Treating schizophrenia: Can it be treated? Medication, psychotherapy and more

In general, treatment depends on the stage of the disease.

If there is an acute phase of the disease and the symptoms are intense or the patient is behaving in a way that endangers him/herself and those around him/her, intensive crisis support and care is essential.

In an acute attack, symptoms of psychosis develop and medical treatment is required.

In the phase when the symptoms diminish or disappear, at this time the family and the patient receive information about the illness and psychotherapeutic approaches such as individual, group and family therapy come to the fore.

If the patient's health is stable, he or she can participate in various forms of psychosocial rehabilitation; if he or she has been studying, he or she can return to his or her studies, engage in leisure activities, and so on. Overall, however, the treatment of schizophrenia must be comprehensive, involving biological treatment (pharmacotherapy, electroconvulsive therapy), psychotherapeutic and psychosocial interventions.

From a practical point of view, the treatment of schizophrenia can be divided into 4 phases:

1. Managing the acute psychotic state in schizophrenia, with the aim of achieving calming of the person suffering from schizophrenia and enabling further therapeutic interventions.

The primary intervention is verbal techniques leading to calming the patient, administration of sedative (calming) medication in case of psychomotor restlessness and/or aggressive manifestations, in case of their failure or in case of a high risk of harm to the patient or the surroundings, the use of physical restraint with respect for the legislative norms.

In the pharmacological treatment of acute psychotic symptoms in association with agitation or aggressive symptoms, parenteral or solubilized forms of pharmaceuticals should be used. In addition to antipsychotics, parenteral benzodiazepines should be administered for a higher rate of pacification.

However, the basic treatment remains the administration of apaurine (benzodiazepine).

2. The acute phase, which aims to suppress the acute symptoms of schizophrenia, especially positive symptoms such as delusions, hallucinations and behavioural disturbances.

It usually lasts 6-8 weeks, its efficacy is assessed after 2-4 weeks and a change of treatment in the first two weeks is indicated only in case of adverse effects or intolerance.

3. Stabilization treatment, which aims to minimize stressful situations and to support the patient's recovery of his/her ability to adapt in his/her original social environment.

If the patient's condition is stable on a particular therapy set up in the acute phase, this should be continued for at least 6 months at an unchanged dosage.

This period is optimal for the main non-pharmacological procedures such as psychotherapeutic interventions, psychoeducation, psychosocial interventions. If available, a form of partial hospitalization in a psychiatric inpatient unit can be used.

4. The goal of the maintenance phase is to prevent relapse and create the conditions for full social recovery (remission).

Pharmacotherapy and electroconvulsive therapy belong to the standard biological methods of treatment of schizophrenia in our conditions.

Electroconvulsive therapy (ECT) is a safe therapeutic method with a rapid therapeutic effect that is currently performed under general anaesthesia with modern devices that allow dosing and monitoring of both efficacy and adverse effects to minimise both risks and side effects.

The indications for ECT in schizophrenia are mainly peracute life- or health-threatening conditions and also pharmacoresistant (non-responsive to medication) forms of the disease, where its effect is synergistic with the administration of AP. 

Psychotherapy in the treatment of schizophrenia is not an alternative to pharmacological treatment, but together with biological-psychopharmacological treatment it effectively helps to reduce the symptoms of schizophrenia to a minimum, including cognitive deficits.

Supportive therapy with psychoeducation about the illness and treatment is important in the psychotherapy of patients with schizophrenia.

We take into account the patient's clinical condition, resources and deficits when providing information. Education reduces anxiety, self-blame, and hopelessness, and can also help the patient develop his or her own coping resources to manage stress, prevent relapses, and regain healthy functioning.

In the treatment of patients with schizophrenia, the cooperation of family members is important to support the patient in treatment, in recognizing early warning signs as well as in reducing stressors that could lead to relapse.

Cognitive-behavioural therapy (CBT) helps to improve the social functioning of patients with schizophrenia, as well as to correct cognitive deficits, to control chronic positive and negative symptoms, and to prevent relapses.

CBT uses a number of developed methods and strategies to achieve this goal, such as social competence training, self-instruction techniques, isolated deficits training, etc.

Community care has a significant role in the overall management of the patient with schizophrenia. It represents one of the alternatives to psychiatric care, especially for cooperating patients with schizophrenia. Within it, patients are part of a therapeutic community, and thus, in conditions of emotional support, interpersonal contact and the possibility of daily monitoring of the patient's condition, effective comprehensive help can be provided.

Other forms of community care are psychosocial centres, sociotherapeutic clubs, self-help groups. However, the patient must be as well informed as possible about his or her illness, depending on its stage.

Being an informed patient is the surest path to success.