informative essay on schizophrenia

On the Origins of Schizophrenia

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• Schizophrenia

Schizophrenia is a serious mental health condition that affects how people think, feel and behave. It may result in a mix of hallucinations, delusions, and disorganized thinking and behavior. Hallucinations involve seeing things or hearing voices that aren't observed by others. Delusions involve firm beliefs about things that are not true. People with schizophrenia can seem to lose touch with reality, which can make daily living very hard.

People with schizophrenia need lifelong treatment. This includes medicine, talk therapy and help in learning how to manage daily life activities.

Because many people with schizophrenia don't know they have a mental health condition and may not believe they need treatment, many research studies have examined the results of untreated psychosis. People who have psychosis that is not treated often have more-severe symptoms, more stays in a hospital, poorer thinking and processing skills and social outcomes, injuries, and even death. On the other hand, early treatment often helps control symptoms before serious complications arise, making the long-term outlook better.

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Schizophrenia involves a range of problems in how people think, feel and behave. Symptoms may include:

• Delusions. This is when people believe in things that aren't real or true. For example, people with schizophrenia could think that they're being harmed or harassed when they aren't. They could think that they're the target for certain gestures or comments when they aren't. They may think they're very famous or have great ability when that's not the case. Or they could feel that a major disaster is about to occur when that's not true. Most people with schizophrenia have delusions.
• Hallucinations. These usually involve seeing or hearing things that other people don't observe. For people with schizophrenia, these things seem real. Hallucinations can occur with any of the senses, but hearing voices is most common.
• Disorganized speech and thinking. Disorganized speech causes disorganized thinking. It can be hard for people with schizophrenia to talk with other people. The answers people with schizophrenia give to questions may not be related to what's being asked. Or questions may not be answered fully. Rarely, speech may include putting together unrelated words in a way that can't be understood. Sometimes this is called word salad.
• Extremely disorganized or unusual motor behavior. This may show in several ways, from childlike silliness to being agitated for no reason. Behavior isn't focused on a goal, so it's hard to do tasks. People with schizophrenia may not want to follow instructions. They may move in ways that are not typical or not appropriate to the social setting. Or they may not move much or respond at all.
• Negative symptoms. People with schizophrenia may not be able to function in the way they could before their illness started. For example, they may not bathe, make eye contact or show emotions. They may speak in a monotone voice and not be able to feel pleasure. Also, they may lose interest in everyday activities, socially withdraw and have a hard time planning ahead.

Symptoms can vary in type and how severe they are. At times, symptoms may get better or worse. Some symptoms may be present at all times.

People with schizophrenia usually are diagnosed in the late teen years to early 30s. In men, schizophrenia symptoms usually start in the late teens to early 20s. In women, symptoms usually begin in the late 20s to early 30s. There also is a group of people — usually women — who are diagnosed later in life. It isn't common for children to be diagnosed with schizophrenia.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are like those in adults, but the condition may be harder to pinpoint. That's because some early symptoms of schizophrenia — those that occur before hallucinations, delusions and disorganization — are commonly seen in many teens, such as:

• Withdrawing from friends and family.
• Not doing well in school.
• Having trouble sleeping.
• Feeling irritable or depressed.
• Lacking motivation.

Also, the use of recreational drugs, such as marijuana, stimulants like cocaine and methamphetamines, or hallucinogens, can cause similar symptoms. Compared with adults with schizophrenia, teens with the condition may be less likely to have delusions and more likely to have hallucinations.

When to see a doctor

People with schizophrenia often don't know that they have a mental condition that needs medical attention. As a result, family or friends often need to get them help.

Helping someone who may have schizophrenia

If people you know have symptoms of schizophrenia, talk to them about your concerns. While you can't force them to seek help, you can offer encouragement and support. You also can help them find a healthcare professional or mental health professional.

If people are a danger to themselves or others, or they don't have food, clothing or shelter, you may need to call 911 in the U.S. or other emergency responders for help. A mental health professional needs to evaluate them.

Some people may need an emergency stay in a hospital. Laws on mental health treatment against a person's will vary by state. You can contact community mental health agencies or police departments in your area for details.

Suicidal thoughts and behavior

Suicidal thoughts and attempts are much higher than average in people with schizophrenia. If a person is in danger of suicide or has made a suicide attempt, make sure that someone stays with that person. Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).

Proper treatment of schizophrenia can reduce the risk of suicide.

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It isn't known what causes schizophrenia. But researchers believe that a mix of genetics, brain chemistry and environment can play a part.

Changes in certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may play a part in schizophrenia. Neuroimaging studies show changes in the brain structure and central nervous systems of people with schizophrenia. While researchers haven't yet been able to apply these findings to new treatments, the findings show that schizophrenia is a brain disease.

Risk factors

Although the cause of schizophrenia is not known, these factors seem to make schizophrenia more likely:

• A family history of schizophrenia.
• Life experiences, such as living in poverty, stress or danger.
• Some pregnancy and birth issues, such as not getting enough nutrition before or after birth, low birth weight, or exposure to toxins or viruses before birth that may affect brain development.
• Taking mind-altering — also called psychoactive or psychotropic — drugs as a teen or young adult.

Complications

Left untreated, schizophrenia can lead to severe problems that affect every area of life.

Complications that schizophrenia may cause or be related to include:

• Suicide, suicide attempts and thoughts of suicide.
• Anxiety disorders and obsessive-compulsive disorder, also known as OCD.
• Depression.
• Misuse of alcohol or other drugs, including nicotine.
• Not being able to work or attend school.
• Money problems and homelessness.
• Social isolation.
• Health and medical problems.
• Being victimized.
• Aggressive or violent behavior, though people with schizophrenia are more likely to be assaulted rather than assault others.

There's no sure way to prevent schizophrenia. But staying with your treatment plan can help stop symptoms from returning or getting worse. Researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and treatment.

