Before we talk about the stages of the modern treatment of schizophrenia, it is important to talk about the disease itself. Term schizophrenia originated from the Greek schizo – split and fren – mind. Splitting means disorganization of the psyche, lack of harmony, discrepancy, illogicality from the point of view of ordinary people (and not a split personality, how often this is not truly understood).
Schizophrenia is a mental disorder that is caused by a violation of the unity of the processes of thinking and emotional reactions, and which leads to a specific (apatic-dissociative) dementia. Most often in a society it is believed that the most frequent manifestations of the disease are delusions or auditory hallucinations. But professionals first of all pay attention to speech disorganization and disturbed thinking, which lead to significant social dysfunction. The first symptoms often appear in adolescence. The risk of disease, according to various studies, ranges from 0.4 to 1%.
Schizophrenia most often develops at a young age, however, the disease may occur for the first time in children and in old age. The manifestations of schizophrenia are different, and this gives many researchers reason to speak not about schizophrenia as a single disease, but about a group of diseases. It is important to correctly identify and evaluate the first symptoms of the disease in order to promptly begin the treatment of schizophrenia.
1. Sounding thoughts – when thoughts “acquire sonority,” become “audible to others,” sometimes they are quietly heard from the ears, head, chest or abdomen, or in general it is not clear from where. 2. Internal voices that argue among themselves. 3. “Voices,” which comment on the actions, actions, or even thoughts of the sick person. 4. Body passivity (I don’t want to do anything, there is a feeling that someone controls the motor acts, etc.). 5. The feeling of artificiality of thoughts and their alienness – other people’s thoughts, which are invested in the head. Similar changes can occur with feelings – it is not the patient himself who feels hungry, but he is made to feel hunger. 6. Introduction and taking out of thoughts, as well as cessation of thinking (blockage of thoughts). 7. Mental broadcasting (thought broadcast). 8. Crazy ideas of impact, influence – a person interprets the feelings that have arisen so that all changes occur due to external influence (“aliens”, “SBU”, “mafia”, neighbors). 9. Inadequate ideas of identifying oneself with religious or political figures, statements about inhuman supernaturals, etc. 10. Long-term “freezing” in uncomfortable positions, refusals to answer any questions, lying down for several days, curled up in a ball. Or vice versa – motor aimless excitement (they dance, jump, fancifully move around the room, suddenly rush to others around with a cry, they are aggressive), which can last for hours and sometimes days.
These signs are called productive symptoms, as this is something that normally does not normally happen in a person, which is added to his condition.
But the main ones in determining the diagnosis of schizophrenia are the so-called “negative symptoms”: dulling of emotions, diminishing their brightness, indifference to their appearance, untidiness, disturbances in the form of the content of statements, breaks in thoughts, lack of motivation to do anything, social alienation, attention disorders, as well as consistency and consistency of thinking.
Serious distortions of thinking, perception and inadequate emotions lead to the fact that a person is no longer understood by others, he becomes ridiculous, and sometimes aggressive in behavior, becomes socially disadapted. And the subsequent destruction of the psyche leads to a complete emotional and motivational exhaustion. Psychiatrists, the state when a patient with schizophrenia lies curled up and does not leave this state, is called the initial (final) one. And modern treatment of schizophrenia aims to prevent such a state.
Depending on the predominance of certain symptoms, various forms of schizophrenia are distinguished: paranoid, hebephrenic, catatonic, etc. However, there is schizophrenia, in which no “additional” symptoms occur. This is a simple form, which consists in a fairly rapid increase in the defect (deficit) of mental activity, expressed in reducing the energy of behavior, in increasing isolation and alienation from relatives, in emotional destitution, in unusual age-related interests and in striving for hours of meaningless reasoning. First develops a decrease in mental productivity, then lost harmony of reasoning. Patients lose their natural feelings for loved ones, begin to deal with distracted problems, become rude and lonely.
The group of schizophrenic disorders also includes “schizoaffective disorder”, “polymorphic psychotic disorder”, “schizotypical disorder” or “chronic delusional disorder”. Each of them has its own characteristics in the manifestations of the disease, but the treatment, at this stage in the development of psychiatry, is very similar.
