Schizophrenia Therapy

Schizophrenia is a severe, chronic mental disorder that causes people to experience a distorted reality.
Schizophrenia Therapy
The main treatment commonly involves psychotropic medication combined with counseling.

What is Schizophrenia?

Schizophrenia is a severe, chronic mental disorder that causes people to experience a distorted reality. This condition is characterized by frequent audio and visual hallucinations, delusions, disordered thought processes, and abnormal behaviors that negatively affect one’s daily functioning. Thus, schizophrenia can be extremely disabling and life-altering for both the individual and his/her loved ones.

People with schizophrenia often experience social stigmas that are hard to shake. These individuals are often characterized as being “violent,” “unpredictable,” and even “dangerous.” However, studies suggest that the opposite is true – in many cases. In fact, the results indicate that those with schizophrenia tend to be shy, and more withdrawn, preferring to be left alone, than those without the condition.

Common Signs and Symptoms of Schizophrenia

People with Schizophrenia often complain of “hearing voices” – voices that others don’t hear. In addition, these individuals may come across as “being paranoid” to others. Moreover, many times, people with schizophrenia truly believe that others are “after them” and/or trying to read their minds and control their behaviors – even when that is untrue and irrational. The belief that others are plotting against them is a hallmark sign of paranoid schizophrenia. As a result, these individuals tend to be continuously terrified, anxious, depressed, withdrawn, and/or extremely agitated. More so, it’s not uncommon for them to experience chronic delusions, catatonia, and/or vivid hallucinations.

Because of these strange behaviors, previous psychologists, medical doctors, psychiatrists, and scientists believed that these individuals were possessed by demons, who tormented them with fears of being exiled, harmed, killed, shunned, and/or imprisoned.

The main proponent of schizophrenia is distortion. In other words, it distorts the way the brain processes stimuli from the world around them. In fact, studies have compared the scans of healthy brains to the brains of those affected with schizophrenia and found significant “differences” in the frontal lobes and temporal lobes, and the hippocampus in those with the condition, as compared to those without it.

Results suggest the frontal and temporal lobes, and the hippocampus is somewhat “smaller” in those with schizophrenia,  as compared to those without it. Moreover, individuals with this condition appear to lose brain volume every year until properly treated.

What Causes Schizophrenia?

The exact cause of schizophrenia is currently unknown, however, there appear to be certain risk factors that may play a pivotal role in the development of this disorder.

Research suggests that a combination of genetic and environmental factors may be precursors to the condition. Moreover, the results indicate that approximately 50% of those affected with schizophrenia either abuse or frequently use drugs and alcohol, or are addicted to them.

Although substance abuse and addiction are not commonly believed to cause schizophrenia, these issues may make the condition worse for some people, possibly triggering other psychological issues, such as stress, anxiety, depression, and/or suicidal thoughts.

When Does Schizophrenia Generally Arise?

Schizophrenia usually presents during early adulthood – during the late teens to mid-twenties. It’s important to understand that it is usually friends, co-workers, romantic partners, and/or loved ones that first spot the signs and symptoms of the disorder – not the individual suffering from it. In fact, most affected people cannot tell that something is wrong for a long time – if ever. They may also be resistant or in denial when told that they need to see a trained professional for help.

How Common is Schizophrenia?

Schizophrenia is considered a rare psychiatric condition because only about 1% of the population (approximately 2 million people) appears to be affected by it – or at least, diagnosed with it and treated for it.

What Methods, Approaches, and Techniques Are Commonly Used During Schizophrenia Treatment?

Once a proper schizophrenia diagnosis is rendered by a psychologist or psychiatrist, treatment can begin. Trained and qualified mental health professionals use a variety of methods, approaches, and techniques to treat people with this condition. The tactics used depend on the type of schizophrenia and the severity of it.

The main treatment, however commonly involves treatment with psychotropic medications (i.e. lithium), sometimes combined with anti-anxiety and antidepressants, and counseling. Some schizophrenics, who have milder versions, can be treated on an outpatient basis, while schizophrenia with more severe versions may require frequent hospitalizations and involuntary admittance to skilled nursing facilities (nursing homes) and/or residential homes.

What Happens During the First Visit with a Qualified and Trained Mental Health Professional (Psychologist and/or Psychiatrist) for the Treatment of Schizophrenia?

