Treating Schizophrenia

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What help will I be offered?

The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for treating and managing schizophrenia. It covers psychological treatments, medication and the services that should be made available in hospital and in the community. The guidelines also state that, in addition to medical treatment, help should be offered for social issues that may be affecting your mental health. NICE recommends that you should get help as quickly as possible. (Visit www.nice.org.uk).

If you decide to see your GP, he or she will probably refer you to psychiatric services for initial assessment, treatment and care. However, once treatment is established, your GP can be responsible for your on-going care.

Help may be different depending on whether you have just been diagnosed or if you need more long-term support.


Staying well and recovering

Medication

Doctors usually prescribe neuroleptic drugs (also known as antipsychotic drugs or major tranquillisers) to control the ‘positive’ symptoms. They have a sedative action, which can make it more difficult to cope with side effects or to benefit from talking treatments. They have unpleasant side effects, particularly in high doses. These include:

  • neuromuscular effects (shaking and muscle stiffness)
  • antimuscarinic effects (blurred vision, rapid heartbeat, constipation)
  • sexual side effects (breast development, loss of sexual desire, loss of periods)

Older neuroleptics, such as chlorpromazine (Largactil) and haloperidol (Serenace, Haldol) have been associated with severe and long-term side effects including involuntary movements and muscle spasms (known as tardive dyskinesia) which may be permanent.

The newer neuroleptics are:


  • risperidone
  • amisulpride
  • olanzapine
  • paliperidone
  • quetiapine 

These drugs have been developed to have fewer neuromuscular side effects. They are, however, more likely than the older drugs to cause metabolic symptoms which include: weight gain; high blood sugar, with diabetes in some cases; high cholesterol; and high blood pressure. People taking any neuroleptics should have their weight, blood pressure and blood sugar checked regularly. They may also improve ‘negative’ symptoms (see above), which are much more difficult to treat and control.

Neuroleptics come in tablet, syrup or injectable form, and may be taken daily, weekly, fortnightly or monthly.

Some people get short-term help from medication, then come off it and remain well. Others may benefit from more long-term treatment. If you do stay on medication long term, staying on the lowest effective dose of the drug may be the best way of dealing with symptoms and at the same time reducing side effects. If you are taking these drugs, you should have the dosage reviewed regularly, with the aim of keeping it as low as possible. You may have to try more than one drug to find the best one for you. This may not make too much difference to your symptoms but it could reduce the side effects. Some people stop taking medication because of the side effects, others find they can manage without medication.

Anyone with the following should use these drugs with caution:

  • liver or kidney disease
  • myasthenia gravis (a disease affecting nerves and muscles)
  • cardiovascular (heart and circulation) disease – or a family history of these diseases
  • an enlarged prostate
  • a history of glaucoma, an eye disease
  • family history of diabetes 
  • Parkinson’s disease
  • lung disease with breathing problems
  • epilepsy 
  • depression
  • some blood disorders.


Talking treatments

Talking therapies, such as psychotherapy, counselling and cognitive behaviour therapy (CBT), can help to manage and treat schizophrenia. Talking treatments help you to identify the things you have issues with, explore them and discuss strategies or solutions. They can allow you to explore the significance of your symptoms, and so to defeat them.

NICE guidelines recommend CBT is offered (increasingly available on the NHS) and family therapy made available, so ask your doctor about this. Otherwise, accessing talking treatments can be difficult if you can’t afford to pay. Some local voluntary projects, including local Mind associations, offer free services.

 

Transcranial magnetic stimulation (TMS)

TMS is a fairly new treatment that’s still only used in research studies. Although still on trial, it’s non-invasive and seems to be quite safe. It uses magnetic impulses to stimulate the frontal regions of the brain. This may be helpful for people who have mainly ‘negative’ symptoms, and has also had some success in treating auditory hallucinations.

