Schizophrenia

Diagnosis

Diagnosis of schizophrenia involves ruling out other mental health conditions and confirming that symptoms are not caused by substance use, medication, or another medical condition.

Diagnosis may include:

• Physical exam to check for related complications and rule out other medical problems.

• Tests and screenings, including laboratory tests and imaging studies such as MRI or CT scan, to rule out other causes.

• Mental health evaluation, where a healthcare professional assesses mental status by observing behavior and asking about thoughts, moods, delusions, hallucinations, substance use, and risk of suicide or violence. Family and personal history are also considered.

Treatment

Schizophrenia requires lifelong treatment with medicines and psychosocial therapy to manage symptoms. Some people may need hospital stays during crises. Treatment is guided by a psychiatrist, often with a multidisciplinary team including psychologists, social workers, psychiatric nurses, and case managers.

Medicines are the cornerstone of treatment:

• Antipsychotics are the main treatment, acting on brain receptors for dopamine and serotonin. Newer drugs like xanomeline and trospium chloride target acetylcholine receptors.

• Additional medications may include antidepressants, mood stabilizers, or antianxiety drugs.

• Medication choice and dosage are tailored to minimize side effects, including tardive dyskinesia, a movement disorder.

Second-generation antipsychotics available as pills include:

• Aripiprazole (Abilify)

• Asenapine (Saphris)

• Brexpiprazole (Rexulti)

• Cariprazine (Vraylar)

• Clozapine (Clozaril)

• Iloperidone (Fanapt)

• Lumateperone (Caplyta)

• Lurasidone (Latuda)

• Olanzapine (Zyprexa)

• Paliperidone (Invega)

• Quetiapine (Seroquel)

• Risperidone (Risperdal)

• Xanomeline and trospium chloride (Cobenfy)

• Ziprasidone (Geodon)

First-generation antipsychotics include:

• Chlorpromazine

• Fluphenazine

• Haloperidol (Haldol)

• Perphenazine (Trilafon)

Long-acting injectable antipsychotics may be given every 2–4 weeks and include:

• Aripiprazole (Abilify Maintena, Aristada)

• Fluphenazine decanoate

• Haloperidol decanoate

• Paliperidone (Invega Sustenna, Invega Trinza, Invega Hafyera)

• Risperidone (Risperdal Consta, Perseris)

Psychosocial interventions support recovery:

• Individual therapy to improve thought patterns, cope with stress, and recognize early warning signs of symptom relapse.

• Social skills training to enhance communication and daily functioning.

• Family therapy to educate and support families in managing schizophrenia.

• Vocational rehabilitation and supported employment to help maintain work.

Hospital stays may be required during severe episodes to ensure safety, proper nutrition, sleep, and hygiene.

Electroconvulsive therapy (ECT) may be considered for adults who do not respond to medications. During ECT, the patient is put under general anesthesia, and small electric currents induce a therapeutic seizure lasting 1–2 minutes. ECT can also help with coexisting depression.