During the first visit, a qualified and trained mental health professional will ask the individual and/or his/her family members about any signs and symptoms – things they have noticed that are unusual. Then, the doctor will evaluate the individual through observation and a physical examination.

If a previous intake has not been performed in advance by an intake specialist, the doctor will inquire about the individual’s medical and psychological history, medications, hospitalizations, signs and symptoms, behavioral changes, place of residence, moods, contact information, treating doctors, official name, email address, age, gender, sexual orientation, sexual habits, partner/spouse, family background, family members with schizophrenia or mental disorders, etc.

Note: Lab tests to definitively diagnose schizophrenia are currently unavailable, so most doctors use a variety of tools (i.e. x-rays, brain scans or imaging, and blood tests) to rule out other conditions and addictions.

Then, the doctor will perform a comprehensive physical on the affected individual. If the first visit is with the individual’s primary doctor, he/she will most likely refer the individual to a psychologist and/or psychiatrist, who can better analyze and diagnose the disease. Psychiatrists and psychologists use specially designed interview and assessment tools to accurately evaluate individuals with a variety of mental health disorders.

During this time a psychologist and/or psychiatrist will properly assess the severity of the disorder and prescribe an appropriate treatment plan. Since this disorder affects people differently, it’s not uncommon for doctors to work together to treat the individual with counseling and medications. The goal of using both a psychologist and psychiatrist is to provide the best treatment for the individual, so he/she can experience some level of normalcy in his/her life.

The most common treatments for schizophrenia include medications, psycho-social therapy, family therapy, hospitalizations, and electroconvulsive therapy (ECT). As mentioned above, medication is the first line of defense for reducing the symptoms of schizophrenia. However, additional treatments may be used to help the individual recognize triggers that may be causing their psychotic episodes.

Keep in mind that schizophrenics are often unfairly characterized as “dangerous,” “unpredictable,” and “violent.” However, statistically, the opposite is actually true. According to studies, only those with advanced forms of the disorder – typically those experiencing vivid hallucinations and hearing voices – exhibit aggressive behaviors, however, it’s important to understand that most of the time, these behaviors stem from fear – not deliberate aggression.

Therefore, although those with schizophrenia may, in some severe cases, be a danger to themselves and others – they do not tend to be suicidal. In fact, these individuals are usually quite shy, quiet, and withdrawn, preferring to be left alone.

Should I Seek Treatment for My Loved One, Who I Suspect Has Schizophrenia?

There is no cure for schizophrenia and it is a hard condition to properly treat. Therefore, there is no way for you to “fix” your loved one, reduce his/her symptoms or improve his/her behavior by yourself. That is why those with the condition require professional help. Therefore, if you suspect that your loved one has schizophrenia, it is imperative that you schedule a consultation with his/her primary doctor and/or a psychologist or psychiatrist – to determine if he/she does, in fact, have this disorder.

The good news is, a qualified psychologist and/or psychiatrist can help both you and your loved one regain a level of normalcy. And, if your loved one is diagnosed with a severe case of the disorder, a psychologist and/or psychiatrist can offer your loved one treatment options and referrals that can reduce his/her symptoms and ease the load on both of you.

What Should I Look for in a Mental Health Professional for My Loved One with Schizophrenia?

Although schizophrenia is rare, thankfully, it is not a completely foreign concept to most trained and experienced mental health professionals. Therefore, the most important thing to look for in a mental health professional for your loved one with schizophrenia is someone who is highly trained to work with individuals with this disorder. Ask for references and proof of education and training in the field.

Ask about success rates, hourly costs for services, how often he/she will need to see your loved one, per week, and about his/her approach to therapy and treatment. You may also want to ask about the medications he/she normally prescribe for this condition, and what a possible treatment plan may look like for your loved one.

Ultimately, however, your choice in doctor is going to boil down to who you and your loved one feel most comfortable and safe with. In other words, who you both feel provides your loved one with the best outcome. The goal should always be for your loved to be as independent as possible. Therefore, look for a doctor with lots of previous experience with different forms of schizophrenia and a personality or approach that meshes with your own. Find your therapist on TherapyTribe to help with Schizophrenia.

