Introduction
Schizophrenic spectrum disorders are a broad group of conditions that share similarities in the mechanism and/or etiology of schizophrenia. In the case, the patient most likely has a disorder with clinical features of schizophrenia: he has hallucinations, voices in his head, and paranoia. Treatment of such disorders involves taking medications and proper psychotherapy. In the acute period, hospitalization is indicated to curb risky behavior; supportive medication therapy is required in the remission period. Several treatment protocols recommended for individuals with schizophrenic spectrum disorder are discussed.
Protocol 1
Schizophrenic disorders include behavioral disorders, and cognitive behavioral therapy (CBT) is recommended. CBT is a set of activities that achieve a change in the patient’s behavioral tactics and a transformation of consciousness. CBT proceeds from believing that a person’s thoughts and beliefs contribute meaningfully to psychological problems (American Psychiatric Association [APA], 2021). Dysfunctional stereotypes and assumptions change emotions and reactions to particular events and, as a consequence, behavior. The behavioral part of therapy is based on reinforcing desirable behaviors – encouraging benevolent and cheerful actions.
CBT has a positive effect on individuals with schizophrenia, allowing patients, in conjunction with pharmacological treatment, to achieve reinforcement of “normal” behavior. Turkington and Lebert (2017) state that combining CBT and traditional approaches achieves rapport with the patient and improves treatment outcomes. They think informing patients during treatment about their symptoms as part of the normal human experience allows patients to ease the burden of illness. The meta-analysis found no significant positive effects of CBT: Laws et al. (2018) believe that minor reductions do not make the therapy advantageous over other treatment tactics. Maximum improvement after CBT was found in only a small number of studies (Bighelli et al., 2018). It point to the controversial nature of CBT treatment, although a proven effect of changing thoughts and cognitions exists.
CBT is helpful in conjunction with antipsychotic therapy: chlorpromazine and brain dopamine blockers are commonly used. Kart et al. (2021) believe that when combined with neuroleptics, CBT aims to reduce the patient’s distress from symptoms and move toward deeper psychotherapeutic solutions. This approach can be used for the patient under study because rapid, effective action is required to reduce paranoia and stabilize anxiety levels (Barnes et al., 2020). It should be understood that neuroleptics are only the first line of opposition to the disorder and require stronger medications, and CBT has no proven long-term effect.
Protocol 2
It is not entirely clear what triggers the abrupt change in the patient’s behavior in the case study; another protocol includes a primary drug and other psychoactive substance screening. The first step is a diagnostic test that includes a general and biochemical blood count (including total bilirubin, glomerular filtration rate, and C-reactive protein), a urine drug screen, and an electrocardiogram (Barnes et al., 2020). It will determine whether the schizophrenic acute manifestations result from drug or medication use and then proceed to treatment.
If drugs cause an acute period, it is necessary to hospitalize the patient and perform procedures to remove the drugs from the bloodstream. Standard psychosocial interventions based on establishing the psychological causes of the disease are recommended. If drugs do not cause the period of exacerbation, clinicians should prescribe antipsychotic medications, among which olanzapine and amisulpride are common (Men et al., 2018). Haloperiod is often prescribed, but no significant difference has been found between the three (Barnes et al., 2020). Medications may be prescribed the same as in the protocol with CBT. They may not show full efficacy in this case because the non-analgesic medications are less fast-acting and not entirely practical.
Psychosocial interventions are especially needed, if the episode is drug-induced. Society is critical for patients on the schizophrenic spectrum because the harm patients inflict can be on themselves and others (Bighelli et al., 2021). According to the American Psychiatric Association, a medication-assisted treatment plan should not exclude social support tools-including family therapy (2021). Family therapy is successfully supported in about 20% of cases – reducing relapses (Stevović et al., 2022). At the same time, other psychosocial interventions for social integration are the most desirable and utilized because they demonstrate high positive outcomes (Stevović et al., 2022). The treatment protocol is based on eliminating a psychoactive substance use disorder and integration through psychosocial interventions in combination with standard therapy.
Personal Choice
Cognitive-behavioral therapy seems to be the winning choice because it allows for quick results, adjustment of the patient’s behavior, and motivation to change. It has received empirical support, and research in this area has shown that second-line antipsychotic medications may not be effective. The rationality of CBT techniques such as analysis or talking to the inner self (including patient voices) has been investigated. Turkington and Lebert (2017) think that emphasizing cognitions and behaviors will achieve positive dynamics. The lack of long-term positive effects may be due to bias and lack of randomization studies. The tactics for CBT are pretty straightforward but require great skill on the part of the clinician.
Nevertheless, the use of protocol 2 is still more effective. First, this is justified by the availability of more confirmed data. In addition, APAs repeatedly cite the need to use psychosocial interventions since the goal of any psychotherapy is to put the person back into society (APA, 2021). CBT, unfortunately, proves insufficient for full integration because it is more personal and personalized therapy. Family psychoeducation combined with new drug therapy techniques should be the first line of choice because it significantly reduces relapses and promotes normal continued functioning of the patient (Bighelli et al., 2021). It reduces the severity of schizophrenia symptoms, and amisulpride avoids the return of hallucinations and delusions for a long time (Men et al., 2018). Protocol 2 seems more promising due to its breadth of application and the ability to control each disorder symptom on a point-by-point basis.
Conclusion
Two evidence-based protocols for treating schizophrenic spectrum disorders have been reviewed. Both are based on the use of neuroleptics and various types of psychotherapy. While optimistic in the short term, CBT has no proven long-term effect. In the context of the case study, it is recommended to use the second protocol, based on establishing the involvement of the disorder in substance use, followed by neuroleptics and psychosocial therapy. This choice is justified by the more significant evidence base and the need for social integration as a critical component of treatment for such disorders.
References
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