• Schizophrenia spectrum and other psychotic disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Jan. 18, 2024.
• Fischer BA, et al. Schizophrenia in adults: Clinical features, assessment, and diagnosis. https://www.uptodate.com/contents/search. Accessed Jan. 18, 2024.
• Stroup TS, et al. Schizophrenia in adults: Maintenance therapy and side effect management. https://www.uptodate.com/contents/search. Accessed Jan. 18, 2024.
• Fisher DJ, et al. The neurophysiology of schizophrenia: Current update and future directions. International Journal of Psychophysiology. 2019; doi:10.1016/j.ijpsycho.2019.08.005.
• Schizophrenia. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/schizophrenia. Accessed Jan. 18, 2024.
• Schizophrenia. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia. Accessed Jan. 18, 2024.
• What is schizophrenia? American Psychiatric Association. https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia. Accessed Jan. 18, 2024.
• Schizophrenia. Merck Manual Professional Version. https://www.merckmanuals.com/professional/psychiatric-disorders/schizophrenia-and-related-disorders. Accessed Jan. 18, 2024.
• Supporting a family member with serious mental illness. American Psychological Association. https://www.apa.org/topics/mental-health/support-serious-mental-illness. Accessed Jan. 18, 2024.
• For friends and family members. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/mental-health/how-to-talk/friends-and-family-members. Accessed Jan. 18, 2024.
• For people with mental health problems. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/mental-health/how-to-talk/people-with-mental-health-problems. Accessed Jan. 18, 2024.
• Roberts LW, et al. Schizophrenia spectrum and other psychotic disorders. In: The American Psychiatric Association Publishing Textbook of Psychiatry. 7th ed. American Psychiatric Association Publishing; 2019. https://psychiatryonline.org. Accessed Jan. 18, 2024.
• Allen ND (expert opinion). Mayo Clinic. April 17, 2024.
• Leung JG (expert opinion). Mayo Clinic. April 16, 2024.
• Antipsychotic drugs. Merck Manual Professional Version. https://www.merckmanuals.com/professional/psychiatric-disorders/schizophrenia-and-related-disorders/antipsychotic-drugs. Accessed Jan. 19, 2024.

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Schizophrenia

What is schizophrenia.

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and for their family and friends. The symptoms of schizophrenia can make it difficult to participate in usual, everyday activities, but effective treatments are available. Many people who receive treatment can engage in school or work, achieve independence, and enjoy personal relationships.

What are the signs and symptoms of schizophrenia?

It’s important to recognize the symptoms of schizophrenia and seek help as early as possible. People with schizophrenia are usually diagnosed between the ages of 16 and 30, after the first episode of psychosis . Starting treatment as soon as possible following the first episode of psychosis is an important step toward recovery. However, research shows that gradual changes in thinking, mood, and social functioning often appear before the first episode of psychosis. Schizophrenia is rare in younger children.

Schizophrenia symptoms can differ from person to person, but they generally fall into three main categories: psychotic, negative, and cognitive.

Psychotic symptoms include changes in the way a person thinks, acts, and experiences the world. A person experiencing psychotic symptoms often has disrupted thoughts and perceptions, and they may have difficulty recognizing what is real and what is not. Psychotic symptoms include:

• Hallucinations : When a person sees, hears, smells, tastes, or feels things that are not actually there. Hearing voices is common for people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem.
• Delusions : When a person has strong beliefs that are not true and may seem irrational to others. For example, individuals experiencing delusions may believe that people on the radio and television are sending special messages that require a certain response, or they may believe that they are in danger or that others are trying to hurt them.
• Thought disorder : When a person has ways of thinking that are unusual or illogical. People with thought disorder may have trouble organizing their thoughts and speech. Sometimes a person will stop talking in the middle of a thought, jump from topic to topic, or make up words that have no meaning.

Negative symptoms include loss of motivation, loss of interest or enjoyment in daily activities, withdrawal from social life, difficulty showing emotions, and difficulty functioning normally.

Negative symptoms include:

• Having trouble planning and sticking with activities, such as grocery shopping
• Having trouble anticipating and being motivated by pleasure in everyday life
• Talking in a dull voice and showing limited facial expression
• Avoiding social interaction or interacting in socially awkward ways
• Having very low energy and spending a lot of time in passive activities. In extreme cases, a person might stop moving or talking for a while, which is a rare condition called catatonia .

These symptoms are sometimes mistaken for symptoms of depression or other mental illnesses.

Cognitive symptoms include problems in attention, concentration, and memory. These symptoms can make it hard to follow a conversation, learn new things, or remember appointments. A person’s level of cognitive functioning is one of the best predictors of their day-to-day functioning. Health care providers evaluate cognitive functioning using specific tests.

Cognitive symptoms include:

• Having trouble processing information to make decisions
• Having trouble using information immediately after learning it
• Having trouble focusing or paying attention

The Centers for Disease Control and Prevention (CDC)  has recognized that having certain mental disorders, including depression and schizophrenia, can make people more likely to get severely ill from COVID-19. Learn more about getting help and finding a health care provider .

Risk of violence

Most people with schizophrenia are not violent. Overall, people with schizophrenia are more likely than those without the illness to be harmed by others. For people with schizophrenia, the risk of self-harm and of violence to others is greatest when the illness is untreated or co-occurs with alcohol or substance misuse. It is important to help people who are showing symptoms to get treatment as quickly as possible.

Schizophrenia vs. dissociative identity disorder

Although some of the signs may seem similar on the surface, schizophrenia is not dissociative identity disorder (which used to be called multiple personality disorder or split personality). People with dissociative identity disorder have two or more distinct identities with distinct behaviors and memories.

What are the risk factors for schizophrenia?

Several factors may contribute to a person’s risk of developing schizophrenia.

Genetics: Schizophrenia sometimes runs in families. However, just because one family member has schizophrenia, it does not mean that other members of the family also will have it. Studies suggest that many different genes may increase a person’s chances of developing schizophrenia , but that no single gene causes the disorder by itself.

Environment: Research suggests that a combination of genetic factors and aspects of a person’s environment and life experiences may play a role in the development of schizophrenia. These environmental factors that may include living in poverty, stressful or dangerous surroundings, and exposure to viruses or nutritional problems before birth.

Brain structure and function: Research shows that people with schizophrenia may be more likely to have differences in the size of certain brain areas and in connections between brain areas. Some of these brain differences may develop before birth. Researchers are working to better understand how brain structure and function may relate to schizophrenia.

How is schizophrenia treated?

Current treatments for schizophrenia focus on helping people manage their symptoms, improve day-to-day functioning, and achieve personal life goals, such as completing education, pursuing a career, and having fulfilling relationships.

Antipsychotic medications

Antipsychotic medications can help make psychotic symptoms less intense and less frequent. These medications are usually taken every day in a pill or liquid forms. Some antipsychotic medications are given as injections once or twice a month.

If a person’s symptoms do not improve with usual antipsychotic medications, they may be prescribed clozapine. People who take clozapine must have regular blood tests to check for a potentially dangerous side effect that occurs in 1-2% of patients.

People respond to antipsychotic medications in different ways. It is important to report any side effects to a health care provider. Many people taking antipsychotic medications experience side effects such as weight gain, dry mouth, restlessness, and drowsiness when they start taking these medications. Some of these side effects may go away over time, while others may last.

Shared decision making  between health care providers and patients is the recommended strategy for determining the best type of medication or medication combination and the right dose. To find the latest information about antipsychotic medications, talk to a health care provider and visit the U.S. Food and Drug Administration (FDA) website  .

Psychosocial treatments

Psychosocial treatments help people find solutions to everyday challenges and manage symptoms while attending school, working, and forming relationships. These treatments are often used together with antipsychotic medication. People who participate in regular psychosocial treatment are less likely to have symptoms reoccur or to be hospitalized.

