I. Recovery period of schizophrenia
The natural course of schizophrenia can generally be divided into prodromal, active, and residual phases. About half of schizophrenia patients develop the disease between the ages of 20 and 30, with a few starting in childhood, adolescence or after middle age, and very few in old age. Most have a chronic or subacute onset, and the form of onset is related to the clinical type and prognosis.
The course of schizophrenia can be broadly divided into 3 main phases: prodromal, active, and residual phases. The disease course can be intermittent or continuous, and the most common course generally includes multiple episodes (active phase) interspersed with a residual phase of functional impairment. The degree of functional impairment in the residual phase tends to increase with attacks in the first few years after onset, but may progress less severely in the later stages of the disease. Those with a persistent course of the disease are chronic in nature and experience a decline in mental activity.
The so-called recovery period refers to a process in which the schizophrenic patient is in systemic treatment. Systemic treatment of schizophrenia with medication is generally divided into a treatment period, a consolidation period, and a maintenance period. The recovery period generally refers to the period after the patient’s psychiatric symptoms are basically controlled, his or her emotions improve, and his or her behavior is basically normal after the acute phase of treatment. The rehabilitation period actually starts from the consolidation period of drug treatment and continues until the end of the maintenance period of drug treatment, and may last longer for some patients.
II. Treatment of rehabilitation period
Treatment during the rehabilitation period includes medication, psychotherapy and social function recovery
Medication: The cause of schizophrenia is not yet known, and the current treatment may only be symptomatic. However, patients with schizophrenia have organic changes in the brain at an early stage, which manifest as degenerative changes in nerve cells and degeneration of neurons in the corresponding areas, leading to atrophy and death of neurons. Antipsychotic drugs can increase the levels of NGF (epidermal growth factor) and BDNF (brain-derived nerve growth factor), which form protection for nerve cells in the brain and can promote increased survival and growth of nerve cells.
It has been clinically demonstrated that patients with schizophrenia who have undergone systematic and regular treatment have a very significantly different prognosis than patients who have been treated irregularly, or who have stopped medication too early, or who have not been treated, with the former having a much better level of social functioning and a more stable condition than the latter. Therefore, the basis for recovery from schizophrenia is medication, formal and systematic medication. Without good medication, it is difficult to talk about recovery without good control of the patient’s condition.
Psychotherapy: There is no psychotherapy today that allows schizophrenia to be cured. Reducing symptoms, lowering relapse rates, and enhancing social adaptability are the main goals of psychotherapy for schizophrenia. Psychotherapy is an adjuvant treatment based on medication, and psychotherapy for schizophrenia is usually given during the recovery period of the disease or the interval period of the disease or the chronic stage of the disease. The following psychotherapeutic approaches are commonly used.
1) Psychoeducation and supportive treatment, which impart basic knowledge about the nature, developmental process and treatment of mental illness.
2) Behavioral techniques including social skills training, behavioral therapy – focusing on social skills training, vocational rehabilitation training, assertive community treatment programs, etc., which are effective in improving employability, reducing re-hospitalization rates and relapse prevention.
3) Family therapy: including family education and community-based family interventions to help family members understand the current problems and how to solve them.
III. About social function recovery
patients’ social functioning includes 4 different dimensions, including socially useful activities (work, study, etc.), personal and social relationships, self-care, interference and aggressive behavior.
Schizophrenia is a chronic, relapsing disorder with recurrent episodes and it is characterized by a high level of relapse that can seriously harm the patient’s social functioning and ability to work. Many patients who relapse after interrupting treatment are no longer able to function at the same level as before, creating a huge burden for families and society. Patients with schizophrenia already have impaired functioning at the time of their first episode. In the past, many physicians have tended to focus on symptom control at the expense of functional improvement. When patients’ functioning is impaired, roles and social relationships granted by society are gradually lost. For example, low employability and opportunities; few marriages and high divorce after the disease; shrinking or extinction of social networks; and low ability to live independently.
The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of schizophrenia have identified improvement in social functioning as the ultimate goal of schizophrenia treatment. When a patient’s social function is improved, it will not only alleviate the disease, shorten the course of the disease, and improve the patient’s treatment outcome, but also greatly reduce the burden on society and the patient’s family, and truly enable the patient to return to society. The earlier the intervention for functional recovery of schizophrenia patients, the better. In the past, functional recovery was often hidden behind symptoms and was often overlooked by clinicians.
With the continuous development of treatment concepts, promoting patients’ social function recovery has become the most important goal of schizophrenia treatment. In clinical treatment, physicians should intervene in functional recovery as early as possible by optimizing medication regimens, combining psychotherapy during the recovery period, and conducting rehabilitation training as early as possible, so that the patient’s level of functioning can be restored to its optimal state.
