Myth / People with schizophrenia have to be institutionalized.
Fact / Recent studies have shown that a variety of settings, ranging from psychiatric hospital care to innovative alternatives, such as an acute care residential facility, to supported living in the community can be effective in caring for people with schizophrenia.

The Stepping Stones to Recovery / In general, when inpatient and comprehensive outpatient programs are compared, people in the community-based programs show better outcome for longer periods of time than those treated in the hospital. Even people who are acutely psychotic can be treated effectively in carefully supervised and professionally staffed community settings.

There are three main components of treatment for schizophrenia:

• Medications to lessen symptoms and prevent relapse;
• Education to help patients and families solve problems, deal with stress, and cope with the illness and its complications;
• Social rehabilitation to help patients reintegrate into the community and regain educational or occupational functioning.

Medications / The drugs used to treat schizophrenia are called anti-psychotic or neuroleptic drugs. There are two categories of these drugs, the older neuroleptics and the new or atypical neuroleptics. The older drugs (haloperidol and others) were introduced in the early 1950’s. They relieved some of the positive symptoms but had severe side effects such as muscle rigidity, tremors, involuntary writhing movements, blurred vision and constipation. People taking these drugs had to take a second drug to partially control the side effects. Unfortunately, the second drug had side effects as well. Many patients refused to take medication or took it irregularly because of the side effects. Another problem was that the older drugs worked on the positive symptoms (hallucinations and delusions) but not on the equally disabling negative symptoms (social withdrawal, apathy, and blunted emotions.)
     The new neuroleptics came into use during the 1990s. They include risperidone, olanzapine, and clozapine. These drugs have less severe (though still unpleasant) side effects, and they may work on the negative as well as the positive symptoms.

Education is key / Because the impact of schizophrenia is felt in so many areas of life, effective treatment must address multiple problems, including early recognition of when a relapse may occur, how to prevent relapses, as well as psychoeducation into how to reduce stress. People with schizophrenia fare best when they have information on the disorder, treatment options, its side effects, and strategies to cope with persistent symptoms.
      People with schizophrenia benefit when medical professionals work with the patient to find the method of treatment most suited to that individual. From the ill person’s perspective, continuity of care is important in treatment. In addition, recipients of care are best served when they have a voice in their treatment.

Rehabilitation: Improving quality of life / In recent years, there have been changes in the goals of rehabilitation of persons with mental disorders. In the past, the primary emphasis was placed on returning the individual to work. It has now been accepted that there are many other equally important goals of the rehabilitive process:

• To reduce symptoms that people experience through the use of drug therapy;
• To reduce adverse consequences of the illness;
• To improve the individual’s social competence;
• To increase family and social support in the areas of employment, housing, and socialization.

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