Examples of this kind of treatment include types of psychotherapy such as cognitive behavioral therapy, behavioral skills training, supported employment, and cognitive remediation interventions.

Education and support

Educational programs can help family and friends learn about symptoms of schizophrenia, treatment options, and strategies for helping loved ones with the illness. These programs can help friends and family manage their distress, boost their own coping skills, and strengthen their ability to provide support. The National Alliance on Mental Illness website has more information about support groups and education   .

Coordinated specialty care

Coordinated specialty care (CSC) programs are recovery-focused programs for people with first episode psychosis, an early stage of schizophrenia. Health care providers and specialists work together as a team to provide CSC, which includes psychotherapy, medication, case management, employment and education support, and family education and support. The treatment team works collaboratively with the individual to make treatment decisions, involving family members as much as possible.

Compared with typical care, CSC is more effective at reducing symptoms, improving quality of life, and increasing involvement in work or school.

Assertive community treatment

Assertive community treatment (ACT)  is designed especially for people with schizophrenia who are likely to experience multiple hospitalizations or homelessness. ACT is usually delivered by a team of health care providers who work together to provide care to patients in the community.

Treatment for drug and alcohol misuse

People with schizophrenia may also have problems with drugs and alcohol. A treatment program that includes treatment for both schizophrenia and substance use is important for recovery because substance use can interfere with treatment for schizophrenia.

How can I find help for schizophrenia?

If you have concerns about your mental health, talk to a primary care provider. They can refer you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social worker, who can help you figure out the next steps. Find  tips for talking with a health care provider  about your mental health.

You can  learn more about getting help  on the NIMH website. You can also learn about  finding support    and  locating mental health services   in your area on the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

It can be difficult to know how to help someone who is experiencing psychosis.

Here are some things you can do:

• Help them get treatment and encourage them to stay in treatment.
• Remember that their beliefs or hallucinations seem very real to them.
• Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior.
• Look for support groups and family education programs, such as those offered by the National Alliance on Mental Illness   .

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline   at 988 or chat at 988lifeline.org   . In life-threatening situations, call 911 .

How can I find a clinical trial for schizophrenia?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

• NIMH’s Clinical Trials webpage : Information about participating in clinical trials
• Clinicaltrials.gov: Current Studies on Schizophrenia  : List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
• Join a Study: Schizophrenia : List of studies being conducted on the NIH Campus in Bethesda, MD

Where can I learn more about schizophrenia?

Free brochures and shareable resources.

• Schizophrenia : This brochure on schizophrenia offers basic information on signs and symptoms, treatment, and finding help. Also available en español .
• Understanding Psychosis : This fact sheet presents information on psychosis, including causes, signs and symptoms, treatment, and resources for help. Also available en español .
• Digital Shareables on Schizophrenia : These digital resources, including graphics and messages, can be used to spread the word about schizophrenia and help promote schizophrenia awareness and education in your community.

Research and statistics

• Accelerating Medicines Partnership® Program - Schizophrenia (AMP® SCZ) : This AMP   public-private collaborative effort aims to promote the development of effective, targeted treatments for those at risk of developing schizophrenia. More information about the program is also available on the AMP SCZ website   .
• Early Psychosis Intervention Network (EPINET) : This broad research initiative aims to develop models for the effective delivery of coordinated specialty care services for early psychosis.
• Journal Articles:   This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).
• Psychotic Disorders Research Program : This program supports research into the origins, onset, course, and outcome of schizophrenia spectrum disorders and other psychotic illnesses.
• Risk and Early Onset of Psychosis Spectrum Disorders Program : This program supports research on childhood and adolescent psychosis and thought disorders.
• Recovery After an Initial Schizophrenia Episode (RAISE) : The NIMH RAISE research initiative included two studies examining different aspects of coordinated specialty care treatments for people who were experiencing early psychosis.
• Statistics: Schizophrenia : This webpage provides the statistics currently available on the prevalence and treatment of schizophrenia among people in the United States.
• NIMH Experts Discuss Schizophrenia : Learn the signs and symptoms, risk factors, treatments of schizophrenia, and the latest NIMH-supported research in this area.

Last Reviewed: April 2024

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Evidence-based psychosocial interventions in schizophrenia: a critical review

Stefano barlati.

a Department of Clinical and Experimental Sciences, University of Brescia

b Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy

Gabriele Nibbio

Antonio vita, purpose of review.

Schizophrenia Spectrum Disorders (SSD) are severe conditions that frequently produce significant impairment in cognitive performance, social skills and psychosocial functioning. As pharmacological treatment alone often provides only limited improvements on these outcomes, several psychosocial interventions are employed in psychiatric rehabilitation practice to improve of real-world outcomes of people living with SSD: the present review aims to provide a critical overview of these treatments, focusing on those that show consistent evidence of effectiveness.

Recent findings

Several recent systematic reviews and meta-analyses have investigated in detail the acceptability, the effectiveness on several specific outcomes and moderators of response of different psychosocial interventions, and several individual studies have provided novel insight on their implementation and combination in rehabilitation practice.

Cognitive remediation, metacognitive training, social skills training, psychoeducation, family interventions, cognitive behavioral therapy, physical exercise and lifestyle interventions, supported employment and some other interventions can be fully considered as evidence-based treatments in SSD. Psychosocial interventions could be of particular usefulness in the context of early intervention services. Future research should focus on developing newer interventions, on better understanding the barriers and the facilitators of their implementation in clinical practice, and exploring the opportunities provided by novel technologies.

INTRODUCTION

Schizophrenia Spectrum Disorders (SSD) represent severe and debilitating mental conditions, frequently characterized by impaired cognitive performance [ 1 , 2 ], poor real-world functional outcomes [ 3 , 4 ], reduced quality of life [ 5 , 6 ], high levels of internalized stigma [ 7 – 9 ] and low levels of life engagement [ 10 , 11 ]. In people living with SSD, a combination of reduced access to medical care, unhealthy lifestyles and biological factors lead to an average reduction of life expectancy of 14.5 years, mainly due to cardiovascular disease and cancer [ 12 ▪▪ , 13 ].

Pharmacological treatment represents the cornerstone of SSD treatment, and indeed a massive body of evidence reports that antipsychotic medications are consistently effective in improving psychotic symptoms, preventing relapses and even extending life expectancy in people living with SSD [ 14 – 16 ]. However, pharmacological treatment alone is not currently effective in improving several clinical and functional outcomes, such as cognitive performance, social skills and quality of life, and in improving real-world outcomes, such as finding and maintaining a job or having meaningful personal relationships; in fact, most people living with SSD currently experience only small improvements in outcomes that are important for them in their personal perspective and do not achieve full functional and personal recovery [ 17 – 19 ].

