TREATMENT OF SCHIZOPHRENIA

WHAT YOU SHOULD KNOW

Dr. S. KrishnanAssociate Professor of Psychiatry

Government Medical CollegeThiruvananthapuram

Schizophrenia

Is not multiple personality disorder

A complex disorder which occurs in a person with unique individual, familial and social psychological profile

Unknown, probably specific, environmental and psychological factors might contribute to the development of the disorder

No one therapeutic approach is adequate to deal with this multifaceted disorder

Treatment Approach should be decided by

How the patient has been affected?

How the patient can be helped by the treatment?

Treatment should include

Pharmacological

Psychological

Social strategies

Hospitalization – For What Purposes?

Diagnosis

Stabilization of medications

Patient’s safety – suicidal or homicidal ideation

Grossly disorganized or inappropriate behavior – inability to take care of food, clothing and shelter

Hospitalization

Reduces patient’s stress

Helps the patient to structure the daily activities

Short stays of 4-6 weeks is as effective as long term hospitalization

Hospital settings with active behavioral approaches produce better results than do custodial institutions

Medications

Mainstay of treatment

Treat the symptoms

Not cure

About 2-4 times as many patients relapse when treated with a placebo as do those treated with antipsychotic drugs

Two main group of drugs

Typical antipsychotic drugs

Atypical antipsychotic drugs

Tell the psychiatrist

What are the major distressing symptoms?

Has the patient ever responded any particular medicine in the past?

Has the patient taken treatment with drugs for adequate period of time (4-6 weeks)

Has the patient shown any of the following…

Poor response to two different drugs when given in adequate dose for adequate period of time?

Unpleasant reaction to first dose or unpleasant reaction during the initial week – subjective negative feeling, over-sedation, any severe side effects?

Severe depression or irritability or excitement?

Psychosocial Therapies

Helps to increaseSocial abilitiesSelf sufficiencyPractical skills Interpersonal

communication

Social skills Training

Family Therapy

Group Therapy

Cognitive Behavior therapy

Individual Psychotherapy

Vocational Therapy

Social skills Training

Has shown to reduce relapse rates as measured by need for hospitalization Relationship problems Poor eye contact Unusual delays in response Odd facial expressions Lack of spontaneity in social situations Inaccurate perceptions Lack of perceptions of emotions in other

individuals

Family Therapy

When family plays a role in precipitation of symptoms, perpetuation of symptoms or maintenance of symptoms

Group Therapy

Focus is on:

Real life plans

Real life problems

Relationships

Effective in reducing social isolation, increasing sense of cohesiveness and

improving reality testing

Cognitive Behavior Therapy

Helps to reduce:

Cognitive distortions

Reduces distractibility

Correct errors of judgment

Ameliorates delusions and hallucinations

Individual Therapy

Effect additive to pharmacotherapy

Helps develop good personal relationship with therapist – a predictor of outcome.

Vocational Therapy

Sheltered workshops

Job clubs

Part time employment

Transitional employment programs

How can you take part in the World Mental Health Day, 2014

Visit an individual with Schizophrenia whom you know

Spend some time with him/her

If you don’t know anybody, take a decision that you will care for any individual with schizophrenia, if ever you come across

Take Home Message

Medicine is not the treatment of choice for schizophrenia

Ask your doctor for what nonpharmacological methods are good and effective for your relative with schizophrenia.

THANKS A LOT