Schizophrenia - Treatment 

Treating schizophrenia 

Schizophrenia is usually treated with an individually tailored combination of therapy and medication.

Good schizophrenia care

The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for how people with schizophrenia should be cared for. NICE recommends anyone providing treatment and care for people with schizophrenia should:

  • develop a supportive relationship with patients and their carers
  • explain causes and treatment options to everyone, keep clinical language to a minimum, and provide written information at every stage of the process
  • enable easy access to assessment and treatment
  • work with patients, and their families and carers if they agree, to write advance statements (see below) about their mental and physical healthcare
  • take into account the needs of the patient’s family or carers and offer a carers' assessment.
  • encourage patients and their families and carers to join self-help and support groups

Read more about NICE guidance: schizophrenia (PDF, 124Kb).

In July 2012, the government launched a new mental health implementation framework to help ensure the No health without mental health strategy, which aims to improve mental health and well-being, becomes reality.

Community mental health teams hide

Most people with schizophrenia are treated by community mental health teams (CMHTs). The goal of the CMHT is to provide day-to-day support and treatment while ensuring you have as much independence as possible.

A CMHT can be made up of and provide access to:

  • social workers
  • community mental health nurses (a nurse with specialist training in mental health conditions)
  • pharmacists
  • counsellors and psychotherapists 
  • psychologists and psychiatrists (the psychiatrist is usually the senior clinician in the team)
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Care programme approach (CPA) show

People with complex mental health conditions, such as schizophrenia, are usually entered into a treatment process known as a care programme approach (CPA). A CPA is essentially a way of ensuring you receive the right treatment for your needs.

There are four stages to a CPA.

  • Assessment - your health and social needs are assessed.
  • Care plan - a care plan is created to meet your health and social needs.
  • Appointment of a care co-ordinator - a care co-ordinator, sometimes known as a keyworker, is usually a social worker or nurse and is your first point of contact with other members of the CMHT.
  • Reviews - your treatment will be regularly reviewed and, if needed, changes to the care plan can be agreed.

Not everyone uses the CPA. Some people may be cared for by their GP and others may be under the care of a specialist.

You will work together with your healthcare team to develop a care plan. Your care co-ordinator will be responsible for making sure all members of your healthcare team, including your GP, have a copy of your care plan. The care plan may involve an advance statement or crisis plan, which can be followed in an emergency.        

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Acute episodes show

People who have serious psychotic symptoms as a result of an acute schizophrenic episode may require a more intensive level of care than a CMHT can provide.

These episodes are usually dealt with by antipsychotic medication (see below) and special care.

Crisis resolution teams (CRT)

One treatment option is to contact a crisis resolution team (CRT). CRTs treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis. Without the involvement of the CRT, these people would require treatment in hospital.

The CRT will aim to treat a person in the least restrictive environment possible, ideally in or near the person's home. This can be in your own home, in a dedicated crisis residential home or hostel, or in a day care centre.

CRTs are also responsible for planning aftercare once the crisis has passed to prevent a further crisis from occurring.

Your care co-ordinator should be able to provide you and your friends or family with contact information in the event of a crisis.

Voluntary and compulsory detention

More serious, acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it is necessary.

People can also be compulsorily detained at a hospital under the Mental Health Act (2007). However, this is rare. It is only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder, such as schizophrenia, and if detention is necessary:

  • in the interests of the person's own health
  • in the interests of the person's own safety
  • to protect others

People with schizophrenia who are compulsorily detained may need to be kept in locked wards.

All people being treated in hospital will stay only as long as is absolutely necessary to receive appropriate treatment and arrange aftercare.

An independent panel will regularly review your case and your progress. Once they feel you are no longer a danger to yourself and others, you will be discharged from hospital. However, your care team may recommend you remain in hospital voluntarily.

Advance statements

If it is felt there is a significant risk of future acute schizophrenic episodes occurring, you may want to write an advance statement.

An advance statement is a series of written instructions about what you would like your family or friends to do in case you experience another acute schizophrenic episode. You may also want to include contact details for your care co-ordinator.

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Antipsychotics show

Antipsychotics are usually recommended as the initial treatment for the symptoms of an acute schizophrenic episode. Antipsychotics work by blocking the effect of the chemical dopamine on the brain.

Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but may take several days or weeks to reduce other symptoms, such as hallucinations or delusional thoughts.

Antipsychotics can be taken orally (as a pill) or given as an injection (known as a 'depot'). Several 'slow release' antipsychotics are available. These require you to have one injection every two to four weeks.

You may only need antipsychotics until your acute schizophrenic episode has passed. However, most people take medication for one or two years after their first psychotic episode to prevent further acute schizophrenic episodes occurring and for longer if the illness is recurrent.

There are two main types of antipsychotics:

  • Typical antipsychotics are the first generation of antipsychotics developed during the 1950s.
  • Atypical antipsychotics are a newer generation of antipsychotics developed during the 1990s.

Atypical antipsychotics are usually recommended as a first choice because of the sorts of side effects associated with their use. However, they are not suitable or effective for everyone.

Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them and their severity will differ from person to person.

The side effects of typical antipsychotics include:

  • shaking
  • trembling
  • muscle twitches
  • muscle spasms

Side effects of both typical and atypical antipsychotics include:

  • drowsiness 
  • weight gain, particularly with some atypical antipsychotics
  • blurred vision
  • constipation
  • lack of sex drive
  • dry mouth

Tell your care co-ordinator or GP if your side effects become severe. There may be an alternative antipsychotic you can take or additional medicines which will help you deal with the side effects.

Do not stop taking your antipsychotics without first consulting your care co-ordinator, psychiatrist or GP. If you do, you could have a relapse of symptoms.

See our medicines guide for schizophrenia.

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Psychological treatment show

Psychological treatment can help people with schizophrenia cope better with the symptoms of hallucinations or delusions.

They can also help treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment.

Common psychological treatments include:

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) aims to help you identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and learn to replace this thinking with more realistic and useful thoughts.

For example, you may be taught to recognise examples of delusional thinking in yourself. You may then receive help and advice about how to avoid acting on these thoughts.

Most people will require 8-20 sessions of CBT over the space of 6-12 months. CBT sessions usually last for about an hour.

Your GP or care co-ordinator should be able to arrange a referral to a CBT therapist.

Family therapy

Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, caring for somebody with schizophrenia can place a strain on any family.

Family therapy is a way of helping you and your family cope better with your condition.

Family therapy involves a series of informal meetings over a period of around six months. Meetings may include:

  • discussing information about schizophrenia
  • exploring ways of supporting somebody with schizophrenia
  • deciding how to solve practical problems that can be caused by the symptoms of schizophrenia

If you think you and your family could benefit from family therapy, speak to your care co-ordinator or GP.

Arts therapy

Arts therapies are designed to promote creative expression. Working with an arts therapist in a small group or individually can allow you to express your experiences with schizophrenia. Some people find expressing things in a non-verbal way through the arts can provide a new experience of schizophrenia and help them develop new ways of relating to others.

Arts therapies have been shown to alleviate the negative symptoms of schizophrenia in some people.

NICE recommends arts therapies are provided by an arts therapist registered with the Health and Care Professions Council and who has experience of working with people with schizophrenia.

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Page last reviewed: 17/09/2012

Next review due: 17/09/2014

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

RSF said on 13 January 2011

Schizophrenia Therapeutics conference in London this May. For more information, visit: http://www.iop.kcl.ac.uk/events/default.aspx?id=1201

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