 

In a crisis or when things are difficult

A crisis will most likely be treated in one of the following ways:


Rapid tranquillisation

On rare occasions, when other methods haven’t worked, it may be necessary to use drugs to calm someone down in a hurry. This is known as rapid tranquillisation. It should never be used routinely because it carries risks and is traumatic. After rapid tranquillisation, people should receive a full explanation and support, and an opportunity to discuss what happened.


Crisis services

Community Mental Health Teams (CMHTs), home treatment teams, early intervention teams and acute day hospitals may be able to help you avoid going into hospital in a crisis. Some CMHTs offer accommodation and some aim to send support into your home but services CMHTs provide may be different across the UK.


Hospital admission

If you are feeling particularly distressed, you may prefer to go somewhere that feels safe and undemanding. At present, this usually means going into hospital. It can be upsetting to be around others who are distressed, and the lack of privacy and support can also be difficult to cope with. However, service user or patient groups based in the hospital can be very useful and supportive.

If you are unwilling to go into hospital, you might be compulsorily admitted under the Mental Health Act. The Mind rights guide series gives information about your rights under this Act.


Moving on and day-to-day challenges

There are several support options as you move on to face day-to-day challenges. These are typically:


  • community care 
  • supported accommodation
  • advocacy
  • social and vocational training


 

Community care

 

If you are referred to specialised mental health services you should:

 

  • get a thorough assessment of your health and social care needs to establish a care plan
  • have your care plan reviewed on an on-going basis
  • be appointed a care coordinator or key worker to oversee your care.

 

You are entitled to say what your needs are, and have the right to have an advocate present. The assessment might also include carers and relatives. This is called the care programme approach (CPA). (The systems in Wales and England are similar but not identical.)

 

 

Your local Community Mental Health Teams (CMHT) may make the care assessment. CMHTs are made up of a number of specialist workers, including a psychiatrist. Their job is to enable you to live independently, and to help with practical issues, such as sorting out welfare benefits and housing. They can also organise access to day centres or drop-in centres. A community psychiatric nurse (CPN) may visit you at home. CPNs can give medicines, and may provide other practical help. An occupational therapist may also be on the team and can help you develop new skills. The care assessment may include your need for any community care services. This covers everything from day care to housing.

 

If you’re not assessed by psychiatric services you can ask Social Services to assess your needs. If you need care workers, any charges for this should be included in the needs assessment. Once your need for care has been established, you may be able to request direct payments to employ your own care worker or pay for a chosen day centre, rather than having the care provided by Social Services. You should be able to get information about local mental health services from the CMHT, your GP, Social Services, Patient Advice and Liaison Services (PALS) or local Mind association, which should be listed in your local phone directory and on the internet.

 


Advocacy

 

Advocates are trained and experienced workers who can assist you to communicate your needs or wishes, to access impartial information, and to represent your views to others. Advocates may also be able to help you access community care services and represent you at Tribunals.

 


Supported accommodation

 

Social Services and mental health projects, including some local Mind associations, may provide local supported housing. This might allow you to live independently, but with help at hand from staff or other tenants. Levels of support will vary from place to place.

 


Social and vocational training

 

Training may be available to help you in a variety of ways, from learning how to use public transport, to finding work, managing money, coping with social situations and solving problems. Ask your care coordinator for information about training.

 

 

 

For more information visit:   Mind.org.uk

 


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The Have I Got A Problem website is a free online resource to help people better understand any issues or concerns they may have about mental health or addiction. The website includes resources specifically focused to; general Mental Health, Depression, Stress, Anxiety, Insecurities, Self-harm Schizophrenia, Bipolar, Anger Management, Eating Disorders, Coping, general Addiction, Alcohol, Smoking, Gambling, Drugs, Cocaine, Heroin, Marijuana (Cannabis) Ecstasy, PCP, Mephedrone, Ketamine & Crystal Meth.

The site was created to give the public information to help them understand mental health and addiction issues and to assist people in making better informed decisions about their life and personal choices.

www.haveigotaproblem.com was created and is run by 'Advising Communities’, which is a UK registered charity (Charity No. 1061055)

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