You'll learn about "TREATMENT FOR SCHIZOPHRENIA".

1. TREATMENT FOR SCHIZOPHRENIA
PRESENTED BY
SARITHRA K

2. Overview
 Schizophrenia is characterized by a broad spectrum of cognitive and emotional
dysfunctions that include delusions and hallucinations, disorganized speech and
behavior, and inappropriate emotions.
 The symptoms of schizophrenia can be divided into positive, negative and
disorganized.
Positive symptoms are active manifestations of abnormal behavior, or an
excess or distortion of normal behavior, and include delusions and hallucinations.
Negative symptoms involve deficits in normal behavior on such dimensions as
affect, speech, and motivation.
Disorganized symptoms include rambling speech, erratic behavior, and
inappropriate affect.

3. Treatment and Outcomes
 Before the 1950s the prognosis for schizophrenia was bleak. Treatment options
were very limited. Agitated patients might be put in straitjackets or treated with
electroconvulsive therapy.
 Dramatic improvement came in the 1950s. when a class of drugs known as
antipsychotics were introduced.
 Clinical outcomes shows that 15 to 25 years after developing schizophrenia, around
38 percent of patients have been recovered with the help of therapy and
medications, patients can function quite well.
 Despite many advances in treatment over the last 50 to 60 years, a cure for
schizophrenia has not materialized.
 Mortality of schizoprenia can reduces life expectancy.

4.  Recent data from UK show that,
→Men with schizoprenia die 14.6 years earlier than would be expected based on
national norms.
→For women with schizoaffective disorder the reduction in lifespan is 17.5 years.
 Some of the factors implicated in the early deaths of patients with schizophrenia and
schizophrenia related illnesses are long term use of antipsychotic medications such
as obesity, smoking, poor diet, use of illicit drugs and lack of physical activity.
 The risk of suicide in patients with schizophrenia is also high compared to the
general population with about 12 percent of patients ending their lives in this way.
 In general, overall mortality is lower in patients who are treated with antipsychotic
medications compared to untreated patients.

5. PHARMOCOLOGICAL APPROACHES
 Medications are widely used in the treatment of schizophrenia. Over 60 different
antipsychotic drugs have been developed. The common property that they all share is
their ability to block dopamine D2 receptors in the brain.
 Medications were introduced in 1950. It can be regarded as one of the major medical
advances of the 20th century. They are called first-generation antipsychotics or
typical antipsychotics.
 First-generation antipsychotic medications like chlorpromazine (Thorazine) and
haloperidol (Haldol), which were used to treat psychotic disorders. Sometimes
referred to as neuroleptics.
 First-generation antipsychotics work best for the positive symptoms of
schizophrenia. In quieting the voices and diminishing delusional beliefs, these
medications provide patients with significant clinical improvement. however.
Common side effects of these medications include drowsiness, dry mouth, and
weight gain.

6.  In the 1980s a new class of antipsychotic medications began to appear. The first
of these to be used clinically was clozapine (Clozaril). This drug was introduced
in the United States in 1989.
 The reason why this medication is called second generation antipsychotics is
that they cause fewer extrapyramidal symptoms than the earlier antipsychotic
medications such as Thorazine and Haldol.
 Although it was initially believed that second-generation antipsychotics were
more effective at treating the symptoms of schizophrenia.
 The new research showing that antipsychotic medications may actually
contribute to the progressive brain tissue loss we see in schizophrenia.

7. PSYCHOSOCIAL
APPROACHES
FAMILY THERAPY
→ This idea was to reduce
relapse in schizophrenia by
changing those aspects of the
patient–relative relationship that
were regarded as central to the EE
construct.
→ At a practical level, this
generally involves working with
patients and their families to
educate them about schizophrenia,
to help them improve their coping
and problem-solving skills, and to
enhance communication skills,
especially the clarity of family
communication.
● Family Therapy
● Case Management
● Social skills training
● Cognitive remediation
● Cognitive behavioral therapy
● Individual Treatment

8. CASE MANAGEMENT
→ Case managers are people who help patients find the services they need
in order to function in the community.
→ The case manager acts as a broker, referring the patient to the people
who will provide the needed service.
→ Assertive community treatment programs are a specialized and more
intensive form of case management. It involve multidisciplinary teams with limited
caseloads to ensure that discharged patients don’t get overlooked. The
multidisciplinary team delivers all the services the patient needs.
→ Assertive community treatment programs are cost-effective because they
reduce the time that patients spend in the hospital. They also enhance the stability
of patients’ housing arrangements.
→ These approaches seem to be especially beneficial for patients who are
already high utilizers of psychiatric and community services.

9. SOCIAL SKILLS AND TRAINING
→ Patients with schizophrenia often have very poor interpersonal skills.
→ Social-skills training is designed to help patients acquire the skills they
need to function better on a day-to-day basis.
→ These skills include employment skills,
relationship skills,
self-care skills,
skills in managing medications or symptoms.
→ For conversational skills, these components might include learning to
make eye contact, speaking at a normal and moderate volume, taking one’s turn in a
conversation, and so on. Patients learn these skills, get corrective feedback, practice
their new skills using role-playing, and then use what they have learned in natural
settings

10. COGNITIVE REMEDIATION
→ Cognitive remediation training is to help a patients improve some of
their neurocognitive deficits.
→ The hope is that these improvements will translate into better overall
functioning.
→ The cognitive remediation training does seem to help patients
improve their attention,
memory,
executive functioning skills
→ Patients who receive cognitive remediation training also show
improvements in their social functioning

11. COGNITIVE BEHAVIORAL THERAPY
→ The goal of these treatments is to decrease the intensity of positive
symptoms, reduce relapse, and decrease social disability.
→ Working together, therapist and patient explore the subjective nature of the
patient’s delusions and hallucinations, examine evidence for and against their veracity
or veridicality, and subject delusional beliefs to reality testing.
→ Although the results from the early research studies were encouraging,
whether CBT is an effective treatment for schizophrenia is now the subject of some
debate. Current data suggest that CBT is not very helpful for negative symptoms.
→ A recent meta-analysis also suggests that CBT is no better than control
interventions in the treatment of schizophrenia.

12. INDIVIDUAL TREATMENT
→ Individual treatment for schizophrenia now takes a different form. Hogarty and
colleagues have reported on a controlled 3-year trial of what they call “personal
therapy.”
→ Personal therapy is a nonpsychodynamic approach that equips patients with a
broad range of coping techniques and skills. The therapy is staged, which means that
it comprises different components that are administered at different points in the
patient’s recovery.
→ Educating patients about the illness and its treatment (psychoeducation) is also
helpful Patients who receive psychoeducation in addition to standard treatment are
less likely to relapse or be readmitted to the hospital compared to patients who
receive standard treatment only.
→ These patients also function better overall and are more satisfied with the
treatment they receive. All of this highlights the importance of including patients in
their own care and increasing their knowledge and understanding about their illness.

13. THANK YOU