Introduction
Changes and transformations in diseases have become a daunting task for medical researchers to come up with measures that will not only cure but also control the prevalence of these diseases. While the research goes on, more and more people continue falling prey to diseases. Schizophrenia can be identified among the diseases that have had great negative implications on the American people and the country’s economy. This disease has cost families large sums of money for treatment while others have been subjected to psychological and social turmoil. Schizophrenia is a disorder that disables the brain in a severe and chronic manner. In most cases, the condition has been found to have its onset during an individual’s early adulthood. The period of onset has been identified mostly during the early twenties in men and late twenties in women and in some cases, early thirties. Statistics point out that each year, more than 2.4 million Americans aged 18 and above fall prey to this chronic brain disability condition. Unlike few other medical conditions, study shows that the rate of effect of Schizophrenia has an equal frequency in both sexes (Alonso et al, 2008, p. 2006). Based on this large number of people suffering from the medical condition and the burden associated with it, it was necessary that remedies were found. Consequently, several curative and preventive measures were developed. This paper will examine the different treatments of Schizophrenia and their effectiveness and side effects if present.
Schizophrenia is usually characterized by several symptoms. For instance, patients of the disease are bound to hear voices which, in most cases, are non-existent and hence unheard by other people. In other conditions, they tend to believe that their minds are readable and controllable by other people. Furthermore, schizophrenic patients sometimes live in fear that a plot is being hatched to have them destroyed. Accordingly, they react by total withdrawal or developing an extreme sense of agitation (Alonso et al, 2008, p. 2007). However, people suffering from this disease could be thought to be perfectly normal. This only changes when they express their thoughts. Besides heavy treatment costs, people suffering from schizophrenia usually lead a life of total reliance on others as a result of their inability to hold onto a job (Carr 1983, p. 63).
Research and development in order to come up with treatment have shown the two most important forms of treatment. The first one is the use of drugs, also referred to as antipsychotic drug treatment and the second type involves the use of psychological approaches to alter the intensity of the situation. This can also be referred to as a psychosocial treatment for schizophrenia. These two main approaches have shown substantial improvement in the control and treatment of the disease. However, they have also been characterized by side effects and diverse responses from different people.
Antipsychotic Drug Treatment
In the 50s the medical realms introduced medication for mental illnesses. The first medication to be developed was antipsychotic chlorpromazine. Since the first development, many other medications have been developed. Developers tried to improve on the existing medications so that fewer side effects could be experienced and also increase response and effectiveness. Antipsychotic drugs have been used successfully in the control of schizophrenia and other mental illnesses. Although the main aim of these drugs is not to cure, it works as an agent for alleviation of the symptoms or reduction of the intensity. Some medications act as agents to short the episode periods. Using these drugs, there are several forms of neuroleptic or antipsychotic medications in the treatment of mental illnesses. The main approach of these medications is their effect on neurotransmitters which alters the way the nerve cells communicate with each other. Developed in the 1950s, the drugs led to great improvements in the way psychosis patients were treated. These drugs assisted in the elimination of hallucinations and other paranoid thoughts. However, the drugs were identified to poses several side effects. To begin with, the drugs led to the stiffness of the muscles, they led to abnormal movements, and in some cases, instances of tremor. With such side effects, it was necessary that researchers found alternative medications that would reduce the side effects but maintain similar or better effectiveness (NIMH, 2009, par. 6).
This led to the development of a new form of drug that had fewer side effects as compared to the former generation of antipsychotics. These were referred to as ‘atypical antipsychotics.’ Since then, these drugs have been often used in the treatment of mental diseases as first-line treatment. The first of this group of drugs to be introduced in the United States was Clozapine or Clozaril. These drugs were specifically more effective in the treatment of schizophrenia in cases where the disease had developed resistance to treatment by other conventional drugs. Clozapine was also effective due to its reduced risks of tardive dyskinesia which is a form of movement disorder experienced during treatment by conventional drugs. To this moment, clozapine is still used extensively in the treatment of schizophrenia. However, it has been identified to contain some serious side effects. The use of these drugs can lead to agranulocytosis which is a disorder of the blood with serious effects. As a result, patients being treated with these drugs have to attend blood checkups after every week or at least once every two weeks (NIMH, 2009, par. 8).
