The treatment of schizophrenia may be divided into two stages
The first stage of treatment program is essentially aimed at reducing the acute psychotic symptoms and helping the patient re–establish contact with reality. This phase usually involves admission of the patient into a hospital and administering a biological line of treatment injectable anti–psychotics and very often ECT’s. Short duration psychoses may respond without ECT’s but advanced severe cases do require ECT’s.
The anti–psychotics possibly act on the dopamine levels in the brain and thus help in reducing the hallucinations and delusions and curbing disorganized bizarre behavior. Like all medications, however, anti–psyhotic drugs should be taken only under the careful monitoring of a psychiatrist. Maintenance medication is vital for preventing a relapse. Approximately 40 – 50 per cent of those who stop the medication immediately on discharge from the hospital have a relapse within 1 year. However, if the patients continued taking medication beyond the first year, relapse rates fell to 10 per cent, Maintenance therapy can be given for a long time, even up to 2–3 years, without any major problems, provided it is under the guidance of a psychiatrist.
The second phase of treatment which is equally important is “Aftercare”, which involves helping the partially recovered patient continue recovery while residing in the community. Aftercare programs help the patient to deal with the anxiety.
Depression and confusion that linger after the major symptoms have abated psychotherapy at this stage offers understanding, reassurance, careful insights, and suggestions for developing self–esteem and handling the emotional aspects of the disorder. Often, psychiatrists have to work closely with family members to help them understand the illness and provide an environment which is free from criticism, hostility, and emotional over involvement. A change in the patient’s living and working environment may be suggested to reduce stressful situations.
In aftercare, anti–psychotic maintenance medication serves as a protective cover and buffers the patient from life stresses. Generally, psychiatrists choose a combination of medication, ECT’s and psychotherapy, and modulate them to suit the patient’s individual needs, so that finally the patient may work, live at home, and enjoy the activities that he did previous to developing the schizophrenia.
Points to be kept in mind during rehabilitation
Stages of rehabilitation
During the entire rehabilitation program the relatives have to be taken into full confidence and given appropriate family counseling as to how to deal with the patient, preventing them from expressing their criticisms and negative comments, as well as helping them cope with the erratic behavior patterns, social withdrawal, emotional blunting or apathy demonstrated from time to time by the previously psychotic patient.
Wherever possible, the psychiatrist with or without the assistance of social workers or the family doctor, has to take a personal interest in the social contracts of the patient, paying regular visits to the work environment and keeping in touch with the patients’ friend–circle thereby positively reinforcing the social circuit and network.
The face to face meetings of the patient, his relatives and friends with other patients who are a few steps ahead in the rehabilitation program (often in group therapy) or with other patients who have been completely rehabilitated helps in increasing the confidence of the patient. These meetings also increase the overall co–operation and the accessibility of the patient as well as his relatives to the rehabilitation program.
The answer, in the ultimate analysis, to the final question often asked by patients, their relatives and referring doctors alike, as to whether schizophrenia is treatable or not, is a positive and emphatic “Yes”. With modern day anti–psychotics and the best of psychotherapeutic care and rehabilitation available, schizophrenia is no longer the dreaded disease that it once was.A schizophrenic patient is ultimately able to function on a normal level in terms of business, job, education, family, social and spiritual life, and does not in any way feel different or inferior to his non–schizophrenic counterparts.