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Treatment
When your friend or relative first becomes unwell he or she is usually treated by the hospital, either as an in-patient or outpatient. After that, the person who has been ill can often be treated while living at home, with the support of family and friends. There are also other support services available, such as the growing development of Community Mental Health Teams.
Medication
This is often the first line of treatment used in schizophrenia. The most widely used drugs are called antipsychotics
Antipsychotics alleviate the symptoms of schizophrenia by changing the activity of chemicals that transmit messages in the brain. The main chemical they affect is called dopamine.
There are two groups of antipsychotic medications:
- Newer drugs, called �atypicals� such as abilify, amisulpride, clozapine, olanzapine, quetiapine, risperidone, sertindole or zotepine
- Older drugs, called �typicals�, such as largactil and haliperidol
The main difference between these groups is the frequency and type of side effects they may cause. Special monitoring is needed for clozapine, involving regular blood tests.
With the right medication, some improvements may be seen fairly quickly although it can take a few weeks before all the symptoms respond. As everyone responds differently to a given drug, it may be a matter of time before the best medication is found for an individual.
Most people are recommended to keep taking the prescribed drugs for months if not years. This is to ensure that the person remains well for as long as possible.
Depot injections
Some antipsychotics are available as depot injections which are given into a muscle, usually the hip, and can last in the system for between one and six weeks. At present only one of the �atypicals�, risperidone, is available in this form. (consta)
Side effects
Physical side effects are common with antipsychotic treatments. They may include:
- Sedation, a feeling of drowsiness and/or poor concentration
- Those affecting the autonomic nervous system, such as lowered blood pressure when lying down or standing up quickly causing a feeling of dizziness, constipation, dry mouth, blurred vision and occasionally urinary hesitancy or retention
- Those affecting the area of the brain called the hypothalmus, such as, for women, irregular periods or failure to ovulate, or for men, growth of breast tissue or impotence
- Those affecting the muscles, such as trembling, muscular rigidity or cramp-like spasms. Tardive dyskinesia can occur, which is the development of uncontrollable movements, initially in the face but affecting other parts of the body. (these problems are mostly associated with the older medications)
- Weight gain
- Hypersalivation
However, not everyone experiences all the side effects mentioned above and there are other treatments which can counter some of the unwanted effects. If you or the person you care about have any concerns about side effects, mention them to the medical practitioner who prescribes the medication in question. Your pharmacist can also provide helpful advice on medication.
The Scottish Association for Mental Health have produced booklets on medication which can be viewed here www.samh.org.uk/frontend/index.cfm?page=280
The Health Technology Board for Scotland (HTBS) issued guidance on the use of atypical antipsychotic drugs. HTBS is now part of NHS Quality Improvement Scotland www.nhshealthquality.org
Other forms of treatment (See also Information Paper on Cognitive and other Non Medical Approaches)
Psychological treatment
Once someone has been stabilised on suitable medication, psychological treatment can sometimes be effective.
Psychological treatment is a broad term used to describe any therapeutic approach which aims to adapt thought and behaviours and it can be offered in conjunction with medication.
Each Health Board area has different resources available and these are some of the psychological treatments that may be on offer:
Counselling
Where the individual can explore personal issues in a confidential and safe environment.
Cognitive therapy
Generally offered by psychologists, which focuses on helping the person to adapt their behaviour and cope more readily with the symptoms of their illness.
Group therapy
Where those recovering from acute symptoms can explore some of their issues with others. This can provide a vital source of support for some people.
Family therapy
Which explores the whole family as one unit in a time-limited focused piece of intense work.
Life in the community
Recovery (see also Information Paper on Recovery � what does it mean?) is becoming an important concept in improving the approach to mental illness. Key elements of this are enabling the person to take charge of his/her life with appropriate support and ensuring real choice for individuals. In the jargon, the person is �empowered�.
The emphasis is now on people living in the community, rather than spending long time in hospital, and assisting them to fulfil their potential. This involves various forms of support aiming to help someone regain confidence and self esteem, and possibly build up everyday skills including those needed to manage a household. Opportunities for day-time activity, including volunteering are increasingly being made available.
Self help/mutual support groups
NSF (Scotland) mutual support groups meet in many parts of Scotland. For further information on these go to In Your Area.
Self help support groups such as those run by the NSF (Scotland) Fife Hearing Voices Network can be a very useful complement or alternative to other forms of 'talking treatment'. They tend to be run, supported and used by individuals who are affected by hearing voices of some kind. There is good evidence that discussion among those who hear voices can help people to develop effective coping strategies. People with many different diagnoses (or none at all) find it helpful to get involved with Hearing Voices Groups.
NSF (Scotland) has two Guides related to voice hearing which can be ordered.
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