Other forms of drugs used for treating schizophrenia include risperidone, Olanzapine, quetiapine and Ziprasidone. The choice of the right medication by the doctor depends on the type and characteristics of the diagnosed schizophrenia, intensity of symptoms, the family characteristics to respond to the drug and also the family’s response towards the drug’s side effects, the individual’s age and his weight et cetera. On its part, risperidone has been identified to bring forth greater positive results as compared to conventional drugs. Currently, it is also used in the treatment of schizophrenia. In a study carried out by Chen (2008, p. 236), patients using risperidone had a 5% higher chance of exhibiting positive change as compared to other patients using conventional neuroleptics. In addition, risperidone showed the least signs of extrapyramidal side effects (EPS), least dropout rates, and a higher degree of changes in the PANSS score. With such positive attributes, risperidone has been used extensively in the treatment of schizophrenia.
These forms of treatment have however been found to have some side effects and also other challenges in their usage. In a study carried out by Cheng and colleagues (2008, p. 239), the relevance of antipsychotic drugs in the treatment of schizophrenia is emphasized. However, the study pointed out that the use of these drugs leads to hyperprolactinemia, a medical condition that leads to the production of prolactin within the body of an individual. Prolactin is a hormone that plays a major role in preparation for the development of breast milk and also sustaining lactation. Another challenge exhibited by these atypical antipsychotic drugs is the unpredictability of the response of the patient towards treatment.
Another challenge experienced by the use of drugs to treat schizophrenia is the characteristic interconnection of symptoms. This is to say, schizophrenic patients usually experience disorders associated with mood, thought and anxiety. With a combination of all these, it calls for different medications that will deal with the different manifestations. This means that a practitioner will need to prescribe all these different medications in order to attain any form of control of the disease. In addition, antipsychotic treatment has been impeded by high dropout rates. Many of the patients, especially those with chronic cases, fail to hold onto their prescribed medication for more than one year. According to the National Institute of mental health, more than three-quarters of patients stop using the drugs after the first year of use. This behavior is attributed to the perception that they felt no changes or effectiveness of the drug. Secondly, it has also been attributed to the intolerable side effects associated with some of these drugs (Goggin 1993, p. 299).
Psychotherapy
Studies show that the use of medication alone cannot be assured of the best result results. Many researchers have pointed out the need to combine psychotherapy and medication for best results. This would facilitate the treatment of schizophrenia because it was a means that could address these challenges that were associated with medication. There was a need for a treatment method that would not be characterized by side effects like those pointed out in the use of antipsychotic drugs. This resulted in the development of psychological-based methods of treatment like the use of cognitive-behavioral therapy (CBT) and other psychosocial therapies. Psychotherapy plays an important role in the process of treating a schizophrenic patient (NIHM 2009; Goggin 1993, p. 299). To begin with, it acts as a tool by which the psychiatrist can ensure that the patient is adhering to the medication plan. The therapy also ensures that the patient acquires the skills necessary for social wellbeing. Also, this therapy assists the patient to set his goals. The therapy provides assistance like arming the patient with adequate education concerning his state, reassurance, assistance in limit setting, and also enables the patient to undergo a process of reality testing. Considering the difficulties in performing daily duties, it is the role of psychotherapy to ensure that the patients acquire the confidence to cope with life in a way that much fuller and rewarding. These methods have also exhibited great successes in controlling symptoms and episodes of schizophrenia. Similarly, the choice of the psychological method to be used depends on the characteristics of the disease and the individual’s own characteristics. This part of the paper will examine the use of these approaches in controlling the intensity of the symptoms and the episodes of schizophrenia among the patients.
Therapy is also a tool with which relapse can be reduced. According to Grohol (2006, par. 5), family therapy can allow a schizophrenic member to reduce his chances of relapse. Grohol further argues that during the first year after discharge from the hospital, schizophrenic patients from high-stress families usually relapse at an approximated 50%-60% of their time. However, if given good family therapy treatment, this rate drops to a mere 10%. These points show that therapy is an integral part of the treatment of any mental illness including schizophrenia. Examples of these therapies will be examined one after the other in order to bring out a clear picture of the situation (Beck 1984).
Use of cognitive Behavioral Therapy
Cognitive-behavioral therapy has been successfully used in several circumstances and its effectiveness proved in the control of several mental illnesses. Among the illnesses that CBT has been proved to be effective is schizophrenia (Bradshaw 1998, par. 12). However, the efficacy of this method in the treatment of schizophrenia has been characterized by limited research. In addition, the application of this method does not take a generic approach. According to Bradshaw, the application of CBT on schizophrenia is limited. Its application has been employed uniquely in certain cases. This limited employment is however attributed to the absence of a theoretical framework (Kingdom and Turkington 1994, p. 12).