This is where psychosocial interventions come into play. Complementing and enhancing the effects of pharmacological treatments, and targeting domains and features that are not currently improved by antipsychotic treatment, various psychosocial interventions have shown consistent effectiveness on several different outcomes [ 20 ▪ , 21 ▪▪ ], and are now recommended as evidence-based treatments for SSD in many national and international guidelines [ 14 , 22 – 24 , 25 ▪ ].

Considering that SSD represent a clinically heterogeneous spectrum and no valid one-size-fits-all treatment protocol exists, having a good understanding of the different available evidence-based psychosocial interventions is essential to devise and implement personalized treatment programs, with specific interventions for the specific needs of specific patients [ 18 ]: this currently represents a fundamental step to provide the most effective treatment for people living with SSD. 

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Rather than providing an assessment of the overall effectiveness of psychosocial interventions in SSD, the present work will focus on each specific evidence-based psychosocial intervention, reporting and commenting the available and recent evidence regarding its effectiveness on global as well as on specific outcomes. A summary is reported in Table ​ Table1. 1 . Discussion regarding the gaps in current scientific literature and the intrinsic limitations of specific psychosocial interventions, as well as considerations on the current state of the art and on the implementation of these interventions in clinical practice will also be provided.

Evidence-based psychosocial interventions in Schizophrenia Spectrum Disorders

COGNITIVE REMEDIATION

Cognitive Remediation (CR) is a behavioral training-based intervention targeting cognitive performance with the aim of providing a durable improvement to psychosocial functioning [ 26 , 27 ]. It currently represents the psychosocial intervention with the highest degree of recommendation in the European Psychiatric Association guidelines for the treatment of cognitive impairment in schizophrenia [ 25 ▪ ].

Two high-quality meta-analyses have recently explored the effectiveness of CR, one including both interventions targeting neurocognitive performance and interventions targeting social cognition [ 28 ], and one considering only neurocognition-targeting programs [ 29 ]. Both meta-analyses yielded very similar results, showing that CR provided significant benefits in global cognitive performance as well as in specific cognitive domains that were translated into significant improvement in psychosocial functioning. The effectiveness of social cognition training was also explored in a dedicated meta-analysis, reporting significant improvements in social cognition domains and generalization to the executive functions neurocognitive domain [ 30 ].

Considering treatment-related moderators of effect, the presence of an active and trained therapist delivering the intervention, the structured development of novel cognitive strategies, the implementation of techniques to transfer cognitive gains into the real world and the integration with structured psychiatric rehabilitation programs or other evidence-based psychosocial interventions significantly improved outcomes: these factors emerged as core treatment ingredients, and programs including all these elements provided moderate-sized effects on both global cognition and psychosocial functioning. As regards participant-related predictors of response, no specific characteristics represented a barrier to effectiveness, but more clinically compromised participants reported greater improvements [ 28 ].

The acceptability of CR interventions was also systematically assessed: a recent meta-analysis investigated CR trials drop-outs, and found that CR overall has a good acceptability profile, in line with that of other psychosocial interventions [ 31 ▪ ]. Evidence from low-income settings also suggest that CR can be feasible and implemented in clinical practice also with very limited available resources [ 32 ].

The main limitation of CR interventions is that, on themselves, they provide no substantial benefits as regards psychotic symptoms. The results of an earlier meta-analysis suggested that CR can provide improvements in negative symptoms [ 33 ], but more recent meta-analyses including more high quality studies reported that these gains, if statistically significant, are too small sized to be of clinical relevance [ 28 , 29 ].

METACOGNITIVE TRAINING

Metacognitive training for psychosis (MCT) is a psychosocial intervention that combines elements of psychoeducation, cognitive bias modification and strategy teaching, aiming at improving positive symptoms, and persistent symptoms more in general, by improving metacognitive function; it represent the most employed and most investigated metacognitive intervention, a group of treatments that also includes metacognitive therapy and metacognitive insight and reflection therapy [ 34 ].

A recent and high-quality meta-analysis explored the effectiveness of MCT on several different outcomes: MTC provided significant long-term improvement in positive symptoms, particularly delusions, and psychosocial functioning; significant, albeit smaller effects were also observed in negative symptoms, cognitive biases and self-esteem [ 35 ▪ ].

Another meta-analysis investigated the effectiveness of metacognitive interventions on insight: MCT improved self-reflectiveness and overall cognitive insight both after treatment and at follow-up observations, and self-certainty after treatment only. Findings on clinical insight could not be quantitatively synthesized, but trials results suggest that MCT can be effective also in this aspect [ 36 ].

SOCIAL SKILLS TRANING

Social skills training (SST) is a psychosocial intervention that targets interpersonal and social skills with the aim of improving real-world outcomes such as social performance and social interactions. Meta-analytic evidence shows that SST provides improvements in social outcomes as well as significant albeit small improvements in negative and general psychopathology symptoms [ 37 , 38 ].

As the overall effectiveness of SST in SSD has already been well documented and established for several years [ 39 ], recent studies have focused in on combining SST with other psychosocial interventions, in particular components of cognitive behavioral psychological interventions, CR and MCT, showing positive synergies on different outcomes with these combined treatments [ 40 – 44 ].

PSYCHOEDUCATION

Psychoeducation encompasses all the interventions focused on the education of an individual living with a psychiatric disorder regarding topics that may improve the outcomes of treatment and rehabilitation, enabling a behavioral change in the participant; in the treatment of SSD, psychoeducation has been recognized since several years as an intervention that can consistently improve relapse prevention and treatment adherence [ 45 ], and some evidence also suggests that it can improve psychosocial functioning and some psychopathological domains, albeit not core SSD symptoms [ 46 ]. A recent and high-quality network meta-analysis exploring the effectiveness of different psychosocial interventions on relapse prevention confirmed that psychoeducation has a good effectiveness on this specific outcome; this positive effect however was not observed at follow-up observations longer than 12 months [ 47 ].

A recent systematic review explored the effects of psychoeducation on individuals at clinical high risk for psychosis: the results highlighted a good feasibility and acceptability profile of the interventions in this population, and some studies also reported positive effects on psychosocial functioning and psychopathological outcomes, but more high-quality research is currently needed to evaluate the effectiveness of psychoeducation in this population, particularly on high-relevance outcomes such as transition to psychosis [ 48 ▪ ].

FAMILY INTERVENTIONS

It has been widely demonstrated that family environment plays a pivotal role in the long-term course of SSD, as well as in the recovery process [ 49 ]. In this context, several different family interventions models have been developed [ 50 , 51 ].

A recent high-quality network meta-analysis explored the effectiveness of different family interventions in relapse prevention: the vast majority of interventions included some element of family psychoeducation, and almost all interventions were effective in preventing relapse even at follow-up observations longer than 12 months; family psychoeducation alone emerged as the most effective intervention, superior to more complex models that include other treatment elements and showing a moderate-to-large effect size, while the less effective approach were community-based interventions involving family members [ 52 ▪ ].