In patients with schizophrenia, manifestations of the disease can be combined with depression and anxiety disorders; tuberculosis, the risk of alcohol and drug abuse increases. When the treatment of schizophrenia is not carried out, or is carried out incorrectly, social problems, such as loss of work, loss of social ties (families break up), and poverty, increase.
Previously, the treatment of schizophrenia mainly consisted of isolation from society (long-term hospitalization). Modern treatment of schizophrenia provides a reduction or disappearance of symptoms of the disease, without its isolation and failure of the usual rhythm of life. A hospital room today is considered as a means to quickly achieve improvement under the supervision of medical personnel and is used in cases where the patient cannot take medicines himself or when he is dangerous for himself and / or others.
The main treatment of schizophrenia today is in drug therapy (neuroleptics) and various types of psychotherapy (family, behavioral, and so on).
Modern research suggests that schizophrenia (especially its exacerbation) can be characterized as a violation of dopaminergic regulation.
Patients with schizophrenia show increased dopaminergic activity in various parts of the brain. And the treatment of schizophrenia is to prescribe antipsychotics, which act primarily through the suppression of dopamine activity. And if previously used neuroleptics caused many side effects, modern therapy of schizophrenia with atypical antipsychotics, as a rule, does not cause extrapyramidal disorders in their application. Also an important role in the treatment of schizophrenia is played by psychotherapy and social rehabilitation.
In severe exacerbation of the disease, if the patient is dangerous for himself and / or others, involuntary hospitalization may be necessary. However, when using modern drugs, the duration of stay in the clinic may be short. It is not at all necessary that as a result of the disease an inevitable increase in the degradation of the sick will occur. The incidence of almost complete recovery is increasing more and more.
Over the past fifty years, the main group of drugs in the treatment of various forms of schizophrenia are neuroleptics (antipsychotics).
Until the nineties of the 20th century, antipsychotics from the groups of thioxanthenes, butyrophenones and phenothiazines (chlorprothixene, aminazine, haloperidol and
In the 90s, atypical antipsychotics appeared and treatment became more benign, side effects occurred less often and negative symptoms began to decrease.
Treatment of schizophrenia involves an individual approach to the patient, taking into account the effectiveness of this tool with this picture of the disease, as well as taking into account the tolerability of drugs and possible side effects in different patients.
The main thing in the disadaptation of a patient is often played not by the psychotic symptoms themselves, but by the condition that occurs after a schizophrenic episode. In this regard, psychotherapy and social rehabilitation are very important. Psychotherapy can be carried out individually, together with family members or in a group of such patients (depending on the condition of the patient and the goals set). The patient is taught to correctly interpret their feelings, feelings and thoughts, to solve problems in communication. The inclusion of effective behavioral skills in schizophrenia treatment contributes to the re-socialization of patients, gives them the opportunity to learn and work, to build relationships with people.
• treatment of the first psychotic episode of schizophrenia; • treatment of acute psychotic condition (exacerbation) in schizophrenia; • achieving stabilization of the state; • relapse prevention; • treatment of depression in schizophrenia; • overcoming resistance to pharmacotherapy; • social rehabilitation and psychological rehabilitation.
The treatment of schizophrenia provides for an individual approach in the selection of pharmaceutical preparations and is carried out depending on the clinical manifestations of the disease and the tolerability of patient therapy.
The treatment of schizophrenia requires a great deal of effort by the doctor to explain to the patients and their relatives the essence of the disease. Underestimating the symptoms (especially in the simple form) leads to the wrong treatment (for example, sometimes psychologists, not recognizing the disease, try to treat the manifestations of schizophrenia exclusively psychotherapeutic). When identifying the onset of schizophrenia, they prefer treatment with atypical antipsychotics (sulpiride, solian, risperidone, quetiapine, etc.). And treatment is not limited to the elimination of psychotic disorders. It is important to slow the progression of the disease. Treatment of schizophrenia, continued in the period of remission, helps to prevent relapse and slows the growth of apathetic changes.
Early detection and timely treatment of the first psychotic episode of schizophrenia reduces neurocognitive deficit (deterioration of thinking processes), contributes to the onset of remission and social recovery of patients. A number of studies have proven the benefits of using atypical antipsychotics, such as olanzapine, for the first psychotic episode. It acts more harmoniously on delusions and arousal, as well as on depressive experiences. At the same time, autistic and apatisation of patients is being reversed, the social functioning of patients and the quality of their life are restored.
