Schizophrenia Treatment Options – Then and Now

 

Schizophrenia treatment options have varied over the years. There were many that were used in the 19th century that ranged from inhumane to experimental.
In particular, the poor, who lacked financial assets, were locked away in asylums where they often were kept confined in straitjackets. Many were tied to their beds and left for weeks at a time.

Fever therapy was one of the popular schizophrenia treatment options.
High fevers were induced because it was believed this would lessen the symptoms of schizophrenia.

Radical treatments included chiseling the skull. This was done to “let the devil out”. As late as the 1940’s, ice-pick lobotomies were performed. Drilling holes in the patient’s head and inserting items into the brain often resulted in death. Another version of the lobotomy was to insert the ice pick through the eye socket.

Other schizophrenia treatment options used included “dousing therapy”, which was used by psychiatrists. One example was a 19th century psychiatrist, Dr. Willard, who was in charge of an asylum in a town near the border of Rhode Island and Massachusetts.
His treatment consisted of putting the patient in a box filled with holes and lowered under water. When air bubbles stopped rising, the patient was removed and revived. The belief was when the patient almost drowned and was revived, the ‘madness’ would leave him and he would begin anew.

Everything from eating a roasted mouse to swinging the patient round and round in an attempt to “shake out the madness” was considered to be acceptable schizophrenia treatment options.

Today great strides have been made. There is not a cure for schizophrenia; however, there has been extensive research resulting in ways of treating the symptoms of schizophrenia successfully.

A treatment team is an integral part of managing schizophrenia. This team will commonly include:

1. Nurses

2. Doctors

3. Psychologists

4. Psychiatrists

5. Case managers

6. Social workers

7. Family members and friends of the patient

 

Hospitalization

The hospitalization of people with schizophrenia is not as prevalent as it has been in the past.
Many people were sent to live in asylums before the disorder was understood as fully as it is today.

The majority of patients currently benefit from outpatient treatment. If the need arises due to acute psychotic episodes, schizophrenia treatment can include hospitalization for a period of time.
Often this depends on the availability of insurance to cover the hospital stay as well as other factors.

Hospitalization for schizophrenia disorder – even acute episodes – is usually only needed for a short time. The majority of the time spent in the hospital is for starting new medications or putting people back on a medication they may have stopped taking. Again, this depends on how well they respond to treatment and if they will not be a threat to themselves or others.

In the past, patients were often restrained. Only on rare occasions is this used today.

As a rule, it is only necessary to protect the patient’s safety or the safety of others.
In a hospital setting, there are many schizophrenia treatment options. Medication is one, but therapy has been quite successful for treating the symptoms of schizophrenia. There are group as well as individual sessions that allow doctors to assess the patient’s symptoms and decide on the best treatment plan.

A hospital stay can also be beneficial for providing patients with a setting that is conducive to controlling symptoms of schizophrenia. This is called “milieu” therapy and is one of the schizophrenia treatment options used mainly for patients who are having difficulties maintaining a regular schedule. A time for eating and a time for sleeping are important to recovery and this is one of the focuses of this type of therapy.

There are even residences in some communities that provide this therapy for those who are released from the hospital.
They live in a residence where their surroundings are controlled. This therapy is one of the schizophrenia treatment options shown to be quite beneficial for reducing the incidence of recurring symptoms for many.

 

Nursing Care Plan for Schizophrenia

When patients are hospitalized, a nursing care plan for schizophrenia must be established. This plan is adjusted according to schizophrenia types. They vary somewhat for those with paranoid schizophrenia, catatonic schizophrenia or disorganized schizophrenia.

The nursing care plan for those who are diagnosed with paranoid schizophrenia include interventions that are different than interventions for catatonic and disorganized schizophrenia.

The following are examples of interventions for those with paranoid schizophrenia:

• Limited contact is recommended to begin with when a patient is newly admitted to a hospital. Brief visits are best and the contact with other staff members should be minimal.
The goal is to build trust and dependability.

• The nurse should never touch the patient without first telling him what they are going to do and asking for his permission. This helps to establish trust.

• It may be necessary to postpone a procedure if the patient becomes agitated.

• The nurse should not make promises that cannot be kept. A patient will often ask for things that cannot be provided at the time.

• The patient should never be threatened.

• When a patient with paranoid schizophrenia hears voices, the nurse should ask what the voices are saying. Reassurance includes telling the patient that while the nurse does not hear the voices, they know that he is hearing them.

• Certain limits should be set while avoiding a disciplinary approach.

The interventions for disorganized and catatonic schizophrenia have many similarities.
Spending time with both is recommended and should be a priority even if he does not respond.
When speaking to him, talk about things that are in the present. If the weather is warm, say so. If it is winter and there is snow on the ground, talk about the snow and tell him it is winter.

Talk directly to the patient and not about him.
Even if he does not respond, he can hear and is generally aware of his surroundings.
He should be encouraged to get up and move around every two hours. When it is time for him to eat or get up and move about, tell him what is expected.
Do not ask him if he would like to go. Often the patient will not talk and this makes it difficult to determine if he is physically ill.

 

Assess the patient for signs of illness or pain.