Another recent meta-analysis explored and attested the effectiveness of family interventions on several different family-level (family's mental health, attitude towards the disorder, family burden, family coping, family health and well being, family functioning) and patient-level (treatment satisfaction and adherence, quality of life, psychiatric symptoms, illness insight, psychosocial functioning, rehospitalization) outcomes: moderate-to-large effect sizes were observed in both categories, with superior effects in family outcomes. Interventions targeting individual family units and delivered only to the family caregivers emerged as superior. The results of this meta-analysis, however, have to be considered with caution as significant publication bias was reported [ 53 ].

Overall, family interventions appear to represent one of the most clinically meaningful categories of psychosocial interventions, but to date the number of studies exploring their effectiveness is still somehow limited, compared to that available for other psychosocial interventions: in this regard, more research on this field is warranted.

COGNITIVE BEHAVIORAL THERAPY

Cognitive Behavioral Therapy for psychosis (CBTp) is a structured psychotherapy intervention that focuses on the connections between thoughts, behaviors, and emotions targeted and adapted for the treatment of SSD. It represents an evidence-based psychotherapy intervention that has been shown to be effective in improving several outcomes, and in particular in reducing the severity of positive symptoms [ 54 , 55 ].

A recent umbrella review of meta-analyses and randomized controlled trials showed a consistent effectiveness of CBT positive symptoms, which represents one of its primary outcomes, while small and nonconsistent effects were observed for negative symptoms [ 56 ▪▪ ].

A recent meta-analysis investigated the effectiveness of CBTp delivered in a group setting: the results of this work partially contested those of previous meta-analyses, showing no significant benefit as regards the severity of positive and negative symptoms, but reported positive effects on other important outcomes such as psychosocial functioning and global psychopathological severity [ 57 ▪ ].

Another recent meta-analysis investigated the use of CBTp in the prodromal phases of psychosis: the results showed that this intervention is indeed effective in reducing the transition to full psychosis at all considered time-points and also in reducing attenuated psychotic symptoms [ 58 ▪ ]. These results are very interesting in a clinical perspective, as this population may represent a target that benefits in particular manner for CBTp, with significant and important long-term consequences.

PHYSICAL EXERCISE AND LIFESTYLE INTERVENTIONS

Physical exercise can be considered to all intents and purposes as a fully evidence-based psychosocial intervention for people living with SSD, capable of improving not only physical fitness, but also psychopathological outcomes [ 59 ] and cognitive performance [ 60 – 62 ].

A recent and large meta-analysis focused on moderators of effects of cognitive improvement, and confirmed that the most effective form of physical exercise for this outcome is aerobic exercise; it also reported a superior effect of group exercise, that supervision of trained exercise professionals substantially enhanced effectiveness and that positive results could be observed with a dose-dependent effect starting from a duration of ≥90 min per week for ≥12 weeks [ 63 ▪ ]. Recent evidence also suggest that combining physical exercise with CR produces a synergic effect, providing faster gains in cognitive performance [ 64 , 65 ].

Another recent meta-analysis explored the effectiveness of physical exercise in people living with SSD on psychosocial functioning: positive and moderate-sized effects were observed for global functioning, for social functioning and for daily life functioning [ 66 ▪▪ ].

Finally, physical exercise, as well as diet and lifestyle interventions were investigated regarding their effectiveness on several different outcomes: anthropometric measures such as BMI weight and waist circumference showed significant lasting benefits, alongside psychopathological, cognitive and functional measure, including quality of life [ 61 ]. In this regard, physical exercise and lifestyle interventions represent an intervention that might be suitable for the vast majority of people living with SSD and be particularly useful in cases where targeting cognitive performance represents a priority.

SUPPORTED EMPLOYMENT

Supported employment and, overall, interventions specifically targeting employment represent a very particular category of psychosocial interventions that, when delivered to people living with SSD, have been show to improve the likelihood of obtaining a competitive job and to improve the number of hours worked in any job [ 67 ].

A recent meta-analysis explored the effectiveness of individual placement and support, a rehabilitation program focused on employment outcomes, across all different psychiatric diagnoses: the results showed that the intervention was effective in all the included populations, but it was more effective in people with severe mental illness and with SSD in particular. The effectiveness of the intervention, however, emerged as limited by symptoms severity [ 68 ▪ ].

Despite this limitation, the evidence supporting the usefulness of this approach is consistent, and is recently leading to the development of novel intervention programs and protocols [ 69 ].

In clinical practice, interventions targeting employment may represent a valuable asset to progress in the recovery process of subjects with a stable clinical condition and good cognitive performance, or where clinical recovery and cognitive performance improvement were already obtained.

OTHER INTERVENTIONS

Several other interventions have been explored in the treatment of different aspects of SSD.

Assertive Community Treatment (ACT) represents an intensive mental health program model including multidisciplinary approaches that can improve clinical and functional outcomes [ 70 ]. A recent study has investigate whether a flexible and less resource-demanding format of ACT can be equally effective, but reported negative findings, with the full ACT group emerging as superior on personal and social functioning outcomes [ 71 ].

Compensatory interventions for cognitive impairment do not directly target cognitive performance, but rather provide targeted aids and strategies to improve functioning despite cognitive deficits: a meta-analysis exploring the effectiveness of this approach has indeed observed functional improvements that were maintained at follow-up observations [ 72 ]. Elements of these interventions could be combined with CR interventions to further increase functioning gains, and they appear to be ideal in participants that do not respond to CR.

Illness self-management interventions, focusing on teaching and training skills to autonomously manage the physical, social and emotional impact of a disorder, provided small but significant improvements in different outcomes in two meta-analyses [ 73 , 74 ].

Motivational interviewing has recently been explored in a meta-analysis in people with SSD and comorbid substance use disorders, reporting mostly negative results [ 75 ]. A systematic review investigating the effectiveness on medication adherence was also conducted, again reporting mostly negative findings [ 76 ].

Mindfulness-based interventions [ 77 ] have also been investigated in people living with SSD, and the results of some studies suggests that they might be effective in improving clinical and functional outcomes [ 78 ]; however, the quantity and the quality of the studies investigating this intervention is not currently sufficient to consider it as fully evidence-based.

EARLY INTERVENTION SERVICES

Early intervention services are designed specifically to provide treatment in first episode or early phase of psychosis subjects, and indeed a wealth of recent literature shows that multidisciplinary teams of mental health professionals providing multimodal treatment in this population produces considerable long-term benefits [ 79 ]. In fact, recent high-quality evidence shows that providing evidence-based psychosocial interventions in early phase subjects clearly represents the most cost-effective course of action, and possibly the overall most effective approach [ 21 ▪▪ ].

