Living with Schizophrenia:
Psychotherapy and Schizophrenia Recovery

Living with schizophrenia is an ongoing challenge for both schizophrenic and their families. Complete schizophrenia recovery is rare: The majority of patients will be living with schizophrenia side effects and residual symptoms for the rest of their lives. Psychotherapy, maintaining antipsychotic medication and family support are all necessary for schizophrenia recovery.

While antipsychotic medications are the best treatments for people living with schizophrenia, recovery rates vary widely. Schizophrenia studies indicate one-third of all patients' psychosis improve enough with treatment to qualify as schizophrenia recovery. An additional third of all cases improve with treatment, but continue living with some schizophrenia psychotic symptoms. The remaining third do not respond well to antipsychotics, and continue to experience schizophrenia psychosis.

Certain factors improve the prognosis, or chance, of a schizophrenia recovery. Patients who were in very good health before the onset of schizophrenia symptoms have a better chance of schizophrenia recovery than average. Patients whose schizophrenia symptoms develop rapidly appear to respond better to treatment than patients whose symptoms develop over a long period of time.

Studies indicate schizophrenics with predominantly "positive" symptoms (such as hallucinations and delusional thoughts) respond better to antipsychotics than patients with mostly "negative" symptoms (blunted emotions, loss of motivation). Patients with paranoid schizophrenia generally have a better chance of schizophrenia recovery than other subtypes of schizophrenia.

Individual psychotherapy and cognitive-behavioral therapy can help people living with schizophrenia learn to control their disorder and deal with problems. However, psychotherapy generally aids schizophrenia recovery after antipsychotic medications reduce psychotic symptoms. Psychotherapy alone will have only limited results.

 

Psychotherapy provides a safe environment for schizophrenics to discuss their perceptions of the world. Talking about experiences, personal beliefs, and the challenges of living with schizophrenia during psychotherapy can help schizophrenics understand their disorder. Psychotherapy can also help schizophrenics identify schizophrenia symptoms and differentiate between real and psychotic stimuli.

Successful schizophrenia recovery allows people living with schizophrenia to re-enter society. For many people, this means returning to the workforce. Employment can raise self-esteem, increase socialization, and improve overall quality of life. Sadly, rates of competitive employment amongst people living with schizophrenia are very low.

Psychotherapy and vocational programs can help schizophrenics return to the workforce. People wishing to return to work after schizophrenia recovery should ask their doctor or psychotherapy counselor what vocational programs are available. Possible programs include:

Families living with schizophrenia have often spent years trying to get schizophrenic family members the help they need. Schizophrenics often refuse treatment, and laws requiring adult consent for medical treatments have often inadvertently sabotaged family attempts to get schizophrenics the help they need. In some cases, desperate family members have lied and told doctors the schizophrenic was a danger to others or suicidal: the two conditions in which an adult may receive medical treatment or psychotherapy without his or her consent.

Families should understand that successful schizophrenia recovery requires long-term treatment. All too often, hospitalized schizophrenics are released after a few days, although it takes weeks for antipsychotics to start working. Once released, the person simply stops taking the medication. Families need to work closely with doctors to ensure schizophrenics receive proper treatment.

One in ten schizophrenics commit suicide; an alarming statistic that people living with schizophrenia sufferers need to know. Schizophrenia recovery does not immediately reduce this risk. In fact, the risk of suicide increases in the first six months of treatment, as psychotic symptoms diminish and the person becomes more aware of his or her psychotic behavior.

Antidepressants taken in combination with antipsychotics may reduce suicide risks during this stage of schizophrenia recovery. People living with schizophrenia patients should "suicide proof" their home, removing potential suicide tools such as guns, knives, poisons, and ropes from the schizophrenic's environment.

Substance abuse is also common amongst schizophrenia sufferers. Forty percent of schizophrenics abuse drugs or alcohol, and family members should watch for evidence of possible substance abuse.

Noncompliance with medication needs is one of the biggest threats to schizophrenia recovery. The schizophrenic stops taking antipsychotic medication, and symptoms return. Approximately forty percent of schizophrenia relapses result from noncompliance.

 

It can be difficult to distinguish between noncompliance and medication that simply isn't working well enough. Frequent noncompliance lowers the chance of schizophrenia recovery, as the schizophrenic may not respond as well to medications over time.

People close to schizophrenics can help prevent noncompliance. Family members should explain to the schizophrenic that following a medication schedule is important and is the groundwork for further psychotherapy and rehabilitation.

How others view medication is vital. One-third of all schizophrenics who stick to their medication schedule do so primarily because family and friends believe medication is important.

People living with schizophrenia patients may not immediately recognize noncompliance, as the benefits of antipsychotic medications continue for sometime after stopping medication. Warning signs that noncompliance is a threat to schizophrenia recovery include:

Schizophrenia recovery does not assume the patient will be symptom-free all the time. People living with schizophrenia patients must be aware of this. Delusional thoughts may surface occasionally, even with antipsychotic medications. Psychotherapy can teach schizophrenics to identify delusional thoughts, and by attending some psychotherapy educational sessions, family members can learn how to manage delusional thinking.

Up to 75 percent of all people living with schizophrenia will have some degree of social withdrawal. Verbal communication may be difficult: family members may have to be sensitive to facial expressions. Mood swings and difficulty focusing are also common occurrences even when schizophrenia recovery is a success.

Schizophrenia recovery may suffer relapses, even with regular medication. Family and friends who understand an individual schizophrenic's psychotic behavior may be able to detect symptoms of a relapse in its early stages, allowing treatment to begin as soon as possible. Warning signs may be apparently harmless. For instance, many people clip newspaper coupons. A harmless enough activity, but if a schizophrenic's delusion caused him to believe that coupons were secret messages, suddenly starting to clip and collect coupons may be a sign of a relapse.

Resources

Beers, M.H., & Berkow, R. (ed). Schizophrenia and related disorders. The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999.

Fauci, A., Braunwald, E., Isselbacher, K., Wilson, J., Martin, J., Kasper, D., Hauser, S. & Longo, D. (ed). Harrison's Principles of Internal Medicine, 14th Edition . McGraw-Hill, New York, 1998.

Lehman, A. (1995). Vocational rehabilitation in schizophrenia.Schizophrenia Bulletin 21(4), 645-656.

Murphy, M., Cowan, R. & Sederer, L. Blueprints in Psychiatry. Blackwell Publishing, Massachusetts, 2004.

Schizophrenia.com. (nd). Helping a family member who has schizophrenia but doesn't know they are ill.

Spearing, M.K. (2002, August). Schizophrenia [NIH Publication No. 02-3517]. National Institute of Mental Health.

Thorton, J., Seeman, M. & Plummer, E. (nd). Schizophrenia: Returning home. Merrell Dow Pharmaceuticals (Canada) Inc.

Weiden, P. (nd). How to help someone who stops taking their medicines.