IV. Study of patients in recovery
The majority of schizophrenia patients are currently in their junior and senior high school years. It is especially important to deal with the relationship between treatment and study. At the beginning of the illness, the disease is heavy and patients have more hallucinations and delusions. The treatment at this stage is drug-based, with higher doses of drugs. On the one hand, the symptoms have a great impact on the patient’s mental state, and the attention to study is seriously distracted; on the other hand, the patient’s alertness, attention and memory are also greatly affected by the antipsychotic drugs. At this time, if you insist on studying, you have to consider the effect of medication and the effect of treatment, so it is inevitable that treatment and study lose each other, and eventually the treatment is affected and the study is not effective, and the patient will also have bad emotions and resentment towards treatment or study.
Therefore, it is recommended to treat such patients with temporary rest or suspension from school, so that the disease can be basically controlled and the dose of medication can be reduced before resuming studies, so that the patient’s treatment and studies will not be affected. The maintenance period is usually started after the treatment and consolidation period. The maintenance period is the best stage for most patients to resume their studies. If they resume their studies too early, the effects of their disease and medication will be great; if they resume their studies too late, it will be more difficult for them to adapt.
It is recommended to choose drugs with low sedative effect and low adverse effects at the beginning of treatment, so that even small doses of antipsychotic drugs taken during the maintenance period will not have significant adverse effects on the patient’s studies and other functions.
During the exam period, if the patient is taking a large dose of medication, the dose can be reduced a week in advance to reduce or eliminate the effect of the medication on learning, and then return to the original dose immediately after the exam. As for how to adjust the drug dose, it should be handled according to the patient’s condition, and it is recommended to listen to the patient’s doctor’s opinion, and family members or patients should not adjust the drug dose without permission.
V. Social function of patients in recovery
Patients in the rehabilitation period have basically recovered, but through 3~4 months of medication or inpatient treatment
1) The patient’s longer treatment and social disconnection time is longer, immediately return to normal social life most will not adapt;
2) The patient’s body size or weight has changed significantly, and he or she may be afraid to go out or interact with others because of low self-esteem or fear of being teased by others;
3) Patients may have low self-esteem, fear of not being able to adapt, or lack of self-confidence, depression and other emotional reactions due to the upcoming pressure of study or work.
4) A few patients may experience some degree of mental retardation due to the long duration of the disease. As a result of the above, most patients resort to withdrawal due to instinctive reactions, avoiding others and being alone at home overall. Or, although often determined to go to work or school, they take to avoiding or making various excuses to postpone going out to socialize or work and study when the time comes. They are anxious or worried about the stress of going out, but are at ease at home, or their stress is temporarily relieved and peace is restored.
However, as we said, mental recovery is not only the elimination of symptoms, but mainly refers to the recovery of social functions, and the recovery of social functions, medication is only the basis for the recovery of social functions, and the role of medication itself in the recovery of social functions is limited, at this time, psychotherapy and functional training of behavior is the key to solve the problem at root.
During this period, to recover the social function of the patient, firstly, we should explain to the patient the rules of the onset, treatment and recovery of mental illness and the importance of social function recovery. Secondly, it is necessary to establish the patient’s psychology to overcome low self-esteem and build up the self-confidence to restore normal people. Third, behavioral training should be persistent and persistent, and it will be effective. Different patients should be treated with different methods or intensity. For example, they should be encouraged to go out, patients who used to have more friends should be encouraged to contact and meet with their friends, and students should be treated to encourage them to actively participate in school or class group activities and communicate with their classmates more after school hours. For patients who used to have fewer friends, encourage them to go out for walks and socialize with others in the community.
Encourage them to handle things at home alone, such as going shopping alone, paying utility bills, etc. Enhance visits and games with relatives during holidays, etc. In conclusion, the principle of restoring patients’ social functions is that the more worried, anxious or scared the patient is about something or a scene, the less they should avoid it and the more they should actively participate in it. The consequence of avoidance is that the patient temporarily achieves a calm mood, but the patient’s low self-esteem and nervousness will not reduce by itself, but will get heavier. On the contrary, the patient’s active participation, the patient may temporarily appear uneasy or nervous, but as the number of participation increases, the patient’s mood will gradually calm down and confidence will gradually increase. It is important to note that in the process of the patient’s resumption of social activities
1) Be gradual, not too strong at the beginning, and gradually increase the intensity or duration of participation after the patient has made progress.
2) The patient should be actively encouraged for the progress he/she has made, and he/she should be allowed to see the changes and increase his/her confidence.