Hospitalisation may occur with severe episodes of schizophrenia. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment). Long term inpatient stays are now less common due to the policy of deinstitutionalisation, yet we still have large number of patients admitted to institutions for longer period of stay.
The mainstay of psychiatric treatment for schizophrenia is an antipsychotic medication. These can reduce the “positive” symptoms of psychosis. Most antipsychotics take around 7–14 days to have their main effect. Risperidone (trade name Risperdal) is a common atypical antipsychotic medication.
Treatment was revolutionized in the mid 1950s with the development and introduction of the first antipsychotic chlorpromazine. Others such as haloperidol and trifluoperazine soon followed.
Cognitive Behavioural Therapy (CBT)
CBT is used to target specific symptoms and improve related issues such as the therapy advanced from its initial applications in the mid 1990s, more recent reviews clearly show CBT is an effective treatment for the psychotic symptoms of schizophrenia. Another approach is cognitive remediation therapy, a technique aimed at remediating the neurocognitive deficits sometimes present in schizophrenia. Based on techniques of neuropsychological rehabilitation, early evidence has shown it to be cognitively effective, resulting in the improvement of previous deficits in psychomotor speed, verbal memory, nonverbal memory, and executive function, such improvements being related to measurable changes in brain activation as measured by fMRI.
In view of a many empirical findings suggesting deficits of metacognition (thinking about one’s thinking, reflecting upon one’s cognitive process) in patients with schizophrenia, metacognitive training (MCT) is increasingly adopted as a complementary treatment approach.
MCT aims at sharpening the awareness of patients for a variety of cognitive biases (e.g. jumping to conclusions, attributional biases, over-confidence in errors), which are implicated in the formation and maintenance of schizophrenia positive symptoms (especially delusions), and to ultimately replace these biases with functional cognitive strategies.
Family Therapy or Education
This addresses the whole family system of an individual with a diagnosis of schizophrenia, has been consistently found to be beneficial, at least if the duration of intervention is longer term. Aside from therapy, the impact of schizophrenia on families and the burden on careers has been recognised, with the increasing availability of self help books on the subject.
There is also some evidence for benefits from social skills training, although there have also been significant negative findings. Some studies have explored the possible benefits of music therapy and other creative therapies.