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Treatment
Early Intervention Therapy
Schizophrenia patients with a shorter duration of untreated psychosis have a faster rate of recovery than patients with a longer duration of untreated psychosis. This may suggest that patients with a longer duration of untreated psychosis are less likely to seek treatment or are less likely to be able to adhere to treatment due to the severity of their illness. [1]
Early intervention (EI) programs in schizophrenia are aimed at early detection (ED) of the disease and place a greater focus than most traditional treatment strategies on the investment of resources in the early stages of the disorder to reduce the number of people developing chronic disabilities. EI strategies include targeting people at "high risk" for developing schizophrenia and reducing the "duration of untreated psychosis". Services are delivered by a specialized team and are usually resource intensive. Strategies include treatment with antipsychotics to alleviate chemical imbalances associated with the symptoms of schizophrenia, family interventions to evaluate and positively reinforce a support system for the patient, and cognitive behavior skills training to help the patient interact more normally with society [2].
Psychosocial Therapies
Poor psychosocial functioning, which evidence shows is strongly related to impaired social skills in occupational, social and recreational situations, is a defining characteristic of schizophrenia. These impairments in social skills are often present at the onset of schizophrenia and, without psychosocial treatment, tend to remain stable over time [3].
Social Skills Training
Social skills training (SST) programs for patients with schizophrenia aim to train the patient to overcome such impairments by focusing on goal setting, role modeling, behavioral rehearsal, positive reinforcement, corrective feedback, and homework to promote generalization to the wider world.
Role Development
Role Development is a theory-based, patient treatment developed for health care practitioners, including art therapists, to assist individuals diagnosed with schizophrenia to learn roles and their underlying task and interpersonal skills. The therapist conducts an initial interview with the client to determine the roles and skills the client would like to address, and then the patient and therapist discuss types of interactions and activities could participate in to develop these roles or skills, thus forming a treatment plan. The therapist then checks in weekly with the patient and evaluates the patient’s progress. Art therapy treatments are often employed to develop the role of artist, a role particularly suited to this style of intervention. Therapies such as Role Development serve an important purpose in non-ideal treatment environments such as prison or psychiatric facilities.
Non-traditional Physical Treatments
Electro Acupuncture
Electro acupuncture might increase the urinary secretion of 3-methoxy-4-hydroxypheylglycol sulphate, a metabolite of noradrenalin that is inversely related to the severity of illness in schizophrenics. [4] Such alternative physical treatments may prove invaluable to those patients who are unable to undergo traditional physical treatments such as antipsychotics medications due to other medical conditions.
Factors effecting treatment Success
Quality of Life
In a disease such as schizophrenia, chronic side effects of treatment such as weight gain and diabetes may have just as large an impact on quality of life as the acute symptoms of the condition itself [5]. Newer anti-psychotic medications such as Risperidone and Amisulpride can increase the hormone Prolactin, and so the tendency to develop metabolic problems such as diabetes and weight gain [6]. Atypical antipsychotic drugs, such as Olanzapine, in particular cause considerable weight gain. Obesity is associated with a two to threefold increase in the risk of cardiovascular disease, [7] and is thought to be a major risk factor in patients with schizophrenia. The adverse events primarily associated with the newer antipsychotics: hyperprolactinemia, weight gain, and diabetes are likely to influence the desire of patients and their families to continue with medication, and may cause patients to discontinue, with the associated increase in relapse. This would ensure that more time was spent in the relapsed state with its substantial negative impact on quality of life [8].
Family and Social Support
Studies have shown favorable prognosis in patients with good family and social support, early diagnosis and management [9].Duration of untreated psychosis may be influenced by the attitudes of family, friends and society. If patients with schizophrenia are considered dangerous, they may be isolated and treatment may be delayed. Studies have also shown that disharmony between patients' and professionals' understanding of the causes of schizophrenia affects engagement of patients with psychiatric services and treatment in Western and non-Western countries [10].
Attitudes: Medical Care Providers
Social workers are the primary providers of psychosocial treatment to individuals with schizophrenia [11]. Although social workers have remained committed to serving this population, they often feel inadequately prepared for this challenging work, and that the challenges they face in the course of working with persons with schizophrenia may negatively influence their attitudes toward this population. Such attitudes are of particular importance, as they have been consistently linked with negative treatment outcomes among persons with schizophrenia [12].
- ↑ Chow, D H, Law, B T, Chang, E., Chan, R C, Law, C, & Chen, E Y (March 2005). Duration of untreated psychosis and clinical outcome 1 year after first-episode psychosis. Hong Kong Journal of Psychiatry, 15(1), 4
- ↑ Kulhara, P., Banerjee, A., & Dutt, A. (April-June 2008). Early intervention in schizophrenia. Indian Journal of Psychiatry, 50(2), 128
- ↑ Samuels, N., Gropp, C., Singer, S. R., & Oberbaum, M. (Summer 2008). Acupuncture for psychiatric illness: a literature review. Behavioral Medicine, 34(2), 55
- ↑ Samuels, N., Gropp, C., Singer, S. R., & Oberbaum, M. (Summer 2008). Acupuncture for psychiatric illness: a literature review. Behavioral Medicine, 34(2), 55
- ↑ Briggs, A., Wild, D., Lees, M., Reaney, M., Dursun, S., Parry, D., & Mukherjee, J. (Nov 28, 2008). Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation. Health and Quality of Life Outcomes, 6, 105
- ↑ Sander, R. (Dec 2008). Adverse effects of medication for schizophrenia. Nursing Older People, 20(10), 20
- ↑ Wu R-R, Zhao J-P, Jin H (April 25, 2008). Metformin reduces weight gain in patients on atypical antipsychotics. The Practitioner, p.19
- ↑ Briggs, A., Wild, D., Lees, M., Reaney, M., Dursun, S., Parry, D., & Mukherjee, J. (Nov 28, 2008). Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation. Health and Quality of Life Outcomes, 6, 105
- ↑ Salerno, E. M. (Annual 2002). Hope, power and perception of self in individuals recovering from schizophrenia: a Rogerian perspective. Visions: The Journal of Rogerian Nursing Science, 10(1), 23
- ↑ Saravanan, Balasubramanian, K.S. Jacob, Shanthi Johnson, Martin Prince, Dinesh Bhugra, and Anthony S. David. (June 2007). Belief models in first episode schizophrenia in South India. Social Psychiatry and Psychiatric Epidemiology 42(6), 446
- ↑ (Substance Abuse and Mental Health Services Administration, 2001)
- ↑ Eack, S M, & Newhill, C E (Fall 2008). An investigation of the relations between student knowledge, personal contact, and attitudes toward individuals with schizophrenia. Journal of Social Work Education, 44(3), 77