Treatment

Antipsychotic medications, also known as neuroleptics, are the cornerstone of treatment. Until the 1990s, antipsychotics generally were much more effective in controlling positive symptoms than negative symptoms. A new generation of antipsychotics provides more effective management of both positive and negative symptoms. These newer antipsychotics include clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon) and aripiprazole (Abilify).

Newer antipsychotic medications have fewer side effects. For example, there's a lower incidence of tardive dyskinesia (TD) with the newer drugs than with the older medications. TD results in involuntary movements of your mouth, lips, tongue and other parts of the body. Other possible side effects of the older medications include interactions with other medications, risk of seizures and reductions of the white blood count. The new drugs represent a real advance in the treatment of schizophrenia and have led to greater independence and a higher quality of life for many people with schizophrenia.

In general, the goal of treatment with antipsychotic medications is to effectively control symptoms at the lowest possible dosage. The appropriate medication and dosage vary widely from person to person. Even with good treatment, you may experience relapses despite ongoing drug treatment, but medications may reduce the frequency of relapses.

Although the newer-generation medications have fewer side effects and better adherence rates, nonadherence with medication schedules remains a difficult problem. Unfortunately, some people with schizophrenia fail to adhere to treatment recommendations and deny that anything is wrong with them. The nature of the disorder may prevent them from seeking help or adhering to treatment on their own.

Although medications are the mainstay of treatment to reduce signs and symptoms, many people with schizophrenia also benefit from nondrug therapies. These may include:

• Individual therapy. Cognitive therapy involves a therapist helping you learn ways of coping with stressful thoughts and situations to reduce your risk of a relapse. You may learn to change negative patterns of thought and behavior into ways that put you in control of your thoughts and feelings. Your illness may have made it more difficult for you to do things in your daily life that people without schizophrenia may take for granted. A therapist can also help you comply with your schedule of medications.

• Family therapy. Both you and your family members may benefit from therapy that provides support and education to families. Your symptoms have a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse and can help you stick to your schedule of drug treatment. Conversely, you may not do as well if family members distance themselves from you and are less understanding and more critical of your illness.

• Rehabilitation. Training in social and vocational skills necessary to live independently is an important part of recovery. With the help of a therapist, you can learn social skills such as good hygiene, cooking and traveling. People with schizophrenia who are in programs to train them in social skills or for jobs — and help them find and keep jobs — seem to experience much greater improvement in symptoms than do those who don't receive vocational training and job placement.

Today fewer people with schizophrenia require long-term hospitalization because more people than before respond positively to medications or other forms of treatment for schizophrenia.

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