Treatment for schizophrenia
There are different ways to treat and manage schizophrenia and it is important that any individual who thinks they may have the condition, seeks medical help. Each patient is unique and your healthcare practitioner will advise on the right treatment for you personally.
Most people diagnosed with schizophrenia will be prescribed an antipsychotic by their psychiatrist or family doctor. For most, they will take this voluntarily, but it is now possible, under CTOs (community treatment orders) as well as whilst in hospital under the Mental Health Act 1983 (known as “sectioning”), to force patients to take antipsychotics. Some are available as “depot” injections, which are administered in secondary care (clinics or hospital) by nurses. This is generally only for those who struggle to take medication, frequently forget or are not compliant.
Please see more about antipsychotics in our Schizophrenia treatment section.
Antipsychotics, also known as “neuroleptics” or “major tranquillisers”, are divided in two – the older first-generation “typical” and newer second-generation “atypical” antipsychotics. The atypicals have fewer side effects and are better tolerated. However, for some, the older drugs are the most effective.
There are thought to be a number of chemical messengers in the brain, known as “neurotransmitters”, including serotonin and dopamine. The dopamine system is targeted by antipsychotics and brain imaging scans have shown changes in the number of dopamine receptors in the brain following long-term treatment with the medication.
These drugs have been available since the 1950s and were the most-prescribed for decades. The generic names for the drugs are given first followed by their brand names in brackets:
- Benperidol (Anquil)
- Chlorpromazine (Largactil)
- Flupenthixol (Depixol)
- Fluphenazine (Modecate)
- Fluspirilene (Redeptin)
- Haloperidol (Haldol)
- Levomepromazine (Nozinan)
- Pericyazine (Neulactil)
- Perphenazine (Fentazin)
- Pimozide (Orap)
- Pipothiazine (Piportil)
- Promazine (Sparine)
- Sulpiride (Dolmatil, Sulpitil)
- Trifluoperazine (Stelazine)
- Zuclopenthixol (Clopixol)
These medications are the newer drugs – again generic names first with brand names in brackets:
- Amisulpride (Solian)
- Aripiprazole (Abilify)
- Clozapine (Clozaril, Denzapine, Zaponex)
- Risperidone (Risperdal & Risperdal Consta)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Zotepine (Zoleptil)
Clozpaine works differently to other atypicals and is potentially dangerous in that it can affect the level of white blood cells so regular monitoring of the patient’s blood is necessary. It is generally only prescribed where two other antipsychotics – a typical and another atypical – have failed to provide adequate relief for the patient or where there are very pronounced negative symptoms.
CBT – Cognitive Behavioural Therapy
CBT or cognitive behavioural therapy is recommended by NHS rationing body NICE and 16-20 sessions with a psychologist or CBT therapist should be made available to everyone with a diagnosis of schizophrenia.
Studies have shown that, in combination with medication, a significant degree of improvement in paranoia and functioning and a good deal of recovery are possible with CBT. However access to CBT is patchy across the country and, despite the government’s Improving Access to Psychological Therapies programme, many people with schizophrenia are not getting the help which they deserve.
Early Intervention in Psychosis
One of the most important initiatives of the 2000s was the introduction of Early Intervention in Psychosis. Schizophrenia can have a sudden onset, but more usually it is preceded by something known as a “prodrome” or “prodromal phase” where the person developing symptoms behaves differently to normal – not noticeably at first – but may become more withdrawn, start to develop suspicions about others and to develop early warning signs of paranoia.
Early Intervention in Psychosis teams were set up to address the fact that, until someone was so ill they needed to be sectioned, it was previously impossible for the NHS to treat people whom it felt were at the most severe risk of developing psychosis. Many Early Intervention Teams have now merged with community services, but the philosophy remains the same – intervene as soon as possible to prevent the patient suffering devastating consequences.
©October 2011 Ian Birch/Fantelli Imprint