Treatment methods of schizophrenia

2021-07-15 05:04 PM

They have different side effects and often lead to people taking the drug always looking for ways to reduce their dose or quit.

Anti-psychotic drugs

Most people diagnosed with schizophrenia are already on some sort of medication, although the dose can be reduced or even taken for a stable period. Chlorpromazine, haloperidol, and clozapine are the three most used drugs. Their biggest effect is quiet. They also have a direct effect on hallucinations and paranoia, although their effects also vary widely for different individuals. Chlorpromazine and haloperidol are effective only for positive symptoms of schizophrenia: clozapine is a new drug that is effective in treating negative symptoms even when other forms are ineffective. fruit. Antipsychotics are effective for people with schizophrenia for an average inpatient stay of less than 15 days, whereas in the past it took months, years, or for life. Although antipsychotic medications can be an important protective factor against relapse, relapse rates still account for approximately 40% one year after initial treatment and 15% in subsequent years (Sarti & Cournos, 1990). ). In general, they are more effective in delaying than preventing recurrence.

The use of antipsychotics is not without problems. They have different side effects and often lead to people taking the drug always looking for ways to reduce their dose or quit. For example, side effects of chlorpromazine include dry mouth and throat, drowsiness, vision disturbances, weight gain or loss, skin sensitivity to sunlight, constipation, and depression. The most significant problem, however, is the extrapyramidal symptoms. These symptoms include parkinsonian symptoms, tardive dyskinesia. About a quarter of people who take long-term or very long-term neuroleptic have these symptoms. There is no risk of these symptoms with clozapine treatment. However, those who take it are at increased risk of developing granulomatous leukemia, which can lead to significant damage to the immune system.

Less than 25% of people living in the community adhere to the drug regimen (Douohue et al., 2001). This does not appear to be related to socio-population variables, the severity of the disorder, or even extended to people with extrapyramidal syndromes. In contrast, poor adherence was associated with attitudes towards medication, expectations of drug efficacy, social support, and quality of treatment association (Douohue et al. 2001). Poor memory can also contribute to poor compliance.

Strategies to improve self-discipline in taking medication regimens include education, development of quality treatment links, and support for people with poor memory. Slow-acting injections may also be beneficial. One of the new strategies for educating people about drug use is motivational interviewing (Miller and Rollnica, 2002). This neutral approach does not entail attempts to persuade drug use. On the contrary, it encourages the client to choose whether to use the drug after exploring the costs and benefits of taking the drug. This process gives the client a certain degree of control, improving the therapeutic bond because the therapist is no longer seen as a commanding officer. It also provides an opportunity to identify and correct misconceptions about drugs.

Dose reduction: early signs

The psychological and physical consequences of prolonged drug use have prompted clinicians to search for new ways to reduce drug doses. One approach is to identify “early signs” on the basis that many people with schizophrenia and their families are able to detect situational changes in behavior and emotions before relapse. . Herz & Welville (1980) found that 70% of people with schizophrenia and 93% of their families are aware of such changes. These changes usually occur in a predictable and regular order. Its progression usually occurs within the same month, and in some cases, years, before it becomes more serious. The “early signs” approach assumes that when the individual is comfortable, The dose can be reduced or even stopped completely. When they notice changes in the risk of relapse, they need help (usually according to a predetermined plan of care), and increased medication in combination with/or psychotherapy. to prevent recurrence (Birchwood et al. 2000).

This approach can also work. For example, Gaebel et al. (2002) compared outcomes in 363 people with schizophrenia who received intervention according to “early signs” or prolonged medication after the onset or relapse phases. Those who received the “early signs” intervention took more than 2 years of medication less than the other group. However, based on the criteria of mental illness, social adaptation, and subjective comfort, the effect did not make any difference.

ECT

In the past ECT was the mainstay of treatment for schizophrenia and had certain results. Through meta-analysis, Tharyan (2002) concluded that about half of those treated with ECT had an overall improvement in function when compared with those receiving placebo. However, the effect does not last long. Furthermore, ECT is less effective than antipsychotics. Combining antipsychotics with ECT is also short-lived, and only affects about one-fifth to one-sixth of patients. For these reasons, people now limit the use of ECT while increasing drug and psycho-social therapy.

Psychological approaches

Psychoanalytic approaches

One of the first forms of psycho-social therapy for schizophrenia was by Harry Stack Sullivan in the early 20th century. Sullivan (1953) argued that schizophrenia is the growing difficulty of living increase due to problems in personal and social relationships. The so-called “personality decadence” is merely a perpetuation of childhood personal discontents. His therapeutic approach includes examining personal histories and the consequences of relationship patterns on maladaptive personalities, documenting their relationships with their doctors in everyday life. The most prominent difficulties are often: suspicious of others, two-way in relationships, sometimes looking forward, sometimes fearful of meeting people with close relationships. This conflict can be resolved through psychotherapy. The course of therapy aims to improve psychosis to help the patient become more stable and mature. Sullivan considers psychotherapy to be very important and advocates psychotherapy for people with schizophrenia. However, his approach was less effective than adjuvant therapy and so far, Sullivan's therapy is almost unused.