Post-COVID Update

For some people with severe mental illnesses, like schizophrenia, COVID was confusing and emotionally-distressing. However, for others, COVID played little-to-no role in their everyday lives. In fact, a 2021 study found that some schizophrenics actually experienced an improvement in their psychosis during COVID. The population that was most affected by COVID was paranoid schizophrenics, who already feel like someone, or the world, in general, is out to get them. During COVID, paranoid schizophrenics tended to believe that Asians were trying to kill them with the virus, and the government was trying to kill them with the vaccines. Therefore, for many paranoid schizophrenics, COVID caused a spike in their symptoms.    

According to a 2021 study, COVID-19 patients with a history of schizophrenia also have a high risk of dying, as compared to patients without this history. This is because many schizophrenics are unaware of simply do not care about contracting COVID and passing it on to others. As a result, they are unlikely to receive the vaccine, making the risk of becoming extremely ill and dying from it higher. Schizophrenics are also less likely to tell someone if they feel ill, which also increases their risk of developing COVID. Researchers also found that the most common symptoms of schizophrenics, who experienced changes in thought processes and behavior during COVID, were atypical delirium and confusion, however, this was commonly overlooked by mental health professionals, who were unsure of what to look for during this time. It is important to understand that people with schizophrenia are mentally ill and neurodivergent, which means they think differently than others, so things that are important or scary to others (neurotypical and not mentally ill) are not necessarily important or scary to them. 

Post-COVID schizophrenia therapy for these individuals is designed to ease their stress, angst, fears, and depression, so they do not experience a “flare” in symptoms. However, because of the stress and anxiety surrounding COVID, in general, the medications, such as lithium, of some schizophrenics needed to be altered to ease the tension and control their symptoms. Thus, the goal of schizophrenia therapy now is to assuage the fears of these individuals, and try to help them understand that the “voices” in their heads are not real. 

Understand, however, that treating schizophrenia has always been challenging, but it has become even more challenging since the inception of COVID – with the paranoia of non-mentally ill people invading their minds. Therefore, the aim of post-COVID schizophrenia therapy is to help get clients and patients back on track or help them stay on track, if there has been no change in their behavior since COVID.

References

Mayo Clinic. (2019). Schizophrenia. Retrieved from https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443

Fond, G., Boyer, L., Favez, M., Brunel, L., Aouizerate, B., Berna, F., … Schandrin, A. (2016). Medication and aggressiveness in real-world schizophrenia. Results from the FACE-SZ dataset. Psychopharmacology, 233(4), 571–578. Retrieved from https://doi.org/10.1007/s00213-015-4167-8

Hamzelou, J. (2018). Scans reveal subtypes of schizophrenia. New Scientist, 8. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a2h&AN=128966377&site=ehost-live

Brain scans could help early schizophrenia diagnoses. (2011). Therapy Today, 22(1), 5. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a2h&AN=59224572&site=eho

Miralles, C., Alonso, Y., Verge, B., Setó, S., Gaviria, A. M., Moreno, L., … Martorell, L. (2014). Personality dimensions of schizophrenia patients compared to control subjects by gender and the relationship with illness severity. BMC Psychiatry, 1(41), 242–262. Retrieved from https://doi.org/10.1186/1471-244X-14-151

Brown, S., & Mitchell, C. (2012). Predictors of death from natural causes in schizophrenia: 10-year follow-up of a community cohort. Social Psychiatry & Psychiatric Epidemiology, 47(6), 843–847. Retrieved from https://doi.org/10.1007/s00127-011-0392-6

Thoma, P., & Daum, I. (2013). Comorbid substance use in schizophrenia: A selective overview of neurobiological and cognitive underpinnings. Psychiatry & Clinical Neurosciences, 67(6), 367–383. Retrieved from https://doi.org/10.1111/pcn.12072

Nemani K, Li C, Olfson M, et al. (2021). Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry, 78(4):380–386. Retrieved from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2775179

Barlati, S., Nibbio, G., & Vita, A. (2021). Schizophrenia during the COVID-19 pandemic. Current Opinion in Psychiatry, 34(3), 203–210. Retrieved from https://doi.org/10.1097/YCO.0000000000000702

Palomar-Ciria, N., Blanco Del Valle, P., Hernández-Las Heras, M. Á., & Martínez-Gallardo, R. (2020). Schizophrenia and COVID-19 delirium. Psychiatry Research, 290, 113137. Retrieved from https://doi.org/10.1016/j.psychres.2020.113137