However, implementing early intervention services in routine clinical practice is often accompanied by many challenges, mostly linked to the difficulty of accurately identifying and intercepting early-phase subjects and of building an effective therapeutic alliance with subjects and their families. Organization and resource availably issues might also occur, as maintaining an effective multidisciplinary intervention service might represent a complex endeavor in and of itself [ 80 ].

CONLCUSIONS AND FUTURE DIRECTIONS

Several different psychosocial interventions for people living with SSD have shown consistent evidence of effectiveness in different clinically and personally relevant outcomes.

Most interventions have shown a measure of effectiveness on psychosocial functioning outcomes, and most people living with SSD, despite the recommendations provided in national and international guidelines, at the present time receive only pharmacological treatment [ 81 ]. In this perspective, most people living with SSD would currently benefit in a considerable manner from receiving any kind of evidence-based psychosocial intervention.

However, in the perspective of personalizing and optimizing the treatment options, improving the chances of recovery and accelerating the recovery process [ 18 ], identifying the most appropriate intervention for each individual, and even the most appropriate intervention for the specific phase of the illness and of the recovery journey, actually represents the optimal approach.

CRT and physical exercise are particularly effective in improving cognitive performance: they could be useful in the vast majority of patients, and particularly in those that show cognitive impairment.

Physical exercise may also be particularly useful in subjects showing metabolic issues and medication -related metabolic adverse effects [ 82 , 83 ]. CBTp may also be useful in most patients, and, as MCT, may help in improving positive symptoms that persist with pharmacological treatment. Family interventions and individual psychoeducation could also be of use in the vast majority of patients but may provide the most important results in people with multiple or frequent relapses. SST may be combined with most other interventions to further improve functioning and be suited to individuals with social skills deficits. Finally, supported employment could be of use in individuals with less severe symptoms and smaller clinical impairment, or individuals that have already regained more basic skills and abilities.

It is also important to note that combining different interventions often produces synergic effects, so integrating interventions often represents an effective strategy if the available resources allow this approach [ 28 , 43 , 64 ].

Future research should focus on developing newer, more effective and more optimized interventions and treatment programs, but also on better understanding the barriers and the facilitators of the implementation in real-world everyday clinical practice of evidence-based interventions, aiming to further reduce and resolve the bench-to-bedside gap [ 84 , 85 ].

Finally, research on the usefulness of new digital technologies, including telemedicine and immersive virtual reality approaches, to deliver evidence-based interventions [ 86 – 89 ] could open new avenues and perspective to improve the recovery process of people living with SSD.

Acknowledgements

Financial support and sponsorship, conflicts of interest.

There are no conflicts of interest.

REFERENCES AND RECOMMENDED READING

Papers of particular interest, published within the annual period of review, have been highlighted as:

• ▪ of special interest
• ▪▪ of outstanding interest

Home — Essay Samples — Nursing & Health — Schizophrenia — The History of Schizophrenia

The History of Schizophrenia

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Schizophrenia: Diagnosis and Treatment Approaches Essay

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Introduction

Literature review, works cited, schizophrenia: past theories.

The concept of schizophrenia as the means of embracing a specific set of disorders causing hallucinations and delusions in patients is not new. A range of theories regarding the nature of the disorder, as well as its effects on the patient and the means of addressing it, have been suggested over time.

Despite the fact that schizophrenia is currently referred to as the disorder that people are supposedly predisposed to genetically, there is a viral theory thereof, which can be considered quite viable. According to a recent study, there is a possibility that schizophrenia can be caused partially by the influenza virus or PolyI:C (Fatemi et al. 1).

One might argue that the research in question did not prove that there was a direct correlation between the contraction of the virus and the development of schizophrenia in patients: “Prenatal viral infection at E7 led to gene expression and morphological changes in the placenta at E16” (Fatemi et al. 9). However, the fact that there might be a connection between the identified variables needs to be borne in mind.

Research Question

How can schizophrenia be diagnosed in a patient, and what methods of treatment can be considered the most efficient ones?

A detailed analysis of the factors that affect the patient’s condition, including the internal and the external ones, must be mentioned as one of the essential strengths of the studies that have been conducted on the subject matter so far. The use of the evidence-based approach as the means of locating the essential information about schizophrenia and its nature can be considered the obvious strength of the existing studies.

Finally, the fact that the identified area currently receives significant investments on a regular basis should be viewed as an essential strength. Since the disease has recently become prevalent among the rest of the psychological disorders (Khan et al. E2), there is a consistent need to continue studying the subject matter extensively. Furthermore, the fact that the medications currently used to prevent the patient from having hallucinations, as well as any other symptom of schizophrenia shows that further studies are necessary to improve the quality of the treatment. Therefore, the fact that the target area receives an impressive amount of funding can be listed among the primary strengths.

Limitations

It should be noted that the existing studies on schizophrenia have an array of limitations, which are predetermined primarily by the choice of their methods. Furthermore, because of the lack of understanding of what the nature of schizophrenia is, a range of studies are restricted to reiterating the facts that are already known and making the assumptions that can be deemed as rather far-fetched. Indeed, as Kane et al. explain, “We still do not understand the etiology and pathophysiology of schizophrenia although this remains true of many major illnesses in general medicine as well” (Kane et al. 2).

It would be wrong to assume that the current research has the information that other studies do not. However, the paper aims at reviewing the outcomes of not only one study but a range of clinical trials, therefore, creating the knowledge base that will serve as the foil for making more detailed and accurate conclusions.

Past research shows that the process of diagnosing schizophrenia may become rather complicated. Furthermore, the treatment of schizophrenia is likely to become a problem because of the level of denial shown by the patients. Indeed, studies point to the fact that very few people, in fact, manage to admit the problem and be willing to address it (Morrison et al. 1). As a result of the lack of responsiveness, the treatment becomes ineffective.

Moreover, the fact that some of the agents used to manage the disorder are associated with side effects deserves to be mentioned. For instance, weight gain and the following development of diabetes needs to be listed among the most common negative effects of using the antipsychotics that have been designed comparatively recently (e.g., clozapine (Clozaril), quetiapine (Seroquel), etc.) (Leucht et al. 1).

Significance of the Topic, Research Question, and Investigation

Seeing that there are a plethora of gaps in the past studies in the issue of schizophrenia, there is a pressing need to carry out an all-embracive study that will provide an overview of the innovative techniques and suggest that possible tools for managing the problem. Particularly, the improvement of the communication techniques used to help the patient acknowledge the problem and accept the suggested treatment framework although its side effects will have to be considered as the primary goal of the study. By considering the most recent studies along with the primary resources on the subject of schizophrenia, one will be able to draw the essential conclusions and design the framework of communication that will lead to efficient treatment.

