How Schizophrenia Is Treated

Treating schizophrenia typically involves using a combination of antipsychotic medications—the first-line treatment for this mental disorder—and psychotherapy. Research has shown that 75% of those who took antipsychotics showed a marked to moderate degree of improvement after six weeks compared with those who took a placebo. 

Recovery while living with schizophrenia is often seen over time and involves a variety of factors, including self-learning, peer support, school and work, and finding the right treatment.

Prescription Medications

Antipsychotics are the cornerstone of schizophrenia treatment. They affect dopamine and other neurotransmitters in the brain, including serotonin, and are prescribed to reduce acute psychotic symptoms and help prevent recurrence. Ideally, antipsychotic drugs are administered immediately after the first acute psychotic episode while the patient is being monitored. If you’re reluctant to take medications, talk to your healthcare provider about your concerns.

Antipsychotics can help decrease positive psychotic symptoms and support a return to normal functioning. Treatment with these medications should continue after first episode remission as maintenance therapy to prevent psychotic episode relapse.

Antidepressants and anti-anxiety medications may also be used in cases of comorbid mood and anxiety disorders, but they do not treat symptoms of schizophrenia.

First-Generation Antipsychotics

First-generation antipsychotics, also known as typical antipsychotics, were developed in the 1950s. They have generally been classified according to their chemical structure.

Typical antipsychotics were first developed for the treatment of psychosis. Since then, they have also been used to treat other conditions, including acute mania, agitation, and bipolar disorder. 

These medications can cause serious movement problems that can be acute and short term (dystonia) or develop over the long term (called tardive dyskinesia), as well as muscle stiffness, slowing, and tremor. 

Typical antipsychotics include:

• Chlorpromazine (Thorazine)
• Fluphenazine (Prolixin)
• Haloperidol (Haldol)
• Loxapine (Loxitane)
• Perphenazine (Trilafon)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)

Second-Generation Antipsychotics

Second-generation antipsychotics, also known as atypical antipsychotics, emerged in the 1980s. They have been categorized according to their pharmacological properties. 

These medications are called atypical because they are less likely to block dopamine and have a greater affinity to affect serotonin receptors. They therefore cause less movement disorder-related side effects. They do, however, increase the risk of weight gain and diabetes.

Atypical antipsychotics approved to treat schizophrenia include:

• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Clozapine (Clozaril)
• Iloperidone (Fanapt)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Risperidone (Risperdal)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)

Typical and atypical antipsychotics are similarly effective at treating early psychosis. However, atypical antipsychotics are generally preferred over typical ones because they have been associated with fewer extrapyramidal side effects, including dystonia, tremors, rigidity, restlessness, and tardive dyskinesia.

One unique second-generation antipsychotic is Clozaril (clozapine). It’s the only drug approved by the FDA for the treatment of refractory schizophrenia and has been the only one that reduces suicidality. The risks of using this medication include seizures, myocarditis (heart muscle inflammation), and sedation. It also has the potential to lower white blood cell count, so it requires ongoing blood tests to monitor for this.  

Psychosocial Treatments

Psychosocial treatments enable people to compensate for or eliminate the barriers caused by their schizophrenia and learn to live successfully. If a person participates in psychosocial rehabilitation, they are more likely to continue taking their medication and less likely to relapse.

Assertive Community Treatment (ACT)

Unlike other community-based programs that connect people with mental health or other services, ACT provides highly individualized services directly to people with schizophrenia. ACT professionals help these individuals meet the challenges of daily life. They also address problems proactively, prevent crises, and ensure medications are taken.

Cognitive Behavioral Therapy (CBT)

CBT is a form of individual or group therapy aimed to help patients with schizophrenia focus on ways to remedy delusional thinking patterns and associated behaviors. While CBT is seen as standard therapy for people with schizophrenia, meta-analysis shows only a small (and unsustained) improvement in functioning and no significant effect on distress or quality of life outcome in schizophrenia patients.

Family-Based Therapy 

Family education has been proposed as an additional method that can potentially prevent relapse. It involves educating family members about schizophrenia and providing practical advice to prevent relapse, decrease family distress, and help family members support their loved one.

Clinical research in this area is still needed, but researchers say helping a family build a supportive emotional environment can benefit both caregivers and patients and increase the functional abilities of those with schizophrenia.

Substance Abuse Treatment

Patients with schizophrenia have higher rates of alcohol, tobacco, and drug use disorders than the general population, and this common comorbidity is associated with poorer outcomes, including increased psychotic symptoms and poorer treatment compliance.

While exact intervention depends upon the substance use disorder and severity, the American Psychiatric Association advises that if a person shows signs of an addiction, treatment should occur alongside treatment for schizophrenia.

Social Skills Training and Vocational Rehabilitation 

Schizophrenia can impact every aspect of a person’s life, including their ability to develop and maintain relationships and get and keep a job. Community support services can help patients work, shop, and care for themselves, as well as manage a household, build meaningful relationships, and follow through with treatment.

Examples include cognitive remediation therapy, which is designed to improve attention, working memory, and executive functioning required to learn or relearn task completion techniques, and supported employment, where a patient is provided with onsite support from a job coach to promote integration and adaptation.

Alternative Treatments

Animal-Assisted Therapy (AAT) 

Animal-assisted therapy (AAT), also known as animal therapy or pet therapy, refers to the use of service animals to help a person with a physical or mental disorder. AAT may help patients with schizophrenia who are suffering from anhedonia (reduced ability to experience joy and pleasure) to experience more pleasurable feelings. The use of AAT for schizophrenia, however, remains inconclusive, and there is currently not enough evidence to draw any firm conclusions. 

Nutritional Supplements

The use of nutritional supplements in the treatment of psychotic disorders is of growing interest, but clinical trials are limited and have shown inconsistent results.

Specific nutrients are said to be useful as complementary options in the treatment of schizophrenia due to their essential role in proper brain functioning, including omega-3, vitamin D, and group B vitamins. For example, some researchers believe that omega-3 may help treat mental illness because of its ability to help replenish neurons and connections in affected areas of the brain.

Lifestyle

There are many small but effective lifestyle modifications and management strategies that can help someone with a mental disorder such as schizophrenia. 

These include:

• Stopping or quitting smoking and other substance use
• Exercising regularly
• Maintaining a proper sleep routine 
• Eating a healthy diet that includes a variety of foods 
• Spending time with family and friends
• Developing mindfulness techniques and other ways of coping with daily stressors

A Word From Verywell

Schizophrenia is a life-altering illness that can be extremely distressing. However, treatment options for the person and for their family members are available, and there are many of them.

Talking to your healthcare provider about schizophrenia is the first step, but it’s often also the most challenging step since it takes courage to admit that you have a problem. Seeking help can help jumpstart your treatment process. With the right treatments, you can still live a healthy, fulfilling life with schizophrenia and keep symptoms under control.