Those who are diagnosed with schizophrenia often have periods of time when they are quite hyperactive.

The nurse should be especially watchful during this time so that injury is avoided. Additionally, violent behavior can occur suddenly. Staying alert to this possibility is essential as well.

Getting help immediately will prevent injury to the patient, the nurse or others.

Schizophrenia Treatment Options include Medication

Treatment of schizophrenia includes antipsychotic medicine. This medicine includes typical antipsychotics which were first used in the 1950s and the most common, atypical antipsychotics, which have been in use since the 1990s.

Medication is used particularly for reducing severe symptoms of schizophrenia.

 

The following are examples of typical antipsychotic medications:

• Chlorpromazine

• Fluphenazine

• Haloperidol

• Molindone

• Thiothixene

• Thoridazine

• Trifluoperazine

• Loxapine

 

Examples of atypical antipsychotic medications are:

• Aripiprazole

• Clozapine

• Olanzapine

• Risperidone

• Quetiapine

• Ziprasidone

Neurotransmitters are chemicals in the brain that relay information. The signals are sent between nerve cells telling the body to perform certain functions, such as breathing. When they become out of balance they can affect concentration, sleep and mood.

Antipsychotic medications are effective schizophrenia treatment options for correcting problems with neurotransmitters, which include serotonin, glutamate and dopamine.

Schizophrenia patients often experience milder symptoms as well as an increased period between the symptoms when antipsychotic drugs are combined with therapy. The use of therapy without medication does not appear to work as well as the combination.

When schizophrenia medications are prescribed, the right type and dosage will vary.
Each patient responds differently and side effects are another consideration. Some can be quite severe.

One side effect of medications chosen as schizophrenia treatment options is extrapyramidal symptoms (EPS). This can cause patients to experience restlessness, slow movement, tremors, body stiffness and a loss of the ability to make facial expressions. EPS is more often caused by the use of typical drugs than atypical drugs. This is one more reason atypical drugs have become more popular

Another side effect is Tardive Dyskinesia (TD). This condition causes involuntary twitching movements of the body, mainly affecting the face and mouth. It can range from moderate to quite severe. Although it is generally not reversible, sometimes partial reversibility is possible.

Other side effects caused by atypical medications include high cholesterol, high blood sugar and weight gain. The patient may experience menstrual problems or a lack of interest in sex or a decline in sexual abilities. A higher sensitivity to the sun and rashes on the skin have been reported as side effects of atypical medications.
This is one reason for the importance of a support team.
Family members, friends, nurses and others can stay alert for the appearance of side effects so the patient’s doctor can monitor them and change medications if necessary or adjust the dosage.

Typical schizophrenia drugs were once considered to work only on the neurotransmitter, dopamine and atypical schizophrenia drugs worked through the other neurotransmitters. However, according to recent studies, both types affect dopamine more so than the other neurotransmitters.

Schizophrenia treatment options often include the use of mood stabilizers and antidepressants as well as antipsychotic medications. The medications are generally available in pill form, but injectable antipsychotics can be a viable option. Injections are not usually given unless the patient refuses medication and it is necessary for their safety or the safety of others.

 

Psychotherapy Schizophrenia Treatment Options

Schizophrenia treatment options include psychotherapy, which is beneficial for patients diagnosed with the disorder.

Cognitive Behavioral Psychotherapy (CBT) is used by therapists to help patients see that their thinking processes and perception are distorted.
Used the majority of the time on patients who are taking medication, this is a method that can help by allowing the patient to control their reaction when experiencing psychotic symptoms.

Psychotherapy through private therapists or community mental health facilities is another of the schizophrenia treatment options that can be beneficial.
This is called supportive psychotherapy and through individual as well as group settings, the patient receives support to help them socialize with others, keep appointments, monitor their health and resources for assistance as needed. Schizophrenia treatment, including medication, may take a long time (weeks or months) to begin working.

 

Drug Abuse can Complicate Symptoms of Schizophrenia

Schizophrenia is often complicated by drug abuse.

Many people with schizophrenia have substance abuse problems. It is thought that they use drugs or alcohol to break away from the symptoms they are experiencing as a result of schizophrenia or as a way of medicating themselves against these symptoms.

The truth is substance abuse makes the symptoms worse rather than alleviating them. This means patients must be treated for both – schizophrenia and substance abuse.

Is there such a thing as drug-induced schizophrenia?
There are many who believe schizophrenia can be caused by drug abuse, but this is not true. Those who abuse drugs or alcohol may experience drug-induced psychosis; however, this is not the same as schizophrenia.
This psychosis is temporary and schizophrenia is not. Drug use is thought to be a triggering factor for someone who has been diagnosed with schizophrenia, but it is a medical condition that would be present with or without the use of drugs.

Schizophrenia treatment options vary from one patient to another. There are many things that must be considered before implementing a plan for treatment.
In addition to the original diagnosis and the plan for treatment, periodic reevaluations must be conducted in the event that adjustments to the plan are necessary.

A diagnosis of schizophrenia is not the end of the world. There are many myths associated with schizophrenia. It is important to remember they are based on fear – not reality.
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