According to DSM-V, schizophrenia can be defined as a “prototypical psychotic disorder” (Chapter 2. Schizophrenia Spectrum and Other Psychotic Disorders DSM.PsychiatryOnline.org ). However, when considering the identified definition, one must view it with a grain of salt since it was provided by an internet resource. Granted that the identified site is known as the DSM library and, therefore, contains the essential data that is also represented in the DSM-V manual, it is hosted at the.org domain, which devalues the quality of the information to a considerable degree. Therefore, the identification of other resources that provide the definition of the subject matter will have to be considered.

As stressed above, the very definition of schizophrenia lacks precision. As a result, diagnosing the problem implies running a range of tests. The process of diagnosing, however, relies primarily on the symptoms and the way in which they manifest themselves in the patient. Although the destructive effects that it has on people’s personalities, such as the inability to make decisions, control emotions, maintain positive relationships, etc., are rather hard to identify at the earliest stages of the disorder development, the existing tests are likely to help determine the problem in a comparatively accurate manner.

The first and most obvious, the development of hallucinations, including not only visual but also auditory ones, need to be determined. Afterward, the patient must be checked for possible delusions. The latter is typically defined as the beliefs that do not coincide with the objective reality and that the patient strives to maintain despite the fact that they are clearly false.

Speech issues, such as the lack of consistency in the communication process, the fact that the patient’s statements do not make sense, etc., should also be considered a possible symptom of schizophrenia. One might also add that bizarre behavior can be viewed as the manifestation of schizophrenia; however, the identified characteristic of the disorder does not necessarily apply to all conditions, and vice versa – the development of weird and asocial behavior does not necessarily imply that the patient has schizophrenia (Bull et al. 194).

Nevertheless, the identified characteristics serve as major indicators of the disorder, especially when observed simultaneously. At present, the American Psychiatric Association (APA) suggests in DSM-V that hallucinations and delusions should be considered primary indicators of schizophrenia (American Psychiatric Association, 2012). Therefore, observations can be considered the primary tool for diagnosing the disorder.

It should be noted, though, that some of the recent theories explaining the nature of schizophrenia deserve a closer look. For instance, the suggestion to scrutinize the factors affecting the development of the disorder from the perspective of the Theory of Mind seems rather sensible. Promoting the analysis of changes in the patient’s social behavior as opposed to the cognitive issues that they are likely to have later, the identified approach can be considered a new and improved tool for diagnosing the problem and addressing it at its onset. As a result, the effects of the proposed treatment are going to be much more spectacular than they would be otherwise.

The Theory of Mind (ToM) is often used as the means of considering the factors that contribute to the development of schizophrenia. To be more accurate, the theory suggests that the nature of schizophrenia should be correlated to the social impairments in the patient as opposed to cognitive ones. Put differently, the framework suggests that ToM should be viewed as the primary marker for determining schizophrenia in patients, especially at its onset.

Despite the fact that further studies must be carried out to provide the ultimate proof of the connection between the variables in question, it is safe to say that ToM serves as the foundation for the identification of schizophrenia development in patients along with the symptoms such as delusions and hallucinations (Bora and Pantelis 34).

At present, however, the theory that suggests a biological predisposition to schizophrenia receives extensive support as the most viable framework. Indeed, the specified approach toward understanding schizophrenia has the most substantial evidence and the greatest amount of support. Nevertheless, the idea of using social indicators as the markers for identifying the early symptoms of schizophrenia can be considered a new and promising approach.

Particularly, it is suggested that the idea of using cognitive markers of schizophrenia as the tools for defining the threat of schizophrenia development should be introduced into the contemporary psychiatry realm. As a result, the issue can be addressed within a comparatively short amount of time. To be more accurate, the use of the identified framework is likely to result in addressing the problem when it has not yet developed into a major issue.

When diagnosing the disorder, one must also bear in mind that there are different types of schizophrenia. As stressed above, the disorder manifests itself in a variety of shapes and types; as a result, the process of diagnosing the issue may become rather convoluted. It should be noted, though, that a number of schizophrenia subtypes have been rejected by the American Psychiatric Association (APA). For instance, in DSM-V, only three essential subtypes of schizophrenia are identified (schizoaffective disorder, delusional disorder, and catatonia) (Arciniegas 715-716).

As far as the treatment options for schizophrenia are concerned, one must bear in mind that the patient cannot be cured. In other words, it is necessary that the strategy for lifelong treatment must be designed. One must not be mistaken by the fact that the obvious symptoms of schizophrenia subside significantly after the first several sessions of treatment. Instead, one must bear in mind that the symptoms are recurrent and that the improvements in the patient’s well-being are temporary.

In light of the facts mentioned above, a psychiatrist must focus on the following goals when addressing the needs of a patient: addressing the symptoms so that the patient could get rid of them entirely or control them to a greater extent; improving the patient’s quality of life, and reinforcing the process of recovery from the disorder in a manner as efficient as possible ( Mental Health Medications NIMH.NIH.gov). The identified objectives are met with the help of a combination of therapy and the use of medications.

As a rule, when addressing the needs of patients with schizophrenia, one must consider the use of antipsychotic drugs. As stressed above, with the discovery of new methods of tending to the needs of people with schizophrenia, new medications were prescribed to manage the disorder and improve the quality of the patients’ lives. The following medications belong to the first generation of drugs for managing schizophrenia and improving the quality of patients’ lives: Chlorpromazine, Haloperidol, Perphenazine, and Fluphenazine ( Mental Health Medications NIMH.NIH.gov). Understandably enough, the identified methods of managing the disorder leave much to be desired in terms of not only their efficacy but also the negative effects that they have on the patients’ well-being (Kimhy et al. 865).

The second-generation medications represent a significant improvement in the framework for tending to the needs of patients with schizophrenia and the associated disorders. Although they also imply severe consequences for patients, their effects are considerably milder (Rummel-Kluge et al. 170). The specified property, however, results in the reduction of the medications’ efficacy. Nevertheless, the second-generation drugs should be viewed as preferable to the ones belonging to the first generation because of the opportunity to not only block the production of dopamine in the patient’s body but also increase the levels of serotonin (Hartling et al. 499).

It seems that the promotion of second-generation drugs as the means of managing schizophrenia seems to be a rather legitimate strategy at present. However, in o0rder to improve the quality of the patients’ lives and create an environment in which they can be proactive and retain their mental and cognitive abilities, one will have to consider the adoption of innovative medicine. Granted that the identified step requires further testing so that the efficacy of the medications could be determined, it opens a range of new opportunities to both patients and psychiatrists. However, one must admit that the identified process is fraught with numerous difficulties, the lack of financial resources being the key one (Priebe 2).

Furthermore, according to a recent study on the subject matter, the second-generation medicine, which aligns with the dopamine theory of schizophrenia, may have an adverse effect on the patient due to the inconsistency in the theoretical framework. The theory in question states that the development of the disorder occurs because of the excessive activity of dopaminergic neurons: “The dopamine hypothesis is based on the observation that antipsychotics block D2 receptors, and their affinity for these receptors highly correlates with their ability to ameliorate some psychotic symptoms” (Rubio et al. 9). Therefore, there is a strong need in focusing on studying the nature of schizophrenia so that the factors that contribute to its development could be eliminated successfully.

