personalized, team approach of ACT for schizophrenia, including housing assistance, medication support, and counseling. (SAMHSA’s National Mental Health Information Center)

Supported Employment – Introduction to programs that help people with schizophrenia and other mental disorders find and maintain employment. (SAMHSA’s National Mental Health Information Center)

Delving deeper into schizophrenia diagnosis and treatment

Practice Guidelines for the Treatment of Patients with Schizophrenia (PDF) – Comprehensive look at current expert recommendations for both the acute and maintenance phase of schizophrenia treatment. (American Psychiatric Association)

Melinda Smith, M.A., Heather Larson, Gina Kemp, M.A., Jaelline Jaffe, Ph.D., and Jeanne Segal, Ph.D., contributed to this article. Last modified on: 01/03/08