Treatments for Schizophrenia and What to Do When Someone Refuses Treatment

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Schizophrenia is a serious, long-term mental health condition. A person with schizophrenia has disturbances in their thoughts, behavior, and the way they perceive their environment.

• Positive symptoms: delusions, hallucinations, and unusual thinking or movement
• Negative symptoms: a decrease in emotional expression, reduced speaking, and a loss of interest in daily activities

It’s estimated that between 0.25 and 0.64 percent of people in the United States have schizophrenia or a related mental disorder. The condition often requires lifelong treatment.

The treatment of schizophrenia typically involves medications and therapy. The specifics of treatment are individualized and can vary from person to person.

The overall goals of schizophrenia treatment are to:

• ease symptoms
• prevent symptom relapse
• promote an increase in functioning with the aim of integration back into the community

The main treatment for schizophrenia involves the use of medications. Antipsychotics are the most commonly prescribed.

These medications can help to manage acute schizophrenia symptoms. They can also be taken as a maintenance medication to help prevent a relapse.

In addition to medications, psychosocial treatments are also an important part of schizophrenia treatment. These are typically implemented once the acute symptoms of schizophrenia are eased with medication.

A variety of medications are used to treat schizophrenia.

Antipsychotic medications

Antipsychotic medications can help to manage the symptoms of schizophrenia. They’re believed to do this by affecting the levels of a neurotransmitter called dopamine.

These medications are often taken daily in pill or liquid form. There are also some long-acting forms that can be given as an injection.

There are two different kinds of antipsychotic medications: first generation and second generation.

First generation antipsychotics include:

• chlorpromazine (Thorazine)
• fluphenazine (Proxlixin)
• loxapine (Loxitane)
• perphenazine (Trilafon)
• thiothixene (Navane)

Second generation antipsychotics are typically preferred over their first generation counterparts. This is because they have a lower risk of causing serious side effects.

Second generation antipsychotics can include:

• asenapine (Saphris)
• brexpiprazole (Rexulti)
• cariprazine (Vraylar)
• clozapine (Clozaril)
• iloperidone (Fanapt)
• lurasidone (Latuda)
• paliperidone (Invega)
• ziprasidone (Geodon)

Your doctor will want to prescribe the lowest possible dose that still manages your symptoms. Because of this, they may try different drugs or dosages to find what works best for you.

Other medications

In addition to antipsychotics, sometimes other medications may be used. These can include medications to ease symptoms of anxiety or depression.

Electroconvulsive therapy (ECT)

In some cases, ECT may be used for adults with schizophrenia who aren’t responding to medications or who have severe depression.

ECT uses electric currents to generate a seizure.

Although no one knows for sure how exactly ECT works, it’s believed to change chemical signaling in the brain. ECT does come with some potential side effects, such as memory loss, confusion, and body aches and pains.

Psychosocial treatments are also an important part of schizophrenia treatment.

Psychotherapy

Different types of psychotherapy, such as cognitive behavioral therapy (CBT), can help you identify and understand the thought patterns associated with your condition.

Your therapist will work with you to develop strategies to help you change or cope with these thought patterns.

Family therapy

Family therapy involves working with the family members of someone with schizophrenia. This is very important, as family support can have a big impact on treatment and risk of relapse.

Family therapy focuses on helping family members:

• understand more about schizophrenia
• lower levels of stress, anger, or burden within the family environment
• develop ways to help communicate with and support someone with schizophrenia
• maintain reasonable expectations for their family member’s treatment

Occupational rehabilitation

This can help people with schizophrenia prepare for or return to employment. Employment may also help with feelings of well-being by providing a meaningful activity as well as income.

Supportive employment helps people with schizophrenia return to work. It can involve things like individualized job development, a rapid job search, and continued support during employment.

Some people with schizophrenia may not be ready to return to work, but wish to in the future. In these cases, things like vocational training or volunteering may be beneficial.

Social skills training

Social skills training can help someone with schizophrenia improve or develop their interpersonal skills.

A variety of methods can be used including but not limited to:

• instruction
• role-playing
• modeling

A variety of alternative treatments for schizophrenia are also being explored.

Many of them focus on dietary supplementation, as some studies suggest that a poorer quality diet is associated with schizophrenia and related disorders.

While more research is still needed into these potential treatments, here’s what’s currently being studied:

• Omega-3 fatty acids: Omega-3 supplementation has been explored for a variety of mental disorders. Studies of its efficacy in schizophrenia have yielded mixed results.
• Vitamin supplementation: Early evidence indicates that supplementation with B vitamins may help reduce psychiatric symptoms in some individuals with schizophrenia.
• Diet: Some studies have indicated that a gluten-free diet may improve outcomes in people with schizophrenia. Studies on the ketogenic diet for schizophrenia are more limited and have mixed results.

