Running head: THE TREATMENT OF SCHIZOPHRENIA 1

The Treatment of Schizophrenia

Janu Patel

PSYC 410-003; University of South Carolina

THE TREATMENT OF SCHIZOPHRENIA 2

The Treatment of Schizophrenia

Ganguly, Soliman, and Moustafa (2018) states that schizophrenia is a disorder that affects

the brain and changes the way a person acts, thinks, and perceives the world through delusions,

hallucinations, disorganized speech, and diminished emotional expression. Many research

studies have been conducted on the effect of pharmacological therapy and non-pharmacological

therapy on individuals with schizophrenia (Ganguly et al., 2018). Although there is no cure to

schizophrenia, these types of treatment have shown to have a tremendous effect, good and bad,

on the life of an individual who suffers from schizophrenia. This paper explores the different

treatment options that are used on individuals with schizophrenia and the results of those

treatments based on different studies conducted.

Kahn and Sommer (2014) reviewed studies on how schizophrenia changes the brain. It

was found that schizophrenia in patients starts from an early age and many do not know they

have it until their first psychotic episode. A normal brain reaches its full size at the age of 13. In

patients with schizophrenia, there is a pause of growth before the age of 13 causing a decrease in

intercranial volume. This result was seen after reviewing neuroimaging studies of more than

18,000 individuals, which included 771 onset patients. After the age of 13, patients with

schizophrenia have brain loss and abnormal development that can go on for years before it is

detected. Since schizophrenia goes undetected for years, early deficits in brain maturation makes

it harder to treat schizophrenia, but they have found that treatment can be effective if given

during the critical development window of the brain (Kahn and Sommer, 2014).

Antipsychotic medication has been one of the most popular treatments of schizophrenia.

Agid et al. (2011) conducted a study on the response rate of three antipsychotic trials on first-

episode schizophrenia. The study included 244 individuals who have first episode psychosis, or a
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schizoaffective disorder based on the DSM-IV criteria. The subjects were moved through two

trials where they were given three varying doses (low, full, or high) of either Olanzapine or

Risperidone at different stages in treatment for four weeks. If the subjects did not respond to the

medication after the first two trials, they were moved through a third trial that offered Clozapine.

The results found that 75% of the participants had responded to either Olanzapine or

Risperidone. This shows that first-episode psychosis patients have a high response rate to the

first antipsychotic medication they are given. The non-responders were changed to a second trial

and it was found that patients who do not respond to the first antipsychotic medication have a

less chance of responding to the second antipsychotic medication. Clozapine was found to

produce a significant improvement in patients, even as the third treatment option, compared to

the response rate of the other two medications. This finding reinforces the fact that Clozapine is

the top treatment for patients who do not respond to the standard treatment of schizophrenia and

is growing in popularity among antipsychotic medications (Agid et al., 2011).

Ganguly, Soliman, and Moustafa (2018) reviewed studies that examined how medication

made an impact on the lives of those living with schizophrenia. The studies not only wanted to

decrease some symptoms of schizophrenia, but also wanted to enhance the quality of life of

patients with schizophrenia. After the first episode of psychosis, only six percent of individuals

actually have a full recovery from symptoms while only one in seven have a total recovery from

schizophrenia. The most common treatment, and usually the only one, are antipsychotic

medications. In a study conducted with 160 patients with schizophrenia, individuals who were

given clozapine for two years had better outcomes than individuals who were given

Chlorpromazine for two years. These medications relieve positive symptoms of schizophrenia,

like hallucinations and delusions, by blocking dopamine receptors in the brain. It was found that
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a dose of 523 and 600 mg/day of Clozapine, an antipsychotic medication, was effective on

positive and negative symptoms of schizophrenia and reduced suicidal behavior tremendously

compared to other medications, but it also was shown to increase weight gain in patients

(Ganguly et al., 2018).

