What are the most effective treatments for schizophrenia?

Schizophrenia is considered a serious mental disorder that affects the functionality and quality of life of the patient in different areas.

Faced with this pathology, different treatments have been used and tested to improve the life of the affected subject. Pharmacological treatment with antipsychotics has been especially useful during the acute phase of the disease, when the symptoms are more intense, in the same way, it also serves as maintenance treatment, reducing the number of relapses.

But it has been observed that it is necessary to complete the treatment with psychosocial therapy, to achieve a better adaptation of the patient to daily life, help decrease symptoms, improve adherence to treatment, and prevent and decrease the number of relapses.

In this article we will introduce the most effective treatments for schizophrenia and that are considered more recommendable.

• Related article: "What is schizophrenia? Symptoms and treatments "

What do we understand by schizophrenia?

Schizophrenia is classified within the group of psychotic disorders, being considered a serious disorder,

causing the person who suffers to perceive or interpret reality in an abnormal way.

The diagnostic manual of the 5th edition of the American Psychological Association requires for the diagnosis of schizophrenia to meet two or more symptoms of the following: delusions, hallucinations, disorganized language, disorganized or catatonic behavior or symptoms negatives.

These alterations must be present at least 1 month and the signs of the disease must last for at least 6 months, including this period the prodromal symptoms, prior to the episode, the psychotic episode and symptoms residuals.

In this way, we verify that the characteristic symptoms of schizophrenia can be divided into two groups: the positive ones, defined as symptoms of excess (new sensations, beliefs ...); and the negative ones, default symptoms that lead to a decrease in a behavior pattern (the patient is less active, her activity decreases).

Having defined what we understand by schizophrenia, let's see what treatments exist and which of them are more effective.

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The most effective treatments to intervene in patients with schizophrenia

Given the severity and chronicity of this disorder, many different treatments have appeared and been tried. Even so, not all have shown the same efficacy since it will also depend on the characteristics of each patient and the phase of disease in which they are.

In the acute phase of the disease, it has been more effective to look for the protection of the patient, trying to reduce overstimulation and possible damageIn this phase, it can be difficult to carry out psychological therapies, such as cognitive behavioral therapy.

6 or 24 months after the acute crisis of the disease, when it is in the stable phase, training in skills, rehabilitation and psychological treatment, it will be much more productive, the patient being more prepared.

The treatment of choice for patients with schizophrenia, that is, the most used, has been pharmacological, but it has been observed that this treatment does not improve all symptoms in the same way, producing very limited improvements in symptoms negatives.

In this way, It is understood as necessary to include and do a joint treatment with psychological therapy, to improve symptoms that do not decrease with medication and to increase adherence to patient to treatment, since 75% of the patients present irregular adherence to the drugs.

Drug therapy is considered an effective treatment for schizophrenia. The most widely used psychotropic drugs are antipsychotics, the first to be used were the typical neuroleptics as they would be haloperidol and chlorpromazine, these only produced improvement in positive symptoms and could even worsen negative ones. In this way, atypical antipsychotics appeared that, apart from reducing the positive symptoms, also improve the negative ones. and they generate fewer side effects than the previous ones, of these new antipsychotics we can name clozapine and quetiapine.

Also as a biological treatment, with drugs, the neuroleptic depot is used.; the drug is injected intramuscularly, allowing the product to be released for a period of between 2 and 4 weeks. This mode of treatment has been found effective in patients with low adherence or who find it difficult to self-administer the neuroleptic on a regular basis, adequately complying with the treatment.

As already mentioned, it is advisable to carry out a psychological treatment in a complementary way to the pharmacological one. It has been proven that those that present more efficacy are assertive community treatment, training in social skills, integrated multimodal packages and sheltered employment procedures for rehabilitation labor. So, let's see what are the most effective psychological treatments in cases of schizophreia.

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1. Assertive community treatment

The assertive community treatment of Arnold Marx, Leonard Stein and Mary Ann Test presents as main objectives that the patient remains linked to the services community mental health services and a reduction in the number and duration of admissions hospitable.

It is a specific treatment for serious mental disorders where a multidisciplinary team (psychologists, doctors, nurses ...) share the responsibility for the treatment and are continuously involved in the care of the patient. Being a team made up of various professionals allows all care to be covered in an integrated and intensive way.

As we have already mentioned, the entry of the subject is avoided, therefore the place of treatment will be the community (the street, home, work ...) in the real places where the affected person lives, in order to be able to work in the natural social system. In the same way, the treatment is individualized, this means that it will be adapted to the capacities, qualities and strengths of each patient.

The individualized intervention carried out in the natural environment where the patient lives predisposes the treatment to be flexible, that is, that adapts to the needs of the moment not only to those of the disorder but to all those that may arise in the individual's day-to-day. Given this need to improve various aspects of the patient's life and to be able to intervene at any time, the coverage, care, will be 24 hours a day.

They will try to make quick interventions, carrying out a close subsequent follow-up, ensuring that the treatment and continue with the improvements, to be able to attend and intervene when a possible risk of abandonment or decompensation. In this way the contact with the patient will be continuous and unlimited, decreasing the intensity as the individual is improving but maintaining close contact to support the needs that may arise.

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2. Social skills training

Training in social skills is essential in patients with schizophrenia given their functional impairment in the social sphere. In order for this improvement and treatment to be generalized, it is proposed to work both the skills not verbal, paralinguistic characteristics, verbal content, interactive balance, and social perception.

Psychiatrist Robert Liberman proposes a social skills program for independent living, presenting the following modules: medication management, symptom self-management, community reintegration, leisure and free time, Conversation Skills, Substance Abuse Management, Job Skills, Intimate Relationships, and Intimate Relationships social.

Liberman pointed out that despite the moderate capacity of schizophrenic patients to generalize the learning of social skills, and the learning difficulties of these by subjects with severe symptoms, individuals who received training in social skills consistently reported a decrease in anxiety Social.

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3. Multimodal Integrated Packages

Multimodal Integrated Packages from Volker Roder, Hans Dieter Brenner and Bettina Hodel They are a group treatment of behavioral orientation divided into 5 hierarchically ordered subprogramsEach subprogram will deal with difficulties at different levels, these levels being related to each other.

The intervention, as has been pointed out, proceeds in a hierarchical manner, first at the lower levels and then we can focus on more complex aspects. The improvements produced with this treatment are observed in both cognitive and social functioning.

The subprograms that work on and treat this therapy are the following: cognitive differentiation, related to attention skills and concept formation; of social perception; verbal communication; social skills and interpersonal problem solving.

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4. Protected employment for job rehabilitation

With the aim that patients with schizophrenia achieve insertion in the workplace, Supported and adaptive work programs are recommendedas it has been observed to be one of the psychosocial treatments whose efficacy for the disorder is supported Similarly, it has obtained better results compared to the rest of the rehabilitation interventions labor.

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5. Other recommended treatments

Cognitive behavioral therapies such as Paul Chadwick's cognitive therapy, with the purpose of the modification of beliefs using mainly the verbal challenge and the reality test, they have probably been considered effective, improving above all positive symptoms, such as delusions and hallucinations and improving adherence to treatment and reducing relapses.

Similarly, psychoeducational intervention is also recommended for patients and their families, so that they know the disease better and are more willing to collaborate in the treatment of is.