Advances in Schizophrenia Treatment
Schizophrenia is one of the most problematic and least tractable of the Serious Mental Illnesses (SMI). Recently, though, there have been advancements in treatment in terms of medications, therapy, and even virtual reality. Let’s take a look at what’s happening.
Medications
Medications have been the traditional way to treat schizophrenia. In the 1970s, there were drugs such as fluphenazine, chlorpromazine, and clozapine, the first atypical antipsychotic. Among the drawbacks were movement disorders such as akathisia, Parkinsonism, and tardive dyskinesia. Many people stopped taking them because they couldn’t handle the side effects. They were also noted for their sedative effects, and were primarily effective for positive symptoms such as hallucinations and delusions rather than negative ones such as flat affect. But medications weren’t the only possibilities. There were also insulin comas, the much-maligned ECT, and the thoroughly abhorrent frontal lobotomy.
In recent years, there have been advancements in medications for schizophrenia. In 2024, for example, the FDA approved a drug called Cobenfy. It combines two other medications, xanomeline and trospium chloride. Apparently, it reduces psychosis and delusions in schizophrenia without many of the side effects like unwanted movements and weight gain. On the other hand, xanomeline has its own side effects, including diarrhea, nausea, vomiting, and increased heart rate and blood pressure, so there’s that. (It’s also used to decrease symptoms in Alzheimer’s patients. Another new drug, KarXT, which is still experimental, is another combination drug that shows promise. Like Cobenfy, it’s supposed to reduce both psychosis and side effects.
Therapies
In the 70’s, effective therapies for schizophrenia were not really available. Psychoanalysis and family therapy were tried, largely to no avail. (The famous book I Never Promised You a Rose Garden epitomized the psychoanalytical approach, misleading many.) They missed the fact that schizophrenia is a serious brain illness, not really amenable to talk therapies.
Still, some psychosocial therapies are now in use. Cognitive remediation is said to show benefits for social and vocational functioning. Another method, called “Errorless learning,” which focuses on rehabilitation, also targets social and work skills. And Integrated psychological therapy is likewise suggested for improving social skills. None of them applies to the more severe cases of schizophrenia, but can be helpful for those who experience milder symptoms or are fairly well controlled by medication.
Virtual Reality
Virtual or augmented reality devices have also been used to help schizophrenic patients learn coping skills. In particular, they are said to be helpful in transferring these skills from a virtual environment to daily life. It’s also been suggested that such alternative realities can be used for research to assess patients’ reactions to specific environments. Computer-animated humanoid agents are also being investigated for use in encouraging medication compliance. An analysis by Chivilgina, Elger, and Jotterand says that these technologies “pose more questions than answers,” however, and to “to establish safe environments, further examination is needed.”
Treatments for Tardive Dyskinesia
You can’t talk about treatments for schizophrenia without talking about treatments for TD. Along with sedation, it’s one of the side effects that frequently causes patients to stop taking their medication. It’s also one of the more disabling side effects, as TD movements can vary from minor yet noticeable to extreme and debilitating. Unfortunately, many of the treatments for TD have a significant side effects: abnormal movements. So, you get a drug that is supposed to treat abnormal movements—and the result can be abnormal movements.
Guidelines from the American Academy of Neurology say that drug treatments for TD include clonazepam, valbenazine (Ingrezza), deutetrabenazine (Austedo), and clonazepam. Among other treatments for TD, clozapine, vitamin E, levodopa, benzodiazepines, botulinum toxin, reserpine, tetrabenazine, propranolol, and gingko biloba have been tried, as well as less common substances used in Chinese medicine. And there are off label uses of drugs usually prescribed for other conditions. For particularly intractable cases, deep brain stimulation can be tried. If this sounds kind of hit or miss, it is. I would hate to be a patient who had to try each of these therapies in hopes of finding one that works for me.
Still, the outlook for schizophrenic patients seems to be improving, and increasingly researched. As with most psychiatric medications, the trick is finding treatments whose side effects aren’t worse than the disorder they’re prescribed for.







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