Schizophrenia

Lifelong treatment with medicines and psychosocial therapy can help manage schizophrenia, though there is no cure for it. These treatments are needed, even when symptoms ease. Some people may need to stay in a hospital during a crisis if symptoms are severe.

A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include a psychologist, social worker, psychiatric nurse and case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.

Medicines

Medicines are the main schizophrenia treatment. Antipsychotic medicines are the most prescribed drugs. They’re thought to control symptoms mainly by affecting brain receptors for different neurotransmitters, or chemical messengers. Most antipsychotic medications act on dopamine and serotonin receptors. A new antipsychotic drug, xanomeline and trospium chloride, affects the acetylcholine receptors.

The goal of treatment with antipsychotic medicines is to manage symptoms at the lowest possible dose. To get the desired result, a healthcare professional or mental health professional may try different drugs and combinations of drugs, and different doses, over time. Other medicines also may help, such as antidepressants, mood stabilizers or antianxiety drugs. It can take several weeks to see whether the medicine helps symptoms get better.

Because medicines for schizophrenia can cause side effects, people with schizophrenia may not want to take them. A psychiatrist monitors for side effects and in some cases may order blood work. Medication choice can be guided to avoid certain unwanted side effects.

Ask your healthcare professional about the benefits and side effects of any medicine that’s prescribed. Antipsychotic medicines can be classified as either first-generation or second-generation. Second-generation antipsychotic medicines may have fewer side effects related to muscle movements. This includes tardive dyskinesia, which causes repetitive and involuntary movements, such as grimacing, eye blinking and other movements. Tardive dyskinesia is sometimes permanent.

Second-generation antipsychotics

The newer, second-generation medicines available as a pill or capsule include:

• Aripiprazole (Abilify).
• Asenapine (Saphris).
• Brexpiprazole (Rexulti).
• Cariprazine (Vraylar).
• Clozapine (Clozaril.
• Iloperidone (Fanapt).
• Lumateperone (Caplyta).
• Lurasidone (Latuda).
• Olanzapine (Zyprexa).
• Paliperidone (Invega).
• Quetiapine (Seroquel).
• Risperidone (Risperdal).
• Xanomeline and trospium chloride (Cobenfy).
• Ziprasidone (Geodon).

First-generation antipsychotics

First-generation antipsychotics include:

• Chlorpromazine.
• Fluphenazine.
• Haloperidol (Haldol).
• Perphenazine (Trilafon).

Long-acting injectable antipsychotics

Some antipsychotics may be given as a long-acting shot in the muscle or under the skin. They usually are given every 2 to 4 weeks but sometimes less often or more often. Ask your healthcare professional for more information on shots. They may be an option for people who prefer fewer pills. Also, shots may help people stay with their treatment plans.

Common medicines that are available as shots include:

• Aripiprazole (Abilify Maintena, Abilify Asimtufii, Aristada).
• Fluphenazine decanoate.
• Haloperidol decanoate.
• Paliperidone (Invega Sustenna, Invega Trinza, Invega Hafyera).
• Risperidone (Risperdal Consta, Perseris, others).

Psychosocial interventions

Once symptoms get better, continuing to take medicine is important. It’s also important to take part in psychological and social or psychosocial treatments, including:

• Individual therapy. Talk therapy, also known as psychotherapy, may help improve patterns of thought. Also, learning to cope with stress and identify early warning signs of the return of symptoms can help people manage their illness.
• Social skills training. This focuses on making communication and social interactions better and making people with schizophrenia better able to take part in daily activities.
• Family therapy. During this therapy, families learn how to deal with schizophrenia. They also get support.
• Vocational rehabilitation and supported employment. This counseling focuses on helping people with schizophrenia prepare for, find and keep jobs.

Most people with schizophrenia need support in daily life. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the treatment team can help find resources. With the right treatment, most people with schizophrenia can manage their illness.

Hospital stay

During crisis periods or times of severe symptoms, people may need to stay in a hospital for their safety. A stay in a hospital also makes sure they eat right, get enough sleep and bathe regularly.

Electroconvulsive therapy

Healthcare professionals may consider electroconvulsive therapy (ECT) for adults with schizophrenia who don’t respond to drug therapy. Electroconvulsive therapy (ECT) is a procedure done with medicine that puts you to sleep, called general anesthetic. While you are asleep, small electric currents are passed through the brain, causing a therapeutic seizure that lasts 1 to 2 minutes. ECT also can help people with depression.