Effective management of schizophrenia symptoms typically involves a combination of medications, psychotherapy, and supportive services. People with schizophrenia can lead productive and fulfilling lives.
Schizophrenia is a complex, lifelong mental health condition with hallmark symptoms of altered perception, decreased emotional expression, and cognitive challenges. Depending on the type of schizophrenia someone has, these experiences may include hallucinations, delusions, flat affect, disorganized thinking and movement, or all of these.
Changes in the brain’s structure and function in schizophrenia can also lead to a variety of mental and physical functional challenges that affect daily activities.
Multidisciplinary management of schizophrenia can help reduce symptom severity and frequency and may help improve the overall quality of life.
Current treatment guidelines recommend a combination approach, using medications, psychotherapy, and psychosocial interventions.
Antipsychotic medications are a staple in schizophrenia treatment. They help manage symptoms of psychosis and improve the ability to think and speak.
These medications work by
Positive and negative symptoms
“Positive” symptoms in schizophrenia are those that add to someone’s baseline function, like hallucinations or delusions.
“Negative” symptoms refer to a loss of function and include experiences like social withdrawal, an inability to experience pleasure, and a loss of interest in self-motivated activity.
Doctors select antipsychotic medications based on individual symptoms and their severity. They choose from two categories: first-generation (typical) antipsychotics and second-generation (atypical) antipsychotics.
First-generation antipsychotics
The earliest versions of antipsychotic medications are called first-generation or typical. They primarily target the dopamine system in the brain and are effective for the management of positive schizophrenia symptoms.
Examples of common first-generation antipsychotics include:
- haloperidol (Haldol)
- chlorpromazine (Thorazine)
- fluphenazine (Prolixin)
Second-generation antipsychotics
Second-generation, or atypical, antipsychotics represent the next versions in antipsychotic development. They work on dopamine and serotonin brain networks, and they’re effective for both positive and negative symptoms.
Doctors recommend some, like clozapine (Clozaril), in cases where schizophrenia symptoms haven’t responded to other treatments.
Common second-generation antipsychotics include:
- aripiprazole (Abilify)
- risperidone (Risperdal)
- clozapine (Clozaril)
Antipsychotic medication use can change throughout someone’s schizophrenia treatment. During their first episode of psychosis, for example, or when symptoms are acute (active), their doctor may suggest standard therapies like risperidone to help stabilize symptoms in an inpatient care setting.
Finding an antipsychotic medication that effectively manages current symptoms can take time. Not everyone finds immediate success with initial first-line therapies.
If taking a pill on a regular schedule is challenging due to changes in the person’s cognition and memory, a doctor may recommend a long-acting injectable antipsychotic to help with consistent dosing.
Psychotherapy alone isn’t enough to manage schizophrenia symptoms. It can’t address the neurological and chemical components that contribute to symptoms. But along with medications, psychotherapy can help with factors like:
- symptom recognition
- stress reduction
- coping skills
- life skill development
Currently, the guidelines from the American Psychiatric Association (APA) recommend cognitive behavioral therapy for psychosis (CBTp) for schizophrenia.
CBTp focuses on recognizing the early symptoms of psychosis, developing prevention strategies, and finding effective ways to cope with symptoms if they occur.
CBTp is just one of several options for schizophrenia management, and the APA supports incorporating other therapies and psychosocial interventions.
Other common psychotherapy and psychosocial options to manage schizophrenia symptoms include:
- Cognitive behavioral therapy (CBT): This focuses on identifying and restructuring unhelpful thought and behavioral patterns related to schizophrenia and coexisting mental health conditions, like depression.
- Family therapy: This strives to improve communication, understanding, and empathy among family members.
- Dialectical behavior therapy: This uses the framework of CBT and adds mindfulness practices to help improve coping and emotional regulation.
- Cognitive remediation therapy: This helps improve cognitive function through structured exercises.
- Acceptance and commitment therapy: This aims to help the person accept symptoms and life experiences and see them from an outside perspective that matches what they value in life.
- Group therapy: This provides psychotherapy support in a group setting to help build a sense of community among people with schizophrenia.
- Social skills training: This uses role-playing to strengthen interpersonal and communication skills.
- Assertive community treatment: This coordinated community-based care plan provides access to treatment, rehabilitation, and support services.
- Psychoeducation: This is an empowerment strategy that teaches the person and their loved ones about schizophrenia, its management, and the importance of treatment adherence.
Schizophrenia affects everyone differently. A comprehensive management plan may include general habit modification, well-being practices, or medical procedures to address symptoms that don’t respond to treatment.
Examples of other management strategies for schizophrenia, if applicable, may include:
- Electroconvulsive therapy: This involves applying controlled electrical pulses to the brain. Doctors typically only recommend it for symptoms that may not respond to other treatment strategies.
- Repetitive transcranial magnetic stimulation: This uses a device that generates magnetic fields that can stimulate brain areas related to schizophrenia symptoms. Doctors generally recommend it only when other approaches haven’t worked.
- Lifestyle modifications: These may include eating a balanced diet, getting quality sleep, doing regular physical activity, and stopping any substance use.
- Relaxation and stress reduction techniques: These include well-being practices for stress management, like meditation, mindfulness, or mind-body arts.
Management of schizophrenia requires a multidisciplinary approach that focuses on the needs of the individual. Medications, psychotherapy, and support interventions can make up a comprehensive, long-term care plan.
Because schizophrenia can affect everyone differently, it may take time to identify the types of medications and therapies that work best. With consistent management of schizophrenia, it’s possible to control symptoms and improve the overall quality of life.