Dr. Lieberman describes the treatments for schizophrenia.
Treatment for schizophrenia comes in two basic categories. The first is medication, or pharmacologic treatments, and the second are psycho-social treatments, things that occur in terms of trying to help or supporting, or training an individual.
Medications mainly involve a class of medicines called antipsychotic drugs, and these are drugs that are very effective, have been proven to work in terms of suppressing or alleviating the positive psychotic symptoms of the illness and preventing their recurrence, preventing relapses from occurring. They are very, very effective at doing that. They don’t work in everybody, but they work in the vast majority of people, at least to some degree.
They also are associated with side effects. Some cause neurologic side effects where they cause some muscle stiffness or slowing or shakiness. Others cause change in appetite. So you are hungrier, you eat more, you can gain weight, and others may cause endocrine effects and endocrine effects can take a variety of forms, and in some cases, in association with the increased appetite, people can get hyperglycemic, meaning their blood sugar goes up. They can potentially develop diabetes. They can develop higher cholesterol and lipids, which can facilitate or lead to long-term cardiovascular disease. So, these treatments have to be used carefully, only when they are really needed, and patients are followed and monitored closely.
The psychosocial treatments are numerous. There are various forms of psychotherapy, meaning somebody meets with the patient and helps them to really deal with the issues of their daily living. There are forms of rehabilitation therapy; that is, after somebody has had an episode of schizophrenia or they may have been hospitalized or they may be incapacitated for a period of time, how do you get back into your life? You just don’t return to school or you don’t return to the job; it’s not that easy. It’s like when you have a broken leg or you have a heart attack. You don’t just resume doing what you were doing immediately; you have to go through a process of rehabilitation.
Similarly, you have to go through a process of re-acclimation or rehabilitation to resume your school, supported education that’s called, resume your job, supported employment it’s called. In some cases the disruption to somebody’s brain processes, brain functioning, and mental processes is so severe that they can’t even, with support, go back to working or school. They need to have a rehabilitation which involves something called cognitive remediation, and this involves working with a trained doctor or therapist using a computer-based system of doing exercises to kind of retrain your brain because you have been out of action for a while and you’ve got to get back into the swing of figuring out things and understanding how you analyze problems in daily living.
There’s also other forms of psycho-social treatment that are very, very helpful. Sometimes people who have schizophrenia don’t want treatment, or don’t feel they need treatment, or just plain forget about treatment. In those cases, with what’s called assertive community treatment, a case manager or somebody that’s assigned to work with that person will go out to find them, will go to their home, you know, ”You haven’t come to the clinic, you haven’t come to the office, you haven’t shown up, what’s going on here, you need to get your medication, you need to go through your rehabilitation,“ so they’ll get after them.
So there’s a whole variety of these things, and then even there’s a therapy that can be directed towards the family. That is, how does a family provide the best care for their family member who has schizophrenia and how do they avoid that person’s illness from providing such great stress on the family that it really has a detrimental impact and is bad. So, there’s family therapy to ease what might be called, the caregiver burden of the family.
About Dr. Lieberman, M.D.:
Jeffrey A. Lieberman, M.D. currently is the Lawrence E. Kolb Chairman of Psychiatry at the Columbia University College of Physicians and Surgeons and Director of the New York State Psychiatric Institute. He also holds the Lieber Chair and Directs the Lieber Center for Schizophrenia Research in the Department of Psychiatry at Columbia.