It’s important to remember not to go off of your prescribed medications without speaking to your doctor first. Doing so without supervision could cause a relapse of symptoms.

In addition to investigating potential alternative treatments, researchers are also looking into improving upon current schizophrenia treatments. This is particularly true for medications.

Some goals are to identify drugs that:

• have fewer side effects, potentially increasing compliance
• better address negative symptoms
• improve cognition

While current medications target dopamine receptors in the brain, researchers are also looking into drugs that target other receptors. By focusing on other targets, it’s hoped that future drugs will help to better manage symptoms.

In 2019, the Food and Drug Administration (FDA) approved a new drug for schizophrenia. Called lumateperone (Caplyta), this drug is believed to target both dopamine and serotonin receptors.

Another drug, called SEP-363856, is currently in clinical trials to evaluate its safety and effectiveness. This drug is also unique in that it doesn’t directly target dopamine receptors.

Antipsychotic medications are the mainstay treatment for schizophrenia, however, they can have a variety of side effects. The type and severity of these side effects can vary by individual and by the specific drug being used.

Some examples of the potential side effects of antipsychotics can include:

Extrapyramidal symptoms are more common with first generation antipsychotics. Meanwhile, side effects like weight gain are more closely associated with second generation antipsychotics.

Neuroleptic malignant syndrome is a rare but potentially life-threatening reaction to antipsychotics. Symptoms involve very high fever, muscle rigidity, and rapid heartbeat.

It’s more common with first generation antipsychotics but can also occur with second generation antipsychotics.

Some of the symptoms of schizophrenia can include hallucinations, delusions, and other disturbances in thinking and perception. Additionally, the medications prescribed to treat the condition can often cause unpleasant side effects.

Because of these factors, some individuals may refuse treatment. However, oftentimes not seeking treatment is associated with a poorer prognosis and quality of life.

Follow the tips below to help a loved one that’s refusing treatment:

• Let them know what you’re thinking. It’s important that you have an open, honest conversation with your loved one about your concerns regarding treatment.
• Think about time and place. Avoid starting a conversation when your loved one is stressed, tired, or in a bad mood. Additionally, try not to have it in surroundings that may make your loved one uncomfortable.
• Carefully consider delivery. Plan out in advance what you’d like to say. Try to use a calm and friendly tone and avoid language that may sound stigmatizing or like you’re setting an ultimatum.
• Listen to what they have to say. Your loved one may want to voice their concerns regarding treatment. If so, be sure to give them an attentive, sympathetic ear.
• Stay patient. They may not change their mind immediately. Continue to offer support and note the importance of seeking treatment in a loving, positive way.
• Offer to help. Sometimes seeking treatment may feel overwhelming. Offer to help them find and make an appointment with a mental health professional.

The following resources are available to help people with schizophrenia:

• Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline (1-800-662-4357): Information and treatment referrals for mental health and substance use disorders offered 24/7.
• National Alliance on Mental Illness (NAMI) Helpline (800-950-6264): Information and treatment referrals available Monday through Friday from 10:00 AM through 6:00 PM (ET).
• Schizophrenia and Related Disorders Alliance of America (SARDAA): Offers support, information, and other resources for people with schizophrenia and their loved ones.

If you or a loved one is experiencing a mental health emergency, it’s important that care is given as soon as possible. In this situation, dial 911.

If you’re the loved one of someone with schizophrenia, follow the tips below to help cope:

• Get information: Learning as much as you can about schizophrenia can help you understand the condition and how you can help.
• Help motivate: Implement strategies to help motivate your loved one to stick to their treatment goals.
• Participate when possible: If your loved one is in family therapy, be sure to participate in the therapy sessions.
• Care for yourself: Relaxation techniques like yoga or meditation can help to alleviate stress. You may also consider joining a support group, as it can be helpful to talk with others who are experiencing similar things.

The treatment for schizophrenia typically involves treatment with medications as well as therapy. Treatment can vary by person and is customized to their individual needs.

The main medications for schizophrenia are antipsychotic drugs. However, these do have potentially serious side effects.

Researchers are currently working to develop new medications that address symptoms while having fewer side effects.

Some people with schizophrenia may refuse treatment. This might be due to the symptoms of their condition or the potential for drug side effects. If a loved one is refusing treatment, have an open, patient conversation with them about your concerns.