What treatments are available?
The treatment of schizophrenia is difficult because there is no causal therapy. The main approaches are therefore drugs, more precisely antipsychotics (formerly known as neuroleptics), and psycho- or behavioral therapy to relieve the symptoms. Unfortunately, very few patients realize that they are ill and are therefore difficult to motivate to a long-term therapy.
The patient can only be reached if his symptoms cause him problems in everyday life, i.e. if he subjectively benefits from a therapy and if he trusts the therapist. The best success is achieved with medication. These mainly act on the so-called plus symptoms, such as delusions and hallucinations.
Negative symptoms, such asB. listlessness and apathy, are unfortunately hardly influenced by the drugs. Side effects are also a major problem with antiposychotic drugs, especially disturbances of the movement sequence, such as twitching or involuntary movements, which can persist even after the drugs are discontinued.
For this reason, attempts are now being made to resort to less potent drugs, as they have far fewer side effects, and to supplement treatment with psychotherapy. Highly potent, i.e. very effective drugs are, for example, the typical antipsychotics such as Ben- or Haloperidol. These work very well and very quickly, but have the big problem of motor side effects such as involuntary twitching and grimacing, so that they should only be given for a short time today.
The new atypical drugs Clozapine and Risperidone work slightly differently and therefore have better controllable side effects, but are still very effective and are today the first choice in the therapy of schizophrenia. Less potent substances are, for example, quetiapine or pipamperone, which have a calming rather than an antipsychotic effect and are preferred for mild disease progressions due to their better side effect profile. Although there are hardly any serious, uncontrollable side effects today, side effects are also frequent with the newer drugs.
All patients must therefore be closely examined and monitored. Doctors have no causal treatment methods at their disposal; the drugs and psychotherapies only serve to control symptoms and prevent relapse. It is assumed that about one third of all patients recover completely after the first episode and are thus cured, one third suffer at least one relapse and the last third develop chronic schizophrenia.
An early therapy has a positive effect on the prognosis, because the psychosis cannot develop completely and the risk of residuals decreases, but a cure is only supported, not directly achieved. Antipsychotics can reduce the risk of relapse from over 80% to under 20% and treated patients are usually relapse-free if treatment is started early enough. However, whether this freedom from relapse was achieved by the drugs that merely keep the symptoms in check or whether the patients are actually cured can only be determined in the longer term. Favorable prognostic factors are the female sex, good social integration, short and acutely beginning schizophrenia relapses and early therapy. Negative factors, on the other hand, are the male sex, a poor psychosocial situation and a creeping onset of the disease with pronounced negative symptoms and delayed treatment.