A number of studies have shown the effectiveness of salian in the treatment of acute attacks of schizophrenia. Its good tolerance makes it possible to use this drug for outpatients. And the fact that it affects the apathetic and autistic components of the disease, as well as depressive symptoms, allows for long-term treatment of a schizophrenic patient with monotherapy (use only one drug).
Antipsychotic therapy is usually aimed at the rapid elimination of productive psychotic symptoms (psychomotor agitation, aggressiveness, hallucinatory-delusional experiences, catatonic-hebephrenic disorders). The duration of adequate neuroleptic therapy of acute conditions may be 1-3 months of outpatient therapy. To achieve a good stable condition in severe exacerbation, 2-4 weeks of inpatient care is required.
After achieving therapeutic remission, treatment of schizophrenia consists in continuing to receive an effective antipsychotic drug (stabilizing therapy), which includes suppressing residual productive symptoms, correcting negative symptoms and restoring the previous level of social and labor adaptation, as well as timely detection of early recurrent disorders and timely strengthening of antipsychotic therapy.
The optimal goal of anti-relapse therapy for schizophrenia treatment is sustained remission. Remission is a condition between the attacks of the disease, in which the patient has improved to such an extent that the remaining symptoms are low-intensity and no longer affect significantly the behavior, allow for normal social and physical functioning.
Treatment of schizophrenia at the stage of stabilization of remission is determined by the tolerance of the selected drug. And the best is the use of the same antipsychotic drug, which was used at the peak of symptoms, only reducing its dosage. The ideal is such a dose of antipsychotic drug, which causes a minimum of adverse reactions and at the same time is effective in eliminating residual symptoms.
Treatment of depression in schizophrenia is often the appointment of both neuroleptics and antidepressants. When prescribing antidepressants and neuroleptics at the same time, the nature of the relationship between depressive and psychotic symptoms in the clinical picture of the disease, and not just their presence, plays an important role. With the development of depressive-delusional states in the framework of bipolar affective disorder, combination therapy with antidepressants and neuroleptics is highly effective. However, in the treatment of acute conditions determined by schizophrenic disorders with elements of depressive disorders, monotherapy with neuroleptics is more effective; and the addition of antidepressants can worsen the condition of patients. And the depression that has arisen already after the transferred psychosis can be effectively eliminated both by adding antidepressants to neuroleptics and by psychotherapeutic help.
Treatment of schizophrenia, its effectiveness, often depend on compliance (eng. Compliance – consent, compliance). In medicine, compliance is the voluntary following of the patient to the treatment regimen prescribed for him, which is manifested in the fact that the patient takes the medicine in time, takes it in the exact dose, comes to the consultation in a timely manner, complies with recommendations on lifestyle and diet. And in this close role can play a close one. It is important that they understand the essence of the disease, know the recommendations of behavior with such patients, and follow these recommendations themselves.
• drug treatment of schizophrenia with modern atypical neuroleptics, which has a stabilizing effect on the psyche, allowing the patient to lead a habitual way of life; • in parallel with drug treatment, cognitive-behavioral psychotherapy is carried out, which will allow the patient to actively and fully engage in life; • with prolonged remission, psychodynamic orientation psychotherapy is possible, which gives the patient spiritual support; • work with family members, teaching patient’s behavior to the patient in the family, not only during the exacerbation of the disease, but throughout the life path.
If you think that you or your relatives need help in diagnosing and treating schizophrenia, start by contacting our Center. You can do this by calling: (044) 228-79-59, (095) 913-69-41.
At the consultation, the psychiatrist, having ascertained the manifestations of the disease, will be able to recommend an optimal recovery strategy. Sometimes, in order to quickly achieve improvement in the condition, hospitalization of schizophrenia is necessary. Thanks to modern drugs, the treatment of patients in the hospital takes 7-10 days, and then the treatment of schizophrenia is performed on an outpatient basis.
Today, the diagnosis of schizophrenia is not a sentence, but, undoubtedly, a serious problem, the solution of which largely depends on the steps taken by both the patient and his relatives. Early diagnosis, full-fledged comprehensive treatment of schizophrenia is the only way to return to normal life.
Integration Center specialists can help you and your loved ones.