A More Natural and Holistic Approach to Schizophrenia Care
Today I have a guest post about the mental health condition, Schizophrenia. Mental illness diseases are not that uncommon and it is always interesting to find out more about them.
Schizophrenia is a serious health condition that affects 1% of the population, yet sufferers and healthcare professionals are becoming increasingly concerned about the effectiveness of conventional treatments. This has led many to seek out complementary and alternative therapies, some of which have shown to possess remarkable benefits for schizophrenia sufferers.
Table of Contents
What is Schizophrenia?
According to the US National Institute of Mental Health, schizophrenia is a chronic, severe and disabling brain disorder that has affected people throughout history. Sufferers may hear voices other people don’t hear or believe that other people are reading their minds, controlling their thoughts or plotting to harm them. As a result, sufferers can become withdrawn or agitated. They may not make sense when they talk or may sit for hours without moving or talking. Other people with schizophrenia may seem perfectly fine until they talk about what they are really thinking.
Symptoms of schizophrenia are divided into ‘positive’ and ‘negative’ signs. Positive symptoms include:
- Disordered thoughts
‘Negative’ symptoms deficits of normal emotional responses or of other thought processes. They include:
- Lack of motivation
- Flat expressions or little emotion
- Poverty of speech
- Lack of motivation
- Inability to experience emotion and pleasure.
Negative symptoms can lead to sufferers neglect themselves or make them appear wrapped up in their own thoughts. They can also lead to difficulty with education or employment. Such negative symptoms are often the most difficult to deal with for families and carers and tend to be the main cause of long-term disability.
What Treatment is Available?
The causes of schizophrenia are still largely unknown, so treatment focus on eliminating the symptoms of the disease. The two mainstays of therapy are antipsychotic medications and psychosocial or talking therapies.
Conventional or ‘typical’ antipsychotics medications have been around since the 1950s, including chlorpromazine (Thorazine) and haloperidol (Haldol). So-called second generation or ‘atypical’ antipsychotics arrived in the 1990s, the most of which is clozapine (Clozaril), an effective medication that treats psychotic symptoms, hallucinations and breaks with reality. However, clozapine can cause a serious problem called agranulocytosis, or the loss of white blood cells needed to fight infection. Other atypical antipsychotics that do not cause agranulocytosis include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel) and aripiprazole (Abilify).
Side effects with antipsychotic medications include:
- Dizziness when changing positions
- Blurred vision
- Rapid heartbeat
- Sensitivity to the sun
- Skin rashes
- Menstrual problems for women
Atypical antipsychotic medications can also cause weight gain and changes in a person’s metabolism, which may increase the risk of diabetes and high cholesterol. Weight, glucose levels and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.
A debate is currently underway in the scientific community about the effectiveness of talking therapies for those with schizophrenia, with two apparently contradictory articles published in the last three months.
Cognitive Behavioural Therapy (CBT) is a well-recognised treatment, however, the results of systematic review and meta-analysis of the effectiveness of CBT published in the British Journal of Psychiatry concluded the therapeutic benefit was only “in the ‘small’ range” and “reduces further when sources of bias, particularly masking, are controlled for”. Only a few weeks later, The Lancet published the results of a single-blind randomised clinical trial that aimed to establish whether cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia. In contrast to the earlier report, the study concluded that cognitive therapy significantly reduced psychiatric symptoms and was “a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs”. This final point – that the patients in the study had chosen not to take their medication – is a crucial element in this debate.
Recent research has suggested that meditation can also help reduce the symptoms of mental health disorders. Click here for more general information on schizophrenia.
Are There Any Other Treatments?
What is clear is that significant doubt exist around the efficacy of both mainstays of schizophrenia treatment. Due to the large number of potentially severe side effects to antipsychotic medications, many sufferers choose not to take them. As a consequence, many experts are recommending that health professionals work in partnership with patients and carers to offer treatment, education, support and psychosocial care in an atmosphere of hope and optimism.
Psychiatrist James H. Lake, who chairs the American Psychiatric Association’s Caucus on Complementary, Alternative and Integrative Care also runs a full-time private practice in integrative psychiatry, an approach that uses both conventional therapies and evidence-based complementary therapies. He emphasises that ‘integrative psychiatry’ is based on compelling evidence from randomised controlled trials and is meant to supplement, not supplant, conventional medications. “By no means am I trying to replace antipsychotic medications with herbs. I prescribe conventional antipsychotics all the time — they are very important.”
With some patients, Lake agrees to work toward a goal of reducing doses or even discontinuing antipsychotics but only is the patient is stable, has a history of good compliance and is committed to an holistic programme that includes healthy diet, exercise and a mind-body practice such as yoga or tai-chi.
There is huge demand for new approaches, says Richard P Brown, Associate Clinical Professor of Psychiatry at Columbia University, and holistic therapy champion. “Patients and families are desperate — they’re saying: There’s got to be more you can do for us.” He views complementary therapies as a broader set of tools that clinicians can employ to help patients lead less disrupted and more fulfilled lives.” However, there has traditionally been little in complementary therapies among US psychiatrists, he admits. “Most psychiatrists are quite frightened by the idea of alternative medicine… [yet] when I give talks on this, the room is stuffed and people are overflowing out into the hall.” It’s a sign, he says, that, “clinicians aren’t satisfied with the treatments we have to offer.”
Dr Brown points to studies that found evidence for the use of a range of nontraditional therapies used alongside antipsychotics, including omega-3 fatty acids, glycine, folate, Chinese herbal medicines, yoga practices and spiritually focused group therapy. Nonconventional therapies may be particularly effective in easing negative symptoms, cognitive symptoms and/or antipsychotic side effects.
One leading area of interest is the use of the dietary supplement, omega-3 fatty acids. Five of six double-blind, placebo-controlled trials in schizophrenia, and four of six such trials in depression, have reported therapeutic benefit from omega-3 fatty acids particularly when used in addition to antipsychotic medication. However, as other reviews have failed to find clinical benefit, more research is needed.
Image Credit: David Goehring