During an acute episode of schizophrenia, hospitalization is often required to promote safety, and to provide for the person's basic needs such as food, rest, and hygiene.

Antipsychotic or neuroleptic medications work by changing the balances of chemicals in the brain and are used to control the symptoms of the illness. These medications are effective, but are also associated with side effects that may discourage a patient from taking them regularly. However, many of these side effects can be addressed, and should not prevent people from seeking treatment for this serious condition.

Common side effects from traditional antipsychotics may include sedation and weight gain. Other side effects are known as extrapyramidal symptoms (muscle contractions, problems of movement and gait, and feelings of restlessness or "jitters").

Long-term risks include a movement disorder called tardive dyskinesia, which involves involuntary movements. Newer agents known as atypical antipsychotics, appear to have a somewhat safer regarding side effects. They also appear to help people who have not benefited from the older traditional medications. Ongoing treatment with medications is usually necessary to prevent a return of symptoms.

Supportive and problem-focused forms of psychotherapy may be helpful for many individuals. Behavioral techniques, such as social skills training, can be used in a therapeutic setting, or in the patient's natural environment to promote social and occupational functioning.

Family interventions that combine support and education about schizophrenia (psychoeducation) appear to help families cope and reduce relapse. Patients who lack family and social support may be helped by intensive case management programs that emphasize active outreach and linkage to a range of community support services.

There are many different potential outcomes of schizophrenia. Most people with schizophrenia find that their symptoms improve with medication, and some achieve substantial control of the symptoms over time. However, others experience functional disability and are at risk for repeated acute episodes, particularly during the early stages of the illness.

Supported housing, vocational rehabilitation, and other community support programs may be essential to their community tenure. People with the most severe forms of this disorder may remain too disabled to live independently, requiring group homes or other long-term, structured living environments.

• Noncompliance with medication will frequently lead to a relapse of symptoms.
• Physical illness occurs at high rates among people with schizophrenia due to psychiatric treatment itself (side effects from medication) and living conditions associated with chronic disability. These may go undetected because of poor access to medical care and because of difficulties communicating with health care providers.
• Persons with schizophrenia have a high risk of developing a coexisting substance abuse problem, and use of alcohol or other drugs increases the risk of relapse.

Call your health care provider if:

• Voices are telling you to hurt yourself
• You are unable to care for yourself
• You are feeling hopeless and overwhelmed
• You feel like you cannot leave the house
• You are seeing things that aren't really there

Rakel RE. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders; 2005:115-124.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:1541-1548.