Schizophrenia is, perhaps, one of the best-known and, ironically, the most misrepresented mental disorders among general audiences, which makes the process of addressing it and building awareness about the needs of patients with schizophrenia a truly excruciating process for healthcare experts. Presently, schizophrenia as a mental health issue, specifically, as a psychotic disorder, is defined in the fifth edition of the Diagnostic and statistical manual of mental disorders as a mental disorder that causes “cognitive, behavioral, and emotional dysfunctions” (American Psychiatric Association, 2014, p. 100). What complicates the process of diagnosing schizophrenia even further is that there are currently no known symptoms that are unequivocally pathognomonic for schizophrenia (American Psychiatric Association, 2014). Therefore, the treatment of the disorder is significantly complicated by the absence of clarity in the identification of primary symptoms. Although the existing biological treatment methods provide a rather robust range of techniques for managing schizophrenia, the proposed treatments have negative implications on patients’ health.
Currently, the biological treatment of schizophrenia implies the use of neuroleptics as the means of inhibiting the binding of dopamine and serotonin, as well as several other hormones causing the experience of excitement and the related emotions (primarily, adrenalin and noradrenalin) (Kehr et al., 2018). The specified approach toward preventing hallucinations and delusions from occurring in patients also causes noticeable changes in patients’ perceptions and emotional responses, minimizing them and causing patients to experience drowsiness, sleepiness, and a rather drastic drop in motivation rates (Kehr et al., 2018). The described outcomes change the patient’s ability to have complete emotional experiences, as well as live a fulfilled life, overall (Kehr et al., 2018). Namely, studies have shown that the use of neuroleptics as the primary biological treatment options for schizophrenia causes patients’ cognitive functions to deteriorate as well (Kehr et al., 2018). Therefore, opportunities for education and the subsequent employment, as well as the quality of life, in general, remain under a major threat for patients with schizophrenia.
Although the use of medication for managing delusions in patients with schizophrenia is indispensable, the amount of the drugs administered to the target audience may be reduced once a proper psychological therapy is in place. Specifically, by balancing out psychological approaches with the biological ones, a healthcare expert can achieve an improvement in the quality of care for patients with schizophrenia. Even though the recent advances in schizophrenia treatment have helped to replace notorious chlorpromazine and haloperidol with much milder asenapine and clozapine, and introduced the possibility of using aripiprazole as the third generation antipsychotic in the future, psychological assistance is still vital for patients with schizophrenia (Todorovic et al., 2019). Thus, a combination of cognitive behavioral therapy (CBT) and psychoeducation, both for the patient and for the family members, is crucial.
The CBT tool must be geared mostly toward assisting patients in coping with their delusions and other symptoms of schizophrenia. Namely, the therapy must focus on helping patients to realize that these delusions have no place in reality, as well as assist the target population in identifying schizophrenic delusions. For this purpose, a multimodal CBT for psychosis (CBTp) will have to be introduced. Implying a combined approach toward managing a psychosis, the suggested framework will help to build awareness about the nature of the disorder and the concept of reality in the patient, therefore, training to distinguish between reality and delusions. Namely, a multimodal CBTp framework suggests that, by collaborating with a therapist, a patient examines the nature of the delusions and hallucinations in order to connect them to traumatic events that may have occurred in the patient’s life (Todorovic et al., 2019). Thus, once the nature of the issues is established, the triggers that may cause hallucinations and delusions to occur can be isolated o that the patient could avoid them (Todorovic et al., 2019). Thus, a behavioral pattern is established for the patient to adhere as the means of inhibiting the effects of schizophrenia and making the symptoms more manageable.
It is also expected that the application of CBT should lead to a decrease in the rate of social anxiety in patients with schizophrenia. Indeed, studies show that the distress experienced by patients with schizophrenia as a result of the social contempt and fear affects the quality of CBTp outcomes to a noticeable extent (Todorovic et al., 2019). Therefore, it is also vital to offer patients the tools for confronting social hostility and negative attitudes in the way that will not affect their emotional health and the ability to manage their emotional well-being.
As far as the psychoeducation issue is concerned, the specified step is critical for two main reasons. First, family members and caregivers must have a clear and profound understanding of how to meet the needs of a patient with schizophrenia. Second, it is vital to remove the stigma from the patient since the rate of prejudice toward people with mental health disorders and, particularly, schizophrenia, is quite high presently (Sin et al., 2017).
It is believed that the type of setting may have an impact on the outcomes of the CBTp. Namely, in the inpatient environment, a more meticulous analysis of the factors affecting the development of hallucinations and delusions can be established. In turn, in the outpatient environment, the extent of emotional distress and anxiety that the patient may experience can be reduced, and the family support effects can be maximized. Nonetheless, the inpatient setting is preferable due to the need to produce a robust and meticulous analysis of the patient’s health issue.
In people with psychotic disorders, in general, and schizophrenia, in particular, the opportunities for long-term treatment are mostly positive. Specifically, studies show that, after several years of continuous therapy, the symptoms of schizophrenia are no longer present in 50% of patients (Takeuchi et al., 2019). While the described statistics implies that the chances for a successful recovery are not quite high, there is still a strong probability of a positive outcome, which needs to be pursued (Colling et al., 2017).
Additionally, apart from improved health outcomes, the effects of schizophrenia treatment have been moved toward the promotion of a fulfilling and happier life for patients. Namely, the emphasis has been placed on assisting patients in achieving their life goals and ensuring that schizophrenia should not become an unsurpassable obstacle for attaining these goals (Colling et al., 2017).
Therefore, presently, the long-term outcomes for patients with schizophrenia that have been provided with CBTp and the relevant treatment options imply living a fulfilled and satisfactory life. As a substantial number of cases has shown, the shift in the focus on the need for suppressing emotional responses toward teaching patients to identify and regulate them accordingly has provided a chance to improve the quality of life in people with schizophrenia substantially (Colling et al., 2017). Nevertheless, further efforts in schizophrenia research must be geared toward increasing the percentage of positive outcomes and seeking the opportunities to cure schizophrenia completely.
References
Colling, C., Evans, L., Broadbent, M., Chandran, D., Craig, T. J., Kolliakou, A., Stewart, R., & Garety, P. A. (2017). Identification of the delivery of cognitive behavioural therapy for psychosis (CBTp) using a cross-sectional sample from electronic health records and open-text information in a large UK-based mental health case register. BMJ Open, 7(7), 1-10.
Kehr, J., Yoshitake, T., Ichinose, F., Yoshitake, S., Kiss, B., Gyertyán, I., & Adham, N. (2018). Psychopharmacology, 235(5), 1593-1607.
Sin, J., Gillard, S., Spain, D., Cornelius, V., Chen, T., & Henderson, C. (2017). Effectiveness of psychoeducational interventions for family carers of people with psychosis: A systematic review and meta-analysis. Clinical Psychology Review, 56, 13-24.
Takeuchi, H., Siu, C., Remington, G., Fervaha, G., Zipursky, R. B., Foussias, G., & Agid, O. (2019). Does relapse contribute to treatment resistance? Antipsychotic response in first-vs. second-episode schizophrenia. Neuropsychopharmacology, 44(6), 1036-1042.
Todorovic, A., Lal, S., Dark, F., De Monte, V., Kisely, S., & Siskind, D. (2020). CBTp for people with treatment refractory schizophrenia on clozapine: a systematic review and meta-analysis. Journal of Mental Health, 1-8.