Schizophrenia (9)

(Continuation)

[99] For other patients who are unwilling or unable to take medication regularly, long-acting depot preparations of antipsychotics may be given every two weeks to achieve control. The United States of America and Australia are two countries with laws allowing the forced administration of this type of medication on those who refuse but are otherwise stable and living in the community. Some findings have found that in the longer-term some individuals may do better not taking antipsychotics.[100] Despite the promising results of early pilot trials,[101] omega-3 fatty acids failed to improve schizophrenic symptoms, according to the most recent meta-analysis.[102]

Psychological and social interventions Psychotherapy is also widely recommended and used in the treatment of schizophrenia, although services may often be confined to pharmacotherapy because of reimbursement problems or lack of training.[103]

Cognitive behavioral therapy (CBT) is used to reduce symptoms and improve related issues such as self-esteem, social functioning, and insight. Although the results of early trials were inconclusive,[104] more recent reviews suggest that CBT can be an effective treatment for the psychotic symptoms of schizophrenia.[105] Another approach is cognitive remediation therapy, a technique aimed at remediating the neurocognitive deficits sometimes present in schizophrenia. Based on techniques of neuropsychological rehabilitation, early evidence has shown it to be cognitively effective, with some improvements related to measurable changes in brain activation as measured by fMRI.[106] A similar approach known as cognitive enhancement therapy, which focuses on social cognition as well as neurocognition, has shown efficacy.[107]

Family Therapy or Education, which addresses the whole family system of an individual with a diagnosis of schizophrenia, has been consistently found to be beneficial, at least if the duration of intervention is longer-term.[108][109][110] Aside from therapy, the impact of schizophrenia on families and the burden on carers has been recognized, with the increasing availability of self-help books on the subject.[111][112] There is also some evidence for benefits from social skills training, although there have also been significant negative findings.[113][114] Some studies have explored the possible benefits of music therapy and other creative therapies.[115][116][117]

The Soteria model is alternative to inpatient hospital treatment using a minimal medication approach. It is described as a milieu-therapeutic recovery method, characterized by its founder as "the 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment."[118] Although research evidence is limited, a 2008 systematic review found the programme equally as efffective as treatment with medication in people diagnosed with first and second episode schizophrenia.[119]

Other: Electroconvulsive therapy is not considered a first line treatment but may be prescribed in cases where other treatments have failed.

...To be continued