Effective cognitive-behavioral therapy involves the joining phase which is aimed at establishing the relationship between the patient and the psychiatrist (Novalis et al 1993, p. 243). This leads to the second phase which is referred to as the socialization phase. This phase helps the patient to understand the goals of cognitive-behavioral therapy and hence give his consent and cooperation. Thirdly, the patient is exposed to early treatment which targets the established faulty thoughts i.e. “I can not do this because I am not man enough to do it.” This stage is followed by the middle phase that aims at identifying the situations that lead to stress and hence leading to episodes. Three stages are given major consideration, the situations that lead to stress, the effect of the disease on the perception and chances of relapse. This phase calls for a total alteration of the thoughts of the “self” so that the patient can develop a positive and more realistic view of himself. This phase of psychotherapy is followed by the ending phase. This phase involves identifying appropriate ways through which the patient’s thoughts will be dealt with in relation to the ending of the treatment. In addition, the phase puts into consideration the plans that should be developed to maintain the gains achieved during treatment. This is an important step because it allows for a sustainable change in the life of the patient. This eventually leads to the final phase of follow-up. This phase ensures that the patient is followed up after the end of the treatment so that sustainability can be identified. This phase also allows the psychiatrist to know the effectiveness of the method used on the patient. The phase can also help the psychiatrist to identify whether the patient needs particular care (Bradshaw 1998, par. 6; Ellis 1970, p. 56).
Conclusion
Schizophrenia is a disease that can have adverse effects on an individual, his family and society as a whole. This means that its treatment does not only benefit the patient but also society. The benefits accrued through the control of this disease include the reduction of financial burdens and reverting of the social trauma associated with the disease. Society as whole witnesses an increase in its productivity as the individuals who could have been unproductive are remolded back to productivity.
For several decades, schizophrenia has witnessed a change in its treatment methods beginning in the 1950s with conventional drugs. These drugs were characterized by several challenges and drawbacks. Among them were the numerous side effects that some of the patients found unbearable. In addition, the medications were characterized by high rates of dropouts. Many patients dropped out of medications after feeling that they were experiencing no improvements. Others stopped continuing with the medications attributing their departure to unbearable side effects. This led to the formation of better drugs that exhibited reduced side effects and even improved rates of dropouts. This brought the atypical antipsychotics which reduced the side effects and increased the effectiveness of the treatment.
Unfortunately, these drugs still experienced challenges. For example, schizophrenia is characterized by various disorders o of mood, anxiety and thoughts. This calls for a combination of several drugs that would address these disorders. Also, the problem of dropouts was not eliminated completely. Although at a comparatively lower rate, some patients stopped using the drugs in their first year of treatment. To address this, behavioral therapy and cognitive therapy were developed. These were later combined to come up with the cognitive-behavioral therapy that combined the two approaches. These skills assisted the patients to stick to medications and also develop skills that would help them cope in society. Cognitive-behavioral therapy also allowed the patients to change their thought patterns that had been altered by the disease to come back to normal. Generally, this therapy assisted the patients to develop skills that would enable them to live a life that is productive and full. Up to this moment, these are the methods used to control the symptoms and episodes of schizophrenia. Hopefully, more effective ways might be developed in the future so that very few people will be affected by the disease.
Reference List
Alonso, J., Ciudad, A., Casado, A and Gilabertem I. (2008). Measuring schizophrenia remission in clinical practice. Canadian Journal of Psychiatry, 53(3), 2002-2006
Beck, A. (1984). Cognitive approaches to stress. In R. Woolfolk & P. Lehren (Eds.), Principles and practice of stress management. New York: Guilford
Bradshaw, W. (1998). Cognitive-Behavioral Treatment of schizophrenia: A case study.
Journal of Cognitive Psychotherapy: An International Journal. 12(1): 13-25. Web.
Carr, V. (1983). Recovery from schizophrenia: A review of patterns of psychosis, Schizophrenia Bulletin, 9,95-121.
Chen, Y. L., Cheng, T. S. and Lung, F. W. (2008). Prolactin Levels in Olanzapine treatment correlate with positive symptoms of schizophrenia: Results from an open-label, flexible-dose study. Prim Care Companion Journal, 2008, 10(2): 230-245
Ellis, A. (1970). The essence of rational psychotherapy. A comprehensive approach to treatment. New York: Institute for Rational Living.
Goggin, W. (1993). Cognitive therapy with schizophrenics? Journal of Cognitive Psychotherapy: An International Quarterly, 7, 297-258.
Grohol, J. (2006). Schizophrenia treatment. Web.
Kingdom, D., & Turkington, D. (1994). Cognitive therapy of schizophrenia. New York: Guilford Press.
National Institute of Mental Health. (2009). Schizophrenia. Web.
Novalis, P., Rojoewicz, S., & Peele, R. (1993). Clinical manual of supportive psychotherapy. Washington: American Psychiatric Press.