Psychotherapy for schizophrenia

Psychotherapy for schizophrenia is a real art. The effectiveness of psychotherapy for schizophrenia requires not only knowledge of psychiatry, but also psychology, philosophy, theology and sociology.    

Modern psychiatry, focused more on syndromes – a set of symptoms (signs) of a mental disorder, and not on nosological forms (diseases, with their onset, course and outcome), with some degree of pessimism refers to the diagnosis of “schizophrenia”.           

The physician who is faced with the task of psychotherapy for schizophrenia should be well aware of the features of the statics and dynamics of the clinical symptoms of this disorder. In addition, today it is difficult to imagine the treatment of schizophrenia without biological therapy, which includes pharmacotherapy, insulin therapy, laser treatment, and , if necessary, even electroconvulsive therapy. In connection with the above, several questions arise that need to be answered. In – First, there is the question of the combination of pharmacotherapy and psychotherapy in the treatment of schizophrenia, in – the second issue of long-term cooperation of the patient and the physician, including full trust in the latter, and, – third, about the role of social activities in the course of biological treatment of schizophrenia and psychotherapy work with a patient with schizophrenia.                     

Let’s take a closer look at these aspects of treating the symptoms of schizophrenia. Modern pharmacotherapy of schizophrenia tends to trend treatment of schizophrenia only one psychotropic drug, how – or atypical antipsychotic, in properly selected dosage, eliminate the side effects of pharmacotherapy of schizophrenia and not affecting the quality of life, suffering from this disease.        

Treatment with one drug opens up wide opportunities for psychotherapy of schizophrenia, and in this case, it is not somehow a vignette, an application to the biological therapy of schizophrenia, but can significantly improve the patient’s condition, direct its efforts to treating the symptoms of schizophrenia and to form a critical attitude towards its manifestations.         

Psychotherapy for schizophrenia, aimed at treating the symptoms of schizophrenia and, less commonly, its syndromes, probably should be problem -oriented or otherwise represent an eclectic version of psychotherapy. It should be noted here that in order to conduct eclectic psychotherapy of schizophrenia, it is necessary to possess the skills of psychological counseling (in a broad sense of humanistic therapy, including its existential variants), psychoanalysis and cognitive-behavioral therapy (therapy that teaches the patient the ability to control his thinking, feelings and behavior). It is extremely difficult to obtain such a psychotherapeutic education, which is necessary for a full-fledged psychotherapy of schizophrenia, today in Russia.            

Even in recognized research institutes of psychiatry today, only in general terms are presented the dynamics of individual symptoms of schizophrenia in the treatment of schizophrenia with modern psychotropic drugs. This becomes especially noticeable with long-term treatment of schizophrenia. What can we say about the course of schizophrenia as a result of combined biological therapy of schizophrenia and psychotherapy of this mental disorder? It is difficult to determine at what stage of the drug treatment of schizophrenia this or that method and form (individual, family or group) of psychotherapy for schizophrenia will be adequate .          

Socio -psychological work with a patient with schizophrenia includes not only full cooperation with the patient, his necessary education in the field of clinical psychiatry, overcoming negative stigma in relation to the diagnosis of schizophrenia, but also a set of social measures aimed at improving the social and labor adaptation of a patient with schizophrenia … In the context of psychotherapy for schizophrenia, we are primarily talking about group and, most importantly, family therapy of a patient with schizophrenia. It is absolutely clear that people around a schizophrenic patient often suffer from various mental disorders. The minimum is neurotic, affective (neuroses and depression), psychosomatic (peptic ulcer, hypertension, polyarthritis, thyrotoxicosis, colitis, bronchial asthma, neurodermatitis), however, it is possible that the relatives of a patient with schizophrenia and personality disorders, alcoholism, drug addiction and even similar diseases. Parallel treatment of relatives of a person suffering from schizophrenia is necessary. Family psychotherapy of schizophrenia actually complicated in mainly based on its positive options and usually shorter in time than the family therapy other psychiatric disorders.                             

It is well known that group psychotherapy of schizophrenia, for some people suffering from this disease, in some cases is impossible, due to the resistance of both the patient himself and other members of the group suffering from other mental disorders. Experience shows that group psychotherapy for schizophrenia is desirable for the patient, requiring the participation of one or even two co – therapists. Even if the patient is simply silently present at the group psychotherapy session, this is no longer a bad thing, and represents an essential step towards the patient’s recovery.           

Psychotherapy for schizophrenia should take into account the severity and characteristics of productive, negative and cognitive symptoms of schizophrenia. We are talking about delirium, hallucinations, mood disorders, asthenovegetative symptoms, isolation, negativism of the patient, his apathy, decreased energy potential, specific disorders of thinking, memory and attention.    

Psychotherapy of delusion requires virtuosity and is practically inaccessible to amateurs. It is important to sustain a neutral position, do not argue and do not agree with the delusional statements of the patient, to sustain his insistence on a return to the discussion of the content of delusions and irritability when trying to get him in the side. A kind of psychotherapist working with the delusions of a schizophrenic patient can be compared to a person who gets honey from an aspen nest. You can try to refute delirium with facts of reality, but at best, the patient will simply ignore it, at worst, he will become embittered or will persistently seek other confirmation of delirium. Psychotherapy for delusions is, first of all, a discussion of other symptoms of schizophrenia, it is psychotherapy of symptoms of schizophrenia that are not associated with delusions, for example, symptoms of cognitive impairment: thinking, memory, attention. It is important to have compassion for a sick person, because most often it is unbearably difficult for him, other people do not understand him and consider him crazy.                   

Psychotherapy of hallucinations requires perseverance in working together with a schizophrenic patient. Such methods of psychotherapeutic work as therapy with creative self-expression, analysis of entries in the patient’s diaries, and teaching him various ways to distract the patient can be useful here . In a short article, it is impossible to talk about all aspects of psychotherapy for schizophrenia, psychotherapy of individual symptoms of schizophrenia, psychological correction of the patient’s attitude to this disease.      

Psychotherapy for schizophrenia can not be effective if there is no comprehensive assessment of the personality traits of the person suffering from this mental disorder. As a result of the above, the need for knowledge of clinical psychology in the process of psychotherapy for schizophrenia becomes clear . It is appropriate to recall here that clinical psychology usually includes psychological diagnostics of the patient’s personality, his pathopsychological examination, and necessarily neuropsychological research, which gives an indirect idea of ​​the work of the cortical structures of the brain.     

Schizophrenia distrustful, suspicious, wary, do not believe the words, and even doubt that the obvious facts, it is not critical either to themselves or to their assessment of the people around him, prone to mysticism and esoteric knowledge, often unintelligible religious, showing increased interest in philosophy … Therefore, psychotherapy for schizophrenia implies a good knowledge of psychology, theology and philosophy.              

In conclusion, it should be said that psychotherapy of schizophrenia seems to be the most important and part of the treatment of schizophrenia, organically woven into the biological therapy of schizophrenia and social assistance to a person suffering from this mental disorder.    

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