Schizophrenia

Treatment

During an episode of schizophrenia, you may need to stay in the hospital for safety reasons, and to provide for basic needs such as food, rest, and hygiene.

Antipsychotic or neuroleptic medications change the balance of chemicals in the brain and can help control the symptoms of the illness. These medications are effective, but they can have side effects. However, many of these side effects can be addressed, and should not prevent people from seeking treatment for this serious condition.

Common side effects from antipsychotics may include:

• Sleepiness (sedation)
• Weight gain

Other side effects include:

• Feelings of restlessness or "jitters"
• Problems of movement and gait
• Muscle contractions

Long-term risks include a movement disorder called tardive dyskinesia, in which people move without meaning to.

Newer drugs known as atypical antipsychotics appear to have fewer side effects. They also appear to help people who have not improved with the older medications. Treatment with medications is usually needed to prevent symptoms from coming back.

Supportive and problem-focused forms of therapy may be helpful for many people. Behavioral techniques, such as social skills training, can be used during therapy, or at home to improve function socially and at work.

Family treatments that combine support and education about schizophrenia (psychoeducation) appear to help families cope and reduce the odds of symptoms returning. Programs that emphasize outreach and community support services can help people who lack family and social support.

Outlook (Prognosis)

Most people with schizophrenia find that their symptoms improve with medication, and some can get good control of their symptoms over time. However, others have functional disability and are at risk for repeated episodes, especially during the early stages of the illness.

To live in the community, people with schizophrenia may need supported housing, work rehabilitation, and other community support programs. People with the most severe forms of this disorder may be too disabled to live alone, and may need group homes or other long-term, structured places to live.

Possible Complications

• People with schizophrenia have a high risk of developing a substance abuse problem. Use of alcohol or other drugs increases the risk of relapse.
• Physical illness is common among people with schizophrenia due to side effects from medication and living conditions. These may not be detected because of poor access to medical care and difficulties talking to health care providers.
• Not taking medication will often cause symptoms to return.

When to Contact a Medical Professional

Call your health care provider if:

• Voices are telling you to hurt yourself
• You are feeling hopeless and overwhelmed
• You are seeing things that aren't really there
• You feel like you cannot leave the house
• You are unable to care for yourself

References

Rakel RE. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders; 2005:115-124.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:1541-1548.

Schultz SH, North SW, Shields CG. Schizophrenia: a review. Am Fam Physician, 2007;75:1821-1829.

Lieberman JA. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia: efficacy, safety and cost outcomes of CATIE and other trials. J Clin Psychiatry, 2007;68:e04.

Addington D, Bouchard RH, Goldberg J, Honer B, Malla A, Norman R, Tempier R. Clinical practice guidelines: treatment of schizophrenia. Can J Psychiatry, 2005;50:7s-57s.