In regard to Clozapine, Muscatello et al. (2011) conducted a study on the effect of

Aripiprazole augmentation of Clozapine in schizophrenia. This randomized, double-blind,

placebo-controlled trial included 40 patients with schizophrenia who did not respond to

clozapine. They were randomly assigned to be given different either a placebo or different doses

(10 mg/day and 15 mg/day) of Aripiprazole along with Clozapine for 24 weeks. Aripiprazole is a

new medication that has a different chemical makeup than other antipsychotic medications and is

suggested to have an effect on negative and cognitive symptoms in schizophrenia. The subjects

were assessed through multiple tests including Wisconsin Card Sorting Test (WCST), Verbal

Fluency Task and the Stroop Colour-word Test. The subjects also attended ten visits where they

were screened. The results found that individuals taking Aripiprazole with Clozapine treatment

showed better outcomes that the individuals taking Clozapine alone. Aripiprazole reduced the

positive symptoms and improved the overall clinical state of the subjects. The study, however,

did have limitations due to the small sample size, so further trials in a larger sample size are

needed to examine the therapeutic potential of Aripiprazole augmentation of Clozapine

(Muscatello et al.,2011).

Another treatment option for patients with schizophrenia is the non-pharmacological

treatment of cognitive-behavioral therapy (CBT). Cognitive behavior therapy (CBT) is a

treatment that helps change unwanted thinking, feeling and behavior (Ganguly et al., 2018). This

therapy is usually administered with the antipsychotic medications in order to see the maximum
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benefits in patients because many schizophrenia symptoms are resistant to drugs. A study

conducted on 90 individuals who were treated using CBT for more than 9 months showed a large

reduction in symptoms compared to individuals who were not treated with CBT. The study found

that cognitive restructuring helps patients deal with delusions because their sense of reality is

challenged, and they have to learn to distinguish fantasy from reality. Cognitive behavior therapy

also helps individuals with schizophrenia alter their unhealthy and negative thoughts to realistic

and positive thoughts, helps with cognitive impairment and social skills to improve relationships,

and helps them improve their lifestyle by encouraging to exercise, to avoid substance abuse and

stigmatizing and to join a community (Ganguly et al., 2018).

Lewis et al., (2002) conducted a study on the outcomes of CBT in early schizophrenia.

The study included 315 patients who were chosen to participate in this study based on five

factors: admission for treatment of psychosis, DSM-IV criteria for schizophrenia and related

disorders, psychotic symptoms for more than 4 weeks, a score of more than 4 on PANSS for

delusions or hallucinations, and substance misuse or organic disorder is not the cause of

psychotic symptoms. The chosen participants went through intervention groups of CBT and

supportive counselling. The treatment was done in four stages. The first stage was the assessment

of the mental state of the patients and their engagement to see how the symptoms might relate to

cognitions, behavior and coping strategies. The second stage was creating a problem list with the

patients. Their problems were prioritized by the degree of distress attached, feasibility, and

clinical risk involved. The ones prioritized were evaluated and a formulation was made that

included issues such as trigger situations and cognitions. The third and fourth stages included

intervention and monitoring. Intervention was used to assess delusions and hallucinations,

creating other hypothesis for abnormal beliefs and hallucinations, and reducing distress
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associated with precipitating and alleviating factors (Lewis et al., 2002).

The subjects were treated with CBT and supportive counseling in the same 5-week

format by the same therapists and were seen in a hospital setting, family practitioner surgeries

and their own home (Lewis et al., 2002). Supportive counseling acted as a control in the study in

order to compare non-specific elements of therapist exposure. Each treatment session was audio

recorded and fifty tapes were chosen and rated on the quality of therapy based on the Cognitive

Therapy Scale for Psychosis (CTS-Psy). The results showed that patients who were treated with

CBT had a quicker weekly improvement over the treatment time compared to the ones on routine

care or supportive counseling. Patients treated with CBT also showed a faster improvement in

auditory hallucinations. This study concludes that patients who are treated with CBT have more

advantages and faster remission from acute symptoms compared to ones who are treated only

with routine care or supportive counseling (Lewis et al., 2002).

