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Treatments and drugs
By Mayo Clinic staffSchizophrenia is a chronic condition that requires lifelong treatment, even during periods when you feel better and your symptoms have subsided. Treatment with medications and psychosocial therapy can help you take control of your condition and become an active and informed participant in your own care. During crisis periods or times of severe symptoms, hospitalization may be necessary for your safety and to make sure you're getting proper nutrition, sleep and hygiene.
Schizophrenia treatment is usually guided by a psychiatrist skilled in treating the condition. But you may have others on your treatment team as well, including psychologists, social workers and psychiatric nurses, because the condition can affect so many areas of your life. You may also have a case manager to make sure that you're getting all of the treatment you need and that your care is coordinated among all of your health care providers.
Medications
Medications are the cornerstone of schizophrenia treatment. But because medications for schizophrenia can cause serious but rare side effects, you may be reluctant to take them. Work with your psychiatrist and other health care providers to find a medication regimen that works for you, with the fewest side effects.
Antipsychotic medications are the most commonly prescribed medications to treat schizophrenia. They're thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin. There are two main types of antipsychotic medications:
- Conventional, or typical, antipsychotics. These medications have traditionally been very effective in managing the positive symptoms of schizophrenia. These medications have frequent and potentially severe neurological side effects, including the possibility of tardive dyskinesia, or involuntary jerking movements. This group of medications includes:
- Haloperidol (Haldol)
- Thioridazine
- Fluphenazine
These typical antipsychotics are often cheaper than newer counterparts, especially the generic versions, which can be an important consideration when long-term treatment is necessary.
- New generation, also called atypical antipsychotics. These newer antipsychotic medications are effective at managing both positive and negative symptoms. They include:
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
- Paliperidone (Invega)
Risperidone (Risperdal) is the only atypical antipsychotic medication that's been approved by the Food and Drug Administration (FDA) to treat schizophrenia in children ages 13 to 17. Atypical antipsychotic medications pose a risk of metabolic side effects, including weight gain, diabetes and high cholesterol.
Which medication is best for you depends on your own individual situation. It can take several weeks after first starting a medication to notice an improvement in your symptoms. In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. Other medications also may be helpful, such as antidepressants or anti-anxiety medications.
If one medication doesn't work well for you or has intolerable side effects, your doctor may recommend combining medications, switching to a different medication or adjusting your dosage. Don't stop taking your medications without talking to your doctor, even if you're feeling better. You may have a relapse of psychotic symptoms if you stop taking your medication. In addition, antipsychotic medication needs to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms.
Be aware that all antipsychotic medications have side effects and possible health risks. Certain antipsychotic medications, for instance, may increase the risk of diabetes, weight gain, high cholesterol and high blood pressure. Clozaril can cause dangerous changes in your white blood cell count. Certain antipsychotic medications can cause serious health problems in some older adults and should be avoided.
Be sure to talk to your doctor about all of the possible side effects and being monitored for health problems while you take these medications. Antipsychotic medications can also have dangerous interactions with other substances. Your doctors should know about all medications and over-the-counter substances you take, including vitamins, minerals and herbal supplements.
Psychosocial treatments
Although medications are the cornerstone of schizophrenia treatment, psychotherapy and other psychosocial treatments also are important. These treatments may include:
- Individual therapy. Psychotherapy with a skilled mental health provider can help you learn ways to cope with the daily life challenges brought on by schizophrenia. Therapy can help you improve communications skills, relationships, your ability to work and your motivation to stick to your treatment plan. Learning about schizophrenia can help you understand it better, cope with lingering symptoms, and understand the importance of taking your medications. Therapy can also help you cope with stigma surrounding schizophrenia.
- Family therapy. Both you and your family may benefit from therapy that provides support and education to families. Your symptoms have a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse, and can help you stick to your treatment plan. Family therapy can also help you and your family communicate better with each other and understand family conflicts. Family therapy can also help family members cope and reduce their distress about your condition.
- Rehabilitation. Training in social and vocational skills to live independently is an important part of recovery from schizophrenia. With the help of a therapist, you can learn such skills as good hygiene, cooking and better communication. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. If you don't have a case manager to help you with these services, ask your doctors about getting one. Today, fewer people with schizophrenia require long-term hospitalization because effective treatments are available.
Treatment challenges
When you have appropriate treatment and stick to your treatment plan, you have a good chance of leading a productive life and functioning well in daily activities. But be prepared for challenges that can interfere with treatment.
For one thing, it's often difficult for people with schizophrenia to stick to their treatment plans. You may believe that you don't need medications or other treatment. Also, if you're not thinking clearly, you may forget to take your medications or to go to therapy appointments. Talk to your doctors about tips to stick to your treatment plan, such as taking a medication that's available in a long-lasting injectable form. Even with good treatment, you may have a relapse. Have a plan in place to deal with a relapse.
Many people with schizophrenia smoke, often heavily. If you smoke, you may need a higher dose of antipsychotic medication because nicotine interferes with these medications.
Similarly, using alcohol and drugs can make schizophrenia symptoms worse. If you have a problem with alcohol or substance abuse, you may benefit from treatment programs that include care for both schizophrenia and substance abuse.
