Treatments of Schizophrenia PDF

Treatments of Schizophrenia  Discarded approaches to treating schizophrenia — In the past have tried: – Lobotomy – Insulin coma therapy – Electroconvulsive therapy (ECT) – “Warehousing” in psychiatric hospitals Q1: What should be targeted as part of treatme...

Treatments of Schizophrenia  Discarded approaches to treating schizophrenia — In the past have tried: – Lobotomy – Insulin coma therapy – Electroconvulsive therapy (ECT) – “Warehousing” in psychiatric hospitals Q1: What should be targeted as part of treatment of schizophrenia? What needs to be changed/ improved? Q2: How could each of those aspects be addressed? What type(s) of treatments/ approaches work?  So how should we approach the treatment of schizophrenia? — 1) Reduce psychotic symptoms (the positive symptoms): – 1950’s: Antipsychotic medications introduced (also called neuroleptics): – The first anti-psychotic meds were the phenothiazines, of which chlorpromazine (Thorazine) was best known. Other phenothiazines: Stelazine, Mellaril, Prolixin. – Other later antipsychotics: Haldol, Navane. – Second-generation antipsychotics: Clozaril, Risperdal, Zyprexa. Reduce positive (& negative) symptoms. Reducing psychotic symptoms, cont. — But phenothiazines have side effects, esp. tardive dyskinesia See Meet Jeff, Living with Tardive Dyskinesia https://www.youtube.com/watch?v=wMjuM8_vt6I (watch 0:43 – 6:01). — Cognitive-behavioral therapy: has been shown to reduce both positive and negative symptoms Additional Considerations in Treatment of Schizophrenia "Even after a) psychosis has resolved, the b) negative symptoms make it difficult to reestablish a sense of interpersonal connectedness, and c) neurocognitive deficits and other lingering problems make it difficult to resume community functioning." At this time treatment for overcoming each of these hurdles is spotty.  How to approach the treatment of schizophrenia, continued — 1) Reduce psychotic symptoms (the positive symptoms): antipsychotic medications, cog-beh therapy. — 2) Reduce negative symptoms: the newer generation of antipsychotic drugs may help; cog-beh therapy — 3) Improve neurocognitive deficits: medications, or cognitive remediation, also called neurocognitive rehabilitation -- may help — 4) Reduce disability, help cope with having the d/o, & improve functional outcome: e.g., social skills training, occupational training, social services, family therapy; assertive community treatment. Reducing Disability & Improving Functioning: Psychological/ Social Treatments — Coping with stress and conflict — Encourage continued use of medication — Cognitive: recognize and change attitudes toward schizophrenia — Behavioral: operant conditioning, e.g., token economy; also modeling to teach skills, e.g., social skills training — Support groups — Family therapy — Assertive community treatment programs (community mental health inc halfway houses, group homes: “The Lodge”)