What is the First Step?

Take the patient to a psychiatrist. The importance of this step cannot be over-emphasized. The sooner the illness is identified and treated for, the greater are the chances of recovery. If schizophrenia is left untreated, it can become chronic- and then it will be too late to effect anything bur the most minimal improvement. Simply labeling the patient as ‘slow-minded’, ‘lazy’ or ‘pretending ‘ does not solve the problem. It must be accepted that there is a problem and the sooner it is treated for, the better.

How is Schizophrenia treated ?

It has been found that the best approach to treating schizophrenia is a broad-based one -comprising  Medical Treatment, Psychotherapy and Social Rehabilitation.

Medical Treatment:
Medical Treatment is the most important part of the program and must be adhered to strictly if the patient is to show consistent improvement. The antipsychotic drugs prescribed aim at controlling the acute symptoms of the illness and suppressing distortions in perception. Sometime ECT-Electro convulsive therapy or  shock treatment – is advised during a schizophrenic episode but usually in conjunction  with the drugs.

How important is medication?

Medication is vital because it aims at restoring the normal functioning of the brain. Once the illness has been identified and the patient is started on a program of drug treatment, it as vital that he keeps to it. These drugs are the product of years of research and are found to have a definite beneficial effect on the patient. If they are stopped for any length of time, the disease will inevitably proceed on its course, causing a relapse. Until recovery has been effected, the drugs should not be stopped, Some times treatment with drugs will have to be continued for years.

Is the treatment safe?

Yes. Administration of drugs and giving ECT or shock treatment is completely safe in expert hands and does not cause damage to the patient’s  mind or body. These drugs do not causes additction and there are no bad effects after they are stopped ,as for instance, in the case of alcohol.  In some patients however, the drugs produce certain side effects-like excessive lethargy, stiffness of limbs, drooling of saliva or fixing of eyeballs in one position. These effects can be removed by counter-active drugs. So patients showing such reactions will have to take a combination of antipsychotic drugs and the counter-active drugs.

Psycho-therapy :
Very often the sever loss of self-esteem and depression suffered by the patient can be countered only by effective psychotherapy – sessions of counseling, encouragement and extension of positive support to the patient by friends and family. Supportive individual talks on a regular basis with mental health professional such as a psychiatrist or psychologist helps the patient to talk freely about his perceptions, problems and experiences. Sympathetic counseling enables him to learn to distinguish the real from the unreal and distorted, and gradually to understand more about his illness and himself. Very often he learns to live with symptoms which cannot be completely eradicated.

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Social Rehabilitation : 
In order that the patient may function normally and become a productive member of society social rehabilitation becomes essential. One aspect of rehabilitation is Occupational therapy which aims at the acquisition of simple social and trade skill in keeping with the patient’s  capabilities so that he may be gainfully employed and resettled in life. A second aspect is Group Therapy by which means a patient is enabled to interact freely with others and thus to regain and strengthen his inter personal skills and his self-confidence.

An important feature of this efforts to rehabilitate the  patient is Family Counseling where the family can discuss the patient, his problems and theirs with a professional psychiatrist and be given guidance on how to treat the patient and how best to aid the recovery process.
All aspects of this program are important although it must be emphasized that medication, as prescribed, should never be neglected, even in case of substantial improvement, since that may lead to a relapse . The overall result of such a comprehensive approach to the treatment of schizophrenia is that the patient not only improves as a result of medication, but as he becomes proficient at some trade and continues his counseling  sessions, also recovers his self-esteem and  become more confident of his place in society.

In India, we now have Clozapine and Risperidone and Olanzapine is expected to be introduced shortly.

What is the extent of recovery possible ?

The extent of recovery possible is dependent to a great extent on the stage at which treatment is begun. This underlines the necessity for  early identification and early treatment. It is possible in may cases to fully rehabilitate the patient with medication and psycho-social therapy- if the illness had been identified in the early stage. However, even if the patient has returned to normal functioning, a periodic check-up with a psychiatrist is advised.

Current figures show that:

About 30-40% register complete recovery
About 30-40% are seen to be partially recovered’ (This means they will improve but need continuous medication) and about 20-30% become chronic.(They may improve but never be fully recovered.)