Treatment for schizophrenia
What is the rate of recovery?
After a first episode of schizophrenia, about a quarter make a good recovery within five years, two thirds will have multiple episodes with some degree of disability between these episodes, and 10-15% will develop severe continuous incapacity. Although the illness is severe and disruptive, many people who suffer from it are eventually able to settle down, work and make lasting relationships.
Early symptom onset is more likely to have long-lasting detrimental consequences for the personality of the individual and the remainder of their life. Although it is treatable, relapses are common, and unfortunately it may never fully resolve. It makes working and studying, relating to other people and leading a full, independent life very difficult, and causes families much distress.
What does the future hold?
There is hope for people with schizophrenia and their families. Research is continually leading to new and safer medications and unravelling the complex causes of the disease. Scientists are using many approaches ranging from the study of molecular genetics to demographic and epidemiologic studies to learn about schizophrenia. The development of new technology and scientific method will certainly reveal important insights into this multifaceted illness.
The outlook for people with schizophrenia has improved over the last 25 years. Although no totally effective therapy has yet been devised, it is important to remember that many people with the illness improve enough to lead independent, satisfying lives. As we learn more about the causes and treatments of schizophrenia, we should be able to help more patients achieve successful outcomes.
Studies that have followed people with schizophrenia for long periods, from the first episode to old age, reveal that a wide range of outcomes is possible. When large groups of patients are studied, certain factors tend to be associated with a better outcome – for example, a pre-illness history of normal social, school, and work adjustment. However, the current state of knowledge, does not allow for a sufficiently accurate prediction of long-term outcome.
What can society do?
People who experience schizophrenic breakdown have to cope with terrifying experiences. The vast majority of them do this with dignity, courage and great humanity. They need to be able to live their lives as ordinary citizens, taking on the responsibilities as well as the freedoms of that role. This includes being able to work, learn and take part in leisure activities in the same way as other people can. Popular prejudice often prevents this – for instance, through misinformed campaigns to stop vital supportive residential facilities being built in particular neighbourhoods, or through bullying behaviour in the workplace. These are exacerbated by media reports that persistently link violence with mental illness.
There are three ways in which a modern society can improve life for those people affected by schizophrenia:
- Through public education, reducing ignorance and prejudice about the disorder.
- By implementing anti-discrimination measures, so that affected people are allowed to carry out their daily lives without fear of society.
- By improving the therapeutic services available, and ensuring that treatment programs are carried out in partnership with the individual, their families and friends, and an adequately resourced team. This partnership should have access to the appropriate resources such as employment, training, education, leisure and accommodation.
What treatments are available?
Effective treatment involves a number of different approaches. Ideally it is most effective when given early in the illness. Some form of medication is essential for most cases. However, this should be in combination with education about the disorder, support and counselling for the emotional effects, and psychological training in how to manage those symptoms that continue despite medication. This work should be carried out both with the individual, and their family and/or close friends.
Probably the best treatment plan is one developed in partnership with the person and their family. This may include attending a rehabilitation program to enable them to return to work, regain social contact with others, and care for themselves. It can be carried out within a hospital setting but increasingly it is possible to assist people to live in their own homes, and indeed there are many reasons why this could be advantageous. In many services a team of professionals including nurses, social workers, psychologists, occupational therapists, physiotherapists and others are able to contribute their different skills in assessing and enhancing the abilities of the affected person. In some areas people who have experienced mental illness are employed in this process, through giving advice, counselling and support, as well as becoming skilled therapists themselves. No mental health professional can understand the distress of mental illness as well as someone else who has had the experience. Self-help groups are another way of using this valuable expertise.
Since schizophrenia may not be a single condition and its causes are not yet known, current treatment methods are based on both clinical research and experience. These approaches are chosen on the basis of their ability to reduce the symptoms of schizophrenia and to lessen the chances that symptoms will return.
What are effective treatments
The goal of treatment is to help the person resume a life that is as normal as possible. At first, treatment focuses mainly on removing the symptoms. It is essential that drug treatments are combined with practical help and support for the young person and their family. To obtain the best outcome, everyone involved, including the young person, the family, the psychiatric team, education and social services, need to work together from an early stage.
