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Schizophrenia Treatment - Outpatient Options

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Outpatient Treatment Options

Inpatient hospitalization has its purposes, but it is not the setting where most care for schizophrenia happens. Most ongoing care takes place in outpatient settings, often at community mental health centers.

Partial Hospitalization

When insurance or money permits and there is a serious need, people with schizophrenia may find partial or day hospitalization helpful. These are daytime care programs that offer medical care, group therapy and many of the structure benefits previously described. These programs are frequently used as transition steps out of inpatient hospitals. People may stay in them for weeks or months. Lack of funding often cuts stays short though.

Supportive Psychotherapy

This is provided outside the hospital setting through community mental health centers and private therapists. In individual and group therapy, therapists can monitor patients' health and symptoms. They can encourage keeping on track with appointments. Therapists can help people socialize and maintain relationships with other people. They can also assist with finding needed resources and in general help to maintain their well-being. This type of therapy focuses on the person's present needs and does not get into the past or future. It is most effective when used in combination with anti-psychotic medications.

Cognitive Behavioral Psychotherapy (CBT)

CBT is another type of psychotherapy available to some people with schizophrenia. CBT therapists teach people methods for looking at their distorted thinking. They also teach people how to test the reality of their thoughts and feelings. Using CBT methods, people can reduce their reactions to psychotic symptoms and stay in reality. This therapy requires patients to have a certain level of insight into their symptoms. Because of this, it is most appropriate for people who are taking medications currently and who were fairly verbal already before symptoms began. CBT is never a first treatment for schizophrenia.

Dual Disorders Treatment

Many people with long-term mental illnesses, including people with schizophrenia, become involved with drugs and alcohol. This makes their conditions worse as they often become addicted to these. People with schizophrenia may start using drugs or alcohol to escape their symptoms or as an attempt to medicate themselves. They may also do it out of boredom or because of peer-pressure from other people with addictions that they may meet. Alcohol and drug use can make psychotic symptoms worse and interferes with people's ability to care for themselves. It also makes treatment more complicated because then the person needs both mental health care and substance abuse programs. It is often considered a best practice to separate people who have both mental illness and substance abuse diagnoses (known as dual disorders) from those who have only a mental health condition for treatment purposes.

As with any substance abuse program, the first step is to focus on getting people to be and stay sober. However, unlike a traditional substance abuse program, a dual disorders program must balance sobriety goals with competing goals. These include helping people stay motivated to take their psychiatric medications and to maintain their overall therapy program. People in a dual diagnosis program participate in relapse prevention programs, daily drug testing, psychiatric care and various types of group psychotherapy. They are also encouraged to participate in twelve step programs such as Alcoholics Anonymous, Narcotics Anonymous, Marijuana Anonymous or Cocaine Anonymous.