Family intervention

Given the recognition that high levels of NEE contribute to the recurrence of schizophrenia, many studies have focused on family interventions to alleviate NEE. One of the early studies in this area was by Leff & Vauglin (1985). The authors randomly surveyed people with schizophrenia who had at least 35 hours/week of contact with other family members with high NEE and offered interventions or routines. Interventions include psycho-educational programs focused on methods of reducing NEE in the home, family support and opportunities for family therapy. This program has achieved great results. Nine months after therapy, only 8% of the participants in the therapy group had a relapse compared with 50% in the control group. After 2 years,

Falloon et al. (1982) also took a similar therapeutic approach. The intervention program includes education about the role of family stress in triggering episodes of schizophrenia and working with families to develop skills to deal with family problems. Their results are also impressive. After 9 months, only 5% of people with schizophrenia in therapy-engaged families had a relapse, compared with 44% in conventional therapy. After 2 years, the recurrence rate was 16% in the study group and 83% in the control group. On this and other basis, Pharoah et al. (2000) concluded that family intervention reduced the risk of relapse by half compared with drug therapy. They also note that the family intervention also reduced the frequency of hospitalizations, length of stay, and improved self-efficacy in taking medication.

Cognitive-behavioral therapy

There are two forms of cognitive-behavioral therapy that are increasingly used by people with schizophrenia. The first is stress management, which involves working with individuals to help them cope with the stress associated with psychotic experiences. The second type, known as belief altering, involves attempts to change the individual's paranoid beliefs.

Stress management

Approaches to stress management include a detailed assessment of individuals' problems and experiences, their triggers and consequences, and the strategies they can use to cope. Once problems are identified, the therapist and client work together to develop specialized coping strategies to help clients cope more effectively. Potential strategies include cognitive techniques such as distracting the wrong thought or questioning its meaning, increasing or decreasing social activity to disengage from false thoughts. or low mood and use breathing or relaxation techniques.

In a longitudinal study following this approach, Tarrier et al. (2000) randomly surveyed people with schizophrenia taking medication either in combination with stress management or supportive counseling. The stress management intervention consisted of 10 sessions over 10 weeks followed by 4 reinforcement sessions at 1 year. By the end of the first course of therapy, those who received the intervention had significantly improved compared to those in the supportive counseling group. Meanwhile, those in the drug-only group tended to worsen. One-third of people in the stress management group experienced a 50% reduction in psychotic experiences. This rate in the support counseling group is only 15%. 15% of people in the stress management group and 7% in the supportive counseling group had all positive symptoms. In the drug-only group, no one achieved this target. After one year, there was still a significant difference between the groups. After 2 years,

Changing beliefs

Belief modification involves using two types of cognitive interventions, using words and performing expected behaviors to deal with delusional and/or hallucinating beliefs. Verbal modality helps the individual to see delusions as one of the possibilities. The client should not be told that his or her beliefs are wrong but may ask him or her to pay attention to a different view that the therapist offers. New possibilities can be tested in the “real world”. Another similar process is used to deal with hallucinations by focusing the patient's beliefs on their strength, determination, and determination. Test the intended behavior by confronting thoughts more directly with specific behaviors.

Due to disagreement with such an approach, the number of studies aimed at evaluating this type of intervention is also small. However, Jones et al. (2000) also did a meta-analysis of the results of four randomized trials and showed a reduction in both frequency and effect of hallucinations. Furthermore, as the persuasiveness of the delusions was reduced, so did the associated stress disorders. Overall, among those taught to deal with delusions or hallucinations, the recurrence rate was half that of those who were not taught.

Jones et al. (2000) analyzed 3 studies of specific interventions in-depth. One of them is the study of Haddock et al. (1998) compared the cognitive approach by questioning the content of the hallucinogen with the cognitive approach by avoiding the hallucinogen. Both are effective for a short time, reducing the frequency of hallucinations and limiting its impact on daily life. However, those who were taught to question the content and nature of the hallucinations said they believed more firmly than the avoidant group that the voice was their thoughts.

Drury et al. (2000) also have a diverse intervention study. Interventions include both individual cognitive therapy and group cognitive therapy. Attendees learn how to deal with delusions and hallucinations. In addition, they also participate in a part of a 6-month family psychological education program and a group activity program to practice life skills. The results of these interventions were compared with those who participated in programs such as sports, recreation, and social groups. The results of the short- and medium-term interventions are quite impressive. Participants in the therapy group recovered faster. After 9 months, 56% of the control group still had moderate to severe problems, while this rate was 5% in the intervention group. However, after 5 years, there is no difference.