Among possible medications that can be used in the future, the following medication types need to be mentioned: ABT-107, ABT-126, etc. (Ahnalen 4). However, apart from an update in the use of medicine, psychiatrists will have to consider an improvement of the therapy approach. According to the guidelines suggested by the American Psychiatric Association, four essential stages must be completed so that the treatment process could be accomplished successfully.

Particularly, there is the design of the treatment plan, the process of establishing a therapeutic alliance between the psychiatrist and the patient, the acute phase treatment, the stabilization phase, and the stable phase. To make sure that every single phase is completed, one will have to apply the appropriate assessment system.

Treatment Plan

Therapeutic alliance.

The process of drafting a treatment plan and implementing it includes the identification of the specific factors that affect the patient’s well-being, the stage of the disorder, and the identification of the tools that may help the patient. Another important component of schizophrenia treatment, the identified stage involves the process of communicating with the patient, as well as their parents or guardians.

Although the essential medical records required to diagnose the problem and determine the treatment framework that will, later on, be used to inhibit the development of the disorder can be acquired from the family members successfully, it is crucial that the psychiatrist should engage the patient in conversation and create the foil for successful cooperation. As stressed above, the therapist is likely to face a range of impediments on their way to enhancing the cooperation process, mainly because patients are prone to a denial of their problem (Jonsodottir et al. 24).

To make sure that the patient is aware of the issue and is willing to comply with the guidelines provided by the therapist, one will have to consider the use of techniques such as inviting the family members to support the patient extensively and the perceived daily benefit. According to a recent study, the use of the identified strategy is likely to help in cases of the patient non-compliance: “As per ROMI, perceived daily benefit was the most significant contributing factor to the compliance of medication in our study, which was followed by positive family belief, relapse prevention and pressure or force by the family members” (Chandra et al. 297).

Acute Phase Treatment

As a rule, the acute phase treatment involves the use of medication. At this point in addressing the needs of the patient, a psychiatrist aims at controlling the patient’s aggressive behavior, encourage the patient to return to the functioning that helps sustain the routine activities and facilitate the enhancement of communication between the patient and the family members or legal guardians. At this point, one might argue that the ToM framework mentioned above aligns with the identified goals since it also implies that the patient should regain their ability to socialize and communicate efficiently.

Therefore, it can be assumed that the postulates of the ToM theory can be used in the identified phase. Indeed, a close look at the identified phase will show that it requires that the process of communication between the patient and the family members should be promoted actively; in other words, it is necessary that the patient should regain the essential communication skills: “The acute phase is also the best time for the psychiatrist to initiate a relationship with family members, who tend to be particularly concerned about the patient’s disorder, disability, and prognosis during the acute phase and during hospitalization” (Lehman et al. 12).

Stabilization Phase

The identified stage involves creating the environments in which the threat of relapse could be reduced to zero. The patient is encouraged to engage in active communication with their family members. Furthermore, at the identified stage of recovery, the patient is provided with a fewer number of directions from the psychiatrist; instead, they are invited to engage in a conversation independently. As the Acute Phase described above, the process in question is in line with the provisions of the ToM framework, which suggests that schizophrenia affects primarily the social aspects of the patient’s life.

The cognitive element, however, is not to be underrated, either (Grant et al. 122; Granholm et al. 10). Thus, the emphasis must be put on helping the person suffering from the disorder to regain a connection with their family and community members. As a result, faster recovery is expected. However, one must bear in mind that the patient will still require medications that will sustain their condition and prevent a relapse.

Stable Phase

The Stable Phase implies that the process of treatment is nearly over and that the patient is ready to reenter the community. As stressed above, though, antipsychotic medications must be taken on a regular basis; otherwise, relapse will be inevitable. More importantly, when evaluating the patient’s progress and their ability to produce adequate responses, the psychiatrist must also determine whether the trial of the prescribed antipsychotic medication has been completed.

Complications

When considering the design of the approach that will help convince the target audience to follow the prescribed treatment plan, one must bear in mind that schizophrenic patients are prone to developing severe depression and even suicidal thoughts (Weiden et al. 735). In other words, as a protest against the proposed treatment, the patient may make an attempt of committing suicide (Fleishhacker et al. 185). Therefore, it is crucial to make sure that the communication process should not occur in a persuasive manner and that the arguments of the psychiatrist, though convincing, must not pressure the patient into making a decision.

In fact, it is worth noting that some of the medicine types currently used as the means of addressing episodes of schizophrenia may contribute to the development of suicidal attitudes among patients. Although a study conducted lately of the subject matter did not find the direct correlation between the two factors, it states that there might be a link between the depression rates and the use of the medicine that affects the production of the thyroid hormone:

Though apparently this finding does not appear to be of much significance, in about 40% patients TSH was normal, and a significant number of patients did not attempt suicide, if these are the same patients who had normal TSH without a suicide attempt in early psychosis, then it would be an argument to investigate this relationship further to examine where normal or high TSH level can indicate the presence of risk for suicide in early psychosis. (Shrivastava et al. 65)

Therefore, a more elaborate approach toward the assessment of suicide tendencies among the patients is strongly recommended. As a result, not only the threat of the patient suffering death or an injury because of a suicide attempt will be prevented successfully but also the recovery process may start due to successful communication between the psychiatrist and the target audience. The problem concerning the likelihood of side effects development should also be addressed.

As the analysis of recent studies has shown, the process of determining the symptoms of schizophrenia in patients requires further improvement since it currently implies defining the existence of hallucinations and delusions inpatients only. While other factors are taken into account, the two variables mentioned above serve as the primary means of detecting the problem. Therefore, it is strongly suggested that other opportunities for diagnosing disorder at its onset will have to be introduced.

Among the most recent innovative solutions, the application of ToM as the tool for diagnosing the disorder needs to be mentioned. In other words, although hallucinations and delusions are viewed as the primary markers of schizophrenia, the disorder can be identified at comparatively earlier stages once the ToM framework is applied and the changes in the social behavior of an individual are identified.

Furthermore, the ToM framework must be included in the treatment process as well. Seeing that the theory in question places a very heavy emphasis on the significance of restoring the patient’s social functions, whereas the rest of the theories focus on the cognitive development, it aligns with the principles of efficient schizophrenia treatment. In other words, the framework is crucial to the efficacy of the diagnosis, as well as the success of the treatment process.

Despite the fact that a combination of medicine and therapy remains the primary tool for managing the disorder, new suggestions regarding the means of managing the problem have emerged. Particularly, the reconsideration of the medications used to prevent hallucinations and delusions in patients and the focus on managing the social skills along with the restoration of cognitive functions need to be mentioned as the essential change.

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