With symptoms usually starting between age 16 and 30, schizophrenia is a serious mental health condition that can be disabling.
Hallucinations and delusions can plague sufferers and obscure reality. For those with the disorder — about 1 percent of the adult population, according to the National Institute of Mental Health — these and other symptoms, like reduced feeling of pleasure and “flat affect,” or reduced expression of emotions, can lead to disengagement and withdrawal.
“For some people, they go through that cycle and they just don’t ever get the life that they wanted — they live solitarily, they keep to themselves,” says Paul M. Grant, a research assistant professor of psychology in the department of psychiatry in the Perelman School of Medicine at the University of Pennsylvania. Some people with schizophrenia turn to drugs or alcohol to cope. A disproportionate number end up homeless.
What’s more, apart from the drastic drain psychosis can have on quality of life and relationships, “schizophrenia is very strongly associated with a shortened lifespan,” Grant says. Research on premature deaths in adults with schizophrenia show the causes range from cardiovascular disease to suicide. Rates of smoking, a risk factor for cardiovascular disease, tend to be higher in individuals with serious psychiatric disorders, as with other mental health conditions, and the risk for suicide is also increased in people with schizophrenia.
Even so, experts note that many individuals with schizophrenia are able, with treatment, to live independently, work and otherwise regain quality of life.
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Antipsychotic medications are often prescribed to treat symptoms of psychosis, like delusions. Though experts say these can be effective — at least in the short-term — to address such symptoms, there are significant limitations and downsides to treating schizophrenia with drugs. “The challenge there is that a lot of people don’t respond to those, or they don’t respond well enough so that they can get back to the life that they used to have or the life that they wanted,” Grant says.
Side effects often make it difficult to stay on antipsychotic medications as well. “When you take an antipsychotic medication, you feel dulled — you feel like your mind doesn’t work very well. You might also develop some tremors,” he says. “But the dulling is what most people tell me they don’t like.”
Despite the drawbacks, medications can still be helpful. But experts say so-called psychosocial interventions have also shown benefit, without the side effects. Psychosocial treatments for schizophrenia include things like social skills training and cognitive behavioral therapy as well as newly developed approaches for treating individuals with the disorder.
For individuals with schizophrenia, it’s critical to ensure they get professional help, though that’s something mental health professionals and researchers say is often difficult for people who are withdrawn. So it can be important, where possible, for loved ones to advocate on the person’s behalf. “Talk to health care professionals working with the individual to see what is available and whether it’s something the individual feels could work for them,” recommends Jo Hodgekins, a clinical psychologist and senior lecturer in clinical psychology at the University of East Anglia in Norwich, England. “Get some support. Lots of research has been conducted over the past few years into different treatments for people with psychosis.”
Studies on treating the disorder show promise. What’s more, research seems to show that essentially baking hope (like for a better life) into the treatment approach makes it more effective. “So often, a diagnosis of psychosis or schizophrenia can be seen as a life sentence. Our research, and that of others, suggests that recovery is possible,” Hodgekins says. “Just knowing that can make a big difference.”
But drawing out an individual who has disengaged is not easily done.
So David Fowler, a professor of clinical psychology at the University of Sussex in Brighton, England, developed what’s called Social Recovery Therapy with Hodgekins and other colleagues, and they’ve studied it in individuals with schizophrenia. The therapy involves helping people who are severely withdrawn in identifying meaningful goals and establishing achievable activities. The focus is not just on helping people return to work, for example, but on “a wider construct of social recovery,” the researchers noted in the study published in the Lancet Psychiatry in December; that can range from what individuals are able to do at home to engagement with peers.
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The research focused on people ages 16 to 35 who were extremely socially withdrawn and had a range of other issues, including anxiety and depression, “and a lack of hope for the future,” the researchers noted. “The key is to stop patterns of a lifestyle of withdrawal and instead to give people the tools to manage symptoms so they can regain meaningful activity,” Fowler says. “This can then be the platform for longer term social reengagement.”
Outside of a research setting, Social Recovery Therapy, is not currently available. “But it is an approach that potentially can be a basis for training case managers and other therapists working on the front line with such cases,” Fowler says.
More broadly speaking, experts say, a key is to reach people where they are. That may include seeing if people who are withdrawn can receive therapy in their home or another setting where they’re comfortable.
In research Grant led, published in Psychiatric Services in October, recovery-oriented cognitive therapy, or CT-R, was found to have a lasting improvement, even six months after the end of treatment of low-functioning individuals with schizophrenia. Because these individuals “are profoundly isolated from interactions with others and have limited access to personal motivation to engage in activities, the treatment approach begins with various methods to engage and establish a connection (for example, listening to music, singing, dancing, and going for a walk),” researchers note.
The therapy aims, among other things, to neutralize defeatist and asocial beliefs that individuals hold while helping them access a more adaptive mode, and involves helping people reconnect with what they really want in life. “That’s when, through the experience of success — successfully achieving whatever it is that they want to achieve — that we start to see them make these kinds of shifts — their thinking gets a lot more flexible,” Grant notes. It’s this adaptive cognitive shift that a person with schizophrenia is guided toward by a therapist, which, researchers say, can help individuals better attenuate, or reduce, the effects of obstacles ranging from low energy and hallucinations to disorganization and aggressive behavior.
Cognitive therapy can improve what’s called cognitive insight in individuals with schizophrenia, or one’s ability to evaluate anomalous experiences like hallucinations as potentially inaccurate or unhelpful. Grant notes that in a previous study “we found a correlation between change in cognitive insight and reduction in psychotic symptoms.”
In the recent study published in Psychiatric Services, though it took longer to see progress in more severe cases, “CT-R produced durable effects that were present even among individuals with the most chronic illness,” the researchers concluded.
[See: 4 Subtle Signs of Depression in Men.]
While more research is needed to replicate results, experts say what’s increasingly clear is that there’s hope for people with schizophrenia — even those who’ve struggled with the disorder for decades. Irrespective of how long a person has had schizophrenia or how severe the disorder is, Grant says the research suggests it’s still possible for that individual to “improve and start to get the life that they’ve always wanted, but never really had a chance to get.”
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Finding the Right Treatment for Schizophrenia originally appeared on usnews.com
