Treatments and drugs

By Mayo Clinic Staff

Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.

A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include a psychologist, social worker, psychiatric nurse and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.

Medications

Medications are the cornerstone of schizophrenia treatment. However, because medications for schizophrenia can cause serious but rare side effects, people with schizophrenia may be reluctant to take them.

Antipsychotic medications are the most commonly prescribed drugs to treat schizophrenia. They're thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin.

Willingness to cooperate with treatment may affect medication choice. Someone who is resistant to taking medication consistently may need to be given injections instead of taking a pill. Someone who is agitated may need to be calmed initially with a benzodiazepine such as lorazepam (Ativan), which may be combined with an antipsychotic.

Atypical antipsychotics

These newer, second-generation medications are generally preferred because they pose a lower risk of serious side effects than do conventional medications. They include:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Clozapine (Clozaril)
  • Iloperidone (Fanapt)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

Ask your doctor about the benefits and side effects of any medication that's prescribed.

Conventional, or typical, antipsychotics

These first-generation medications have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. This group of medications includes:

  • Chlorpromazine
  • Fluphenazine
  • Haloperidol (Haldol)
  • Perphenazine

These antipsychotics are often cheaper than newer counterparts, especially the generic versions, which can be an important consideration when long-term treatment is necessary.

It can take several weeks after first starting a medication to notice an improvement in symptoms. In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. The psychiatrist may try different medications, different dosages or combinations over time to achieve the desired result. Other medications also may help, such as antidepressants or anti-anxiety medications.

Psychosocial interventions

Once psychosis recedes, psychological and social (psychosocial) interventions are important — in addition to continuing on medication. These may include:

  • Individual therapy. Learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness.
  • Social skills training. This focuses on improving communication and social interactions.
  • Family therapy. This provides support and education to families dealing with schizophrenia.
  • Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs.

Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the treatment team can help find resources. With appropriate treatment, most people with schizophrenia can manage their condition.

Jan. 24, 2014