The development of an array of medications and psychosocial interventions has greatly improved the outlook for patients with schizophrenia. Newer antipsychotics can help control the symptoms of the disorder while causing fewer stigmatising side effects. Education and other psychosocial interventions can help patients and families learn to manage the disorder more effectively, reduce social and occupational dysfunction, and enhance the social reintegration of those with schizophrenia. Research to find safer and more effective treatments is underway. In addition, continuing studies on the better prognosis for schizophrenia in developing (as opposed to developed) countries may suggest strategies that can be applied globally to improve the outcome for patients with schizophrenia everywhere.

There are three main components of treatment for schizophrenia:

• Medications to relieve symptoms and prevent relapse;
• Education and psychosocial interventions to help patients and families solve problems, deal with stress, cope with the illness and its complications, and help prevent relapses;
• Social rehabilitation to help patients reintegrate into the community and regain educational or occupational functioning.

Clinicians should be aware of the principles outlined in the World Psychiatric Association's Declaration of Madrid, issued in 1996, which stressed the importance of keeping abreast of scientific developments, conveying updated knowledge to others, and accepting the patient as a partner by right in the therapeutic process. It is also important that the various treatment approaches be provided in an integrated manner; for example, using the principles of case management teams (Kanter 1989). This ensures that all efforts are focused on the same goals and that the patient and family will understand the common therapeutic thread in the treatment plans. Finally, clinicians should encourage patients and families to become involved with patient/family support groups, which can provide valuable help and guidance in coping more effectively with the illness.

Antipsychotic Medications / The medications that are currently used to treat schizophrenia generally fall into two groups:

1. Standard antipsychotics (previously referred to as neuroleptics)
2. Novel antipsychotics (also referred to as second generation or "atypical" antipsychotics)

Standard antipsychotics / The first standard antipsychotic medicines were introduced into clinical practice in the early to mid-1950s. The term 'standard' (or 'traditional' or 'conventional') antipsychotic is used to refer to all the antipsychotic drugs developed before the introduction of clozapine. These antipsychotics were formerly called neuroleptics because of their characteristic side effects on the extrapyramidal motor system, including dystonia, parkinsonism, dyskinesia, and akathisia. These agents have proved useful in reducing, and sometimes eliminating, positive symptoms of schizophrenia such as thought disorder, hallucinations, and delusions. They can also decrease associated symptoms such as agitation, impulsiveness, and aggressiveness. Unfortunately, they do not appear to be as effective in reducing the negative symptoms of schizophrenia such as apathy, social withdrawal, and poverty of ideas. If these medicines are taken consistently, they can also reduce the risk of relapses. The introduction of effective antipsychotic medicines made it much more possible to treat patients with schizophrenia in the community, while avoiding readmission to the hospital. Antipsychotic medication can also help people with schizophrenia benefit from psychosocial forms of treatment.

Common standard (traditional) antipsychotic medications*

Benperidol Levomepromazine
Bromperidol Oxypertine
Butaperazine Penfluridol

Chlorpromazine Perazine
Chlorptothixene Periciazine
Clopenthixol Perphenazine
Clotiapine Pimozide

Droperidol Pipamperone

Fluanisone Promazine
Flupentixol Promethazine
Fluphenazine Sulpiride
Fluspiriline Thioridazine

Haloperidol

*Product names vary from country to country and more than one product name may be used for the same drug within one country.

Novel antipsychotics / Whereas the focus in the earlier years of drug development was mainly on reducing positive symptoms such as hallucinations and delusions, in recent years researchers have been working to develop antipsychotic drugs with fewer side effects and improved efficacy against negative as well as positive symptions; factors that would help improve quality of life and are crucial in modern treatment and rehabilitation efforts. Clozapine was the first antipsychotic drug developed that caused very few extrapyramidal side effects (EPS). Clozapine has been followed by a number of other new drugs (see Appendix D) that share this advantage. The terms "novel," second generation, or "atypical" antipsychotic are used to refer to this group of medications, novel being the preferred term because atypicality is difficult to delineate. A considerably lower propensity to induce EPS is the landmark characteristic of the novel antipsychotics. They also appear to have advantages over the traditional antipsychotics in improving negative symptoms and inducing lower or no relevant increase in prolactin levels.

Education and Other Psychosocial Treatments / It has long been realised that psychosocial factors affect the treatment, prognosis, course and outcome of schizophrenia. Even though drug therapies have revolutionised the treatment of schizophrenia, recent years have also witnessed a growing awareness supported by research evidence that psychosocial interventions have considerable impