Schizophrenia and schizoaffective disorder are serious and life-altering mental health disorders. Their symptoms include hallucinations, delusions, and other cognitive changes. Living with schizophrenia or schizoaffective disorder can be challenging. It is important to stick to the treatment plan recommended by your doctor.
Schizophrenia and schizoaffective disorder are not yet curable, but they are treatable. Some of the treatments recommended for schizophrenia and schizoaffective disorder overlap with treatments prescribed for people with depression or bipolar disorder. Understanding how schizophrenia and schizoaffective disorder are treated is an important first step toward living a healthier, safer life.
Medications are often the first line of defense against the symptoms of schizophrenia and schizoaffective disorder. The primary medications used to treat schizophrenia are a class of pharmaceuticals called antipsychotics. Medications used to treat schizoaffective disorder include antipsychotics, mood stabilizers, and antidepressants. Most of these drug combinations are used for the long-term maintenance of schizophrenia and schizoaffective disorder symptoms.
Antipsychotics fall into two categories: first generation and second generation.
First-generation antipsychotics (also known as typical antipsychotics) were the first antipsychotics developed. They are less commonly used today because of their side effects, such as heart problems and tardive dyskinesia (abnormal and repetitive jerking movements of the face, tongue, and neck). However, sometimes they are still prescribed because they are less expensive than second-generation options. These first-generation antipsychotics act on the brain’s dopamine system by blocking dopamine type 2 receptors. Some common first-generation antipsychotics include chlorpromazine, haloperidol, and thioridazine.
Second-generation antipsychotics (also called atypical antipsychotics) are more commonly used today than first-generation antipsychotics. Second-generation antipsychotics do not have some of the most concerning side effects of first-generation antipsychotics, but they are not without their own side effects. These include sedation, high blood pressure, weight gain, and sexual dysfunction.
Some second-generation antipsychotics also have antidepressant effects. This is due to their mechanism of action. Like first-generation antipsychotics, second-generation antipsychotics work by blocking dopamine type 2 receptors. However, they also act on the serotonin type 2A receptor, which is where their antidepressant actions come from. Common second-generation antipsychotic medications include:
Mood stabilizers are often prescribed for people who have the bipolar type of schizoaffective disorder. These drugs are particularly useful for decreasing the frequency and severity of mood swings, from the “highs” of mania to the “lows” of depression. Mood stabilizers are also anticonvulsants, which means they can be used to treat seizure disorders.
The mechanism of action of mood stabilizers is fairly complicated and can vary depending on the medication. Essentially, they slow down brain communication. Mood stabilizers can also have side effects, such as weight changes, tremors, hair loss, sexual dysfunction, nausea, and effects on the blood. Examples of mood stabilizers include:
Antidepressants are another class of medications used for people with schizoaffective disorder (both the bipolar type and depressive type), to treat depressive symptoms. Antidepressants work by acting on serotonin. They can also affect other mood-altering chemicals, such as noradrenaline and dopamine. This is why they are the primary line of defense against major depression.
Antidepressants can cause side effects like weight gain, nausea, dry mouth, and seizures. Antidepressants prescribed today are typically of the selective serotonin reuptake inhibitor (SSRI) class. Common SSRI antidepressants include:
Antidepressants don’t always work for everyone. However, you should never discontinue medication without first consulting your psychiatrist or another health care provider. There may be another therapeutic combination of medications that might work better for you or your loved one.
There is still a lot to learn about the treatment of schizoaffective disorder and schizophrenia. Although some symptoms may go into remission for some people, currently, no treatment is available that will completely cure these mental health conditions.
Psychotherapy is an important component of many treatment plans for schizophrenia and schizoaffective disorder. In fact, psychotherapy (talk therapy with a psychologist or other mental health professional) helps with many mental illnesses, including depression.
Research has shown that a form of psychotherapy called cognitive behavioral therapy (CBT) can help individuals living with schizophrenia improve their quality of life. CBT focuses on being aware (or mindful) of patterns of thought and behavior. It is a skill-based therapy where techniques such as self-calming or problem-solving can be worked on during a session or out in everyday life.
There are a few forms of CBT therapy, including second-wave techniques such as dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT). A study of 80 people with psychosis found that four sessions of ACT reduced the need for hospitalization for at least a year after the sessions. CBT can also be beneficial for those with medication-resistant psychosis.
While medications and psychotherapy are used for the long-term maintenance of schizophrenia and schizoaffective disorders, there are other treatment options that can also be used either for maintenance or acute episodes. Electroconvulsive therapy (ECT) is one option.
ECT involves passing electrical current through a person’s head to induce a seizure. Some studies have shown that this technique, when prescribed periodically for longer than six months, has been successful as a form of relapse prevention in people with schizophrenia. Another study of 27 people with severe, medication-resistant schizophrenia found research to suggest that ECT may make medications for psychosis more effective.
Another treatment method that may be used more in the future is deep brain stimulation (DBS). DBS involves passing an electric current through an individual’s head in a particular location. There is preliminary research in animals to support the use of DBS for psychotic symptoms. One recent pilot study of two men with severe, treatment-resistant schizophrenia supports the need for further research into DBS for intractable schizophrenia.
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