Schizophrenia: Therapy

General measures

  • Check drug use due topossible effect on the existing disease: schizophrenia patients who continued their cannabis use after the first episode of their psychosis suffered a relapse (recurrence of the disease) significantly more often than patients who became abstinent.Especially risky seems to be the use of “shrunk”, whose content of tetrahydrocannabinol (THC) is particularly high (daily consumption: 3.28 times increased risk of relapse).
  • Nicotine restriction (abstaining from tobacco use).
  • Note: Driving ability is often impaired in patients with schizophrenia on the road, even without medication.

Conventional non-surgical therapy methods

Subsequent procedures may be considered when drug treatment resistance is clear:

  • Electroconvulsive therapy (ECT; synonym: electroconvulsive therapy): electroconvulsive therapy is a procedure in which a seizure is induced in the affected person under anesthesia by electrical stimuli.
  • Transcranial magnetic stimulation (TMS): if necessary. As repetitive transcranial magnetic stimulation (rTMS): repetitive transcranial (“through the intact skull“) magnetic stimulation involves excitation of different brain areas by an external magnetic field; rTMS over the left parietal region was significantly more effective than at other sites – Indication: Patients with schizophrenia and persistent auditory verbal hallucinations (recommendation grade B) [S3 guideline]Note: The current study situation on rTMS is still very heterogeneous.

Nutritional Medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
  • Observance of the following special dietary recommendations:
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio) – as adjunctive symptomatic therapy or as therapy for antipsychotic-induced weight gain [guidelines: S3 guideline].
  • Schizophrenic patients who regularly engage in endurance training show better cognitive abilities and also cope better socially.
  • Preparation of a fitness or training plan with appropriate sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Psychotherapy

  • Psychosocial procedures/measures according to S3 guideline: psychosocial therapies for severe mental illness.
    • Self-management as part of coping with the illness; in this context also references to self-help contact points.
    • Individual interventions
      • Psychoeducation – systematic didactic-psychotherapeutic interventions designed to inform patients and their families about the disease and its treatment, to promote understanding of the disease and self-responsible management of the disease, and to help them cope with the disease.Psychoeducation can be conducted in individual sessions, group sessions or family support. Involvement of family members is an important factor. [A recommendation]Psychoeducation for relapse prevention with a “number needed to treat” (NNT) of 9.
      • Training of daily living and social skills/social skills.
      • Psychosocial therapies: eg.
      • Movement and sports therapies
      • Health promoting interventions
    • Ambulatory psychiatric care (APP) as an aid in times of crisis to establish self and disease history and to promote individual as well as recovery processes.
  • The guideline “Schizophrenia” provides for schizophrenia patients both a structured group psychoeducation and a specific cognitive behavioral therapy (A recommendation).
  • Cognitive behavioral therapy KVT): this represents a behavioral therapy intervention that, in addition to psychoeducation, serves primarily to prevent relapse and reduce so-called positive symptoms (ego disorders, content thinking disorders, sensory illusions and motor agitation); should be offered to all schizophrenia patients to reduce positive and negative symptoms; at least 16, but preferably 25 sessions; start from the first psychotic episode [A recommendation].
  • Relaxation techniques – yoga [guidelines: S3 guideline]
  • Metacognitive training (MKT; MCT) (thinking about thinking); MCT+ = MCT + cognitive behavioral therapy – combines elements of psychoeducation and cognitive behavioral therapy; may be recommended for clinical use
    • In participants who had current existing delusions, the P1 of the delusion subscale (P1) of the PANSS (Positive and Negative Syndrome Scale) decreased during treatment with MCT+: 4.3 points at baseline, to 2.9 points at the end of therapy, and to 2.6 points six months laterLimitation: small study with only 54 patients

    [B-Recommendation.]

  • Family intervention [A recommendation]; at least ten sessions.
  • Cognitive remediation for disorders of attention, memory, learning, and executive function [A-recommendation].
  • Psychosocial training – psychosocial interventions are intended to improve relapse prevention (relapse prophylaxis)and increase medication compliance.
  • Detailed information on psychosomatics (including stress management) is available from us.

Complementary treatment methods

  • Speech therapy (speech therapy) – due toimpairments of speech and communication: affected in schizophrenia are many areas of language: sentence structure, word finding and speech melody, furthermore, content consistency (freedom from contradiction) and coherence (coherence) are often affected.

Rehabilitation

  • The focus is on medical, social and vocational rehabilitation. In the latter, the focus is particularly on Supported Employment (place and train), i.e., support for hard-to-place individuals to obtain and retain paid work in the general labor market [guidelines: S3 guideline].