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World Schizophrenia Day- Schizophrenia treatment in India -- with medication, therapy & other alternatives

Everything you wanted to know about multidisciplinary treatment with medications and psychosocial intervention.

World Schizophrenia Day is observed on May 24 every year. A number of myths surround schizophrenia because of which there are a number of misconceptions. Schizophrenia is well-known but most misunderstood mental illness. The term schizophrenia means split mind. The disorder can be extremely disruptive. Persons suffering from this mental disorder have weakened perception or expression of reality and significant social or occupational dysfunction. Schizophrenics demonstrate disorganized thinking, and experiences delusions or hallucinations. Their ability to carry out everyday tasks and care for themselves or others is largely impacted. The disorder also makes it difficult for them to maintain relationships. They could become catatonic i.e. they don t move or respond to others around them for long periods.

Treatment is multidisciplinary

There is no cure for schizophrenia but it can be treated. The most effective approach encompasses medication, behavioral therapy, social skills training and psychotherapy. The process of recovery is lifelong. Adequate treatment can enable most to manage their symptoms, restore their ability to function, develop the support they need and enjoy a meaningful life.

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Antipsychotic medications are the backbone of schizophrenia treatment. Psychosocial and family dynamics also play a role in the recovery. Psychosocial interventions like behavioral therapy, psychotherapy and social skills training can aid improvement while a warm and non-critical family environment can plays an important role in preventing relapses. According to a study published in the Annals of General Psychiatry in 2009 by Indian psychiatrists, the recovery rate among schizophrenia patients in India was as high as 30%.[1]

Medications - the foundation of schizophrenia treatment

Antipsychotics or neuroleptics are drugs that are used to control symptoms and manage a mental disorder like schizophrenia. They affect the action of some nerve signal transmitting chemicals like dopamine, serotonin, etc. in the brain. The desired improvement in symptoms may take several weeks after trying out different dosages or combinations of various drugs.

The older generation or typical antipsychotics include prochlorperazine, haloperidol, fluspirilene, perazine, loxapine, etc. They help treat psychotic symptoms like hallucinations, paranoia, etc. But they are known to cause significant neurological side effects like tremor and hence, less frequently prescribed. Long-term use can increase the risk of developing tardive dyskinesia, a movement disorder, in which there are slow, repetitive, involuntary movements of the body.

The newer generation or atypical antipsychotics include aripiprazole, clozapine, paliperidone, quetiapine, etc. They have a lower risk of severe side effects and hence, generally preferred. They commonly cause side effects like dry mouth, constipation, headaches, dizziness, sedation, restlessness, sexual dysfunction, breast swelling or tenderness, decreased blood pressure, weight gain, etc.

Dosage reduction and drug discontinuation can cause withdrawal symptoms like increased sweating, nausea, vomiting, diarrhea, loss of appetite, muscle pain, anxiety, agitation, restlessness, sleeplessness, etc.

Benzodiazepines may be used as anxiolytics or antianxiety agents for short-term relief of severe anxiety in a schizophrenic.

Cognitive problems, the major source of dysfunction and disability, have the greatest impact on quality of life in schizophrenics. Memory issues may make it difficult for them to hold down a job and maintain social relationships. Scientists have designed a method to improve mental ability in schizophrenics. According to US researchers, targeted suppression of inflammation in the body coupled with standard therapy can improve their cognitive problems. The scientists have found that tocilizumab an immune-suppressing drug can significantly improve the cognitive abilities suggesting that targeting inflammation may be a feasible therapeutic target at least for cognitive impairment.

A few may need electroconvulsive therapy

During electroconvulsive therapy (ECT), seizures are induced by applying electric current to the brain in patients under general anesthesia. ECT, often used in addition to antipsychotics, is considered for catatonia (unresponsiveness for long periods to others around), past history of good response to ECT, and in treatment resistance (poor response to medication alone). A combination of ECT and antipsychotics has been shown to have a significant advantage with respect to rapidity or quality of response.[2]

Psychosocial interventions

Psychosocial interventions like cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment are essential for the treatment to be successful especially in patients with comorbid conditions like substance abuse, depression, etc. The interventions can reduce psychotic symptoms and relapse, and improve recovery, remission, and illness progression [2].

Cognitive therapy can help recognise negative thinking, change the unhelpful thinking and behavior and work towards effectively responding to current challenging situations. Psychoeducation refers to educating and empowering patients and their families to understand and accept the illness and cope with it in a successful manner [3]. Being around family and friends whom they trust and are comfortable with can help schizophrenics battle the condition. Social skills training can help improve their communication and social interactions and prepare them for jobs. Assertive community treatment is a multidisciplinary approach that provides treatment, rehabilitation, social support, employment or housing services tailor-made to the patient s specific needs.

Schizophrenics are more likely to attempt suicide. Women and those with a history of alcohol or drug abuse and/or major depressive disorder were much more likely to so. Hence, a knowledge of the added risk of suicidal attempts associated with substance abuse and childhood abuse could help therapists improve targeting and outreach.

Patients with acute paranoid schizophrenia will need to be monitored and may require hospitalization for treatment. But most patients don t need to be constantly monitored. They can effectively manage their condition and are capable of living an independent life. In fact, Indian psychiatrists have found that 72% of schizophrenia patients were living independently and 40% of them were able to find employment again following treatment [1].

Yoga can help too

Yoga can help improve quality-of-life in schizophrenia due to its effects on cognitive and negative symptoms [5]. The severity of the condition can be better coped by learning to control it early on in the disease. Some yoga techniques can help manage and relieve some of the symptoms.

Diet plays a key role

Eating a high-fat diet can protect you against schizophrenia. A ketogenic diet, a diet that is high in fat but very low on carbohydrates, provides alternative energy sources in the form of fat breakdown products (ketone bodies) and may help to bypass abnormally functioning energy pathways in the brain cells of schizophrenics.

References

1. Srivastava AK, Stitt L, Thakar M, Shah N, Chinnasamy G. The abilities of improved schizophrenia patients to work and live independently in the community: a 10-year long-term outcome study from Mumbai, India. Annals of General Psychiatry. 2009;8:24. doi:10.1186/1744-859X-8-24

2. Chien WT, Leung SF, Yeung FK, Wong WK. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatr Dis Treat. 2013;9:1463-81. doi: 10.2147/NDT.S49263. Epub 2013 Sep 25. Review. PubMed PMID: 24109184; PubMed Central PMCID: PMC3792827.

3. B uml J, Frob se T, Kraemer S, Rentrop M, Pitschel-Walz G. Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families. Schizophr Bull. 2006 Oct;32 Suppl 1:S1-9. Epub 2006 Aug 18. Review. PubMed PMID: 16920788; PubMed Central PMCID: PMC2683741.

4. Mehta UM, Keshavan MS, Gangadhar BN. Bridging the schism of schizophrenia through yoga-Review of putative mechanisms. Int Rev Psychiatry. 2016 May 17:1-14. [Epub ahead of print] PubMed PMID: 27187680.

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