Kahn and Sommer (2014) also studied non-pharmacological treatments for patients with

schizophrenia such as exercise. Exercise has been shown to benefit mood, self-esteem, and gene

expression in an anti-inflammatory pathway. There was a decrease in systemic inflammation

parameters in sedentary patients who walked for one hour every day. Exercise also prevents the

metabolic-side effects of antipsychotics, diminishes grey matter loss and increases hippocampal

volume. (Kahn and Sommer, 2014). A type of exercise that has been looked at is yoga. Ganguly

et al. (2018) reviewed a study on yoga therapy. Yoga therapy was found to improve cognitive

function and decrease depression and psychotic symptoms because it produces oxytocin in the

body. In order to validate this finding, a study was conducted where 40 patients were given

oxytocin along with antipsychotic medication to mimic the effect of yoga. Patients are

recommended to use yoga therapy with their antipsychotic medications in order to enhance the
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effects of the therapy and improve the overall quality of life in the patients (Ganguly et al.,

2018).

A closer study of yoga therapy was conducted by Govindaraj et al. (2018). This study

examined the effect of yoga therapy as an add-on treatment on social cognition in schizophrenia

patients. Schizophrenia has three types of symptoms: positive, negative, and cognitive. Only

positive symptoms have effective treatments, but many of these treatments have serious side

effects. An inadequate source of treatment for the remaining two groups of symptoms, in

addition to the socio-occupational dysfunctions, adds more distress to the patients with

schizophrenia. Yoga involves the mind and body and is often useful in treating lifestyle-related

disorders. Yoga therapy has shown to be effective in decreasing negative symptoms and

improves functioning in schizophrenic patients because it stimulates the increase in oxytocin

levels in the brain (Govindaraj et al., 2018).

The Govindaraj et.al (2018) study assessed the social cognition of 15 patients with

schizophrenia that were on medication for six weeks. The subjects were taught yoga modules

from a trained yoga instructor for one month. After this month, they attended 20 sessions of one-

hour yoga for six weeks. Their social cognition was measured by using the social cognition

rating tool for Indian setting, psychopathology was measured by the Scale for Assessment of

Negative Symptoms (SANS) and Scale for Assessment of Positive Symptoms (SAPS), and

socio-occupational dysfunction was measured through the Groningen social disability scale

(GDS-II). The results of this study found that the SANS, SAPS, and GDS-II scores were

extremely reduced whereas, the social cognition composite score (SCCS) was increased

(Govindaraj et al., 2018). There was a significant improvement in social cognition and a

reduction in clinical symptoms in patients with schizophrenia after the yoga therapy had
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concluded. The findings of this study are very promising and with further exploration, yoga

therapy could be incorporated into clinical therapy with patients with schizophrenia (Govindaraj

et al., 2018).

Ganguly, Soliman, and Moustafa (2018) concluded that all these methods of treatment are

necessary to treat all the different symptoms that come with schizophrenia. Patients with

schizophrenia usually have problems with relationships, doing household chores, making a meal,

and attention. They are not able to communicate their feelings and thoughts effectively and they

often have to rely on close family to survive. Positive and negative symptoms, as well as societal

symptoms, have a huge impact on an individual with schizophrenia and these treatments will be

able to effectively manage and help improve the lifestyles of people living with schizophrenia.

The treatments can help with clinical symptoms, like hallucinations and delusions, and

nonclinical symptoms like financial constraints, poor relationships and unemployment (Ganguly

et al., 2018).

The ongoing studies to help find different treatments for patients with schizophrenia

show that there is a future in finding a cure for some of the symptoms. Many of the studies

described, have found positive results and with more and larger trials with consistent results,

some of them could be incorporated into every case of schizophrenia. It is important to study and

do more research on all aspect of schizophrenia, especially the cause of the mental illness,

because finding the cause can aid in finding an effective treatment and hopefully prevent it.

Research on the physical, mental and behavioral symptoms of schizophrenia could also aid

medical professionals in treating these patients more effectively. Since there are different types of

treatment available with different approaches, treatment of this mental illness can be customized

to fit the needs of the individual in order to maximize the chance of a better outcome and life.
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References

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Ganguly, P., Soliman, A., & Moustafa, A. A. (2018). Holistic Management of Schizophrenia

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public health, 6, 166. doi:10.3389/fpubh.2018.00166

Govindaraj, R., Naik, S., Manjunath, N. K., Mehta, U. M., Gangadhar, B. N., & Varambally, S.

(2018). Add-on Yoga Therapy for Social Cognition in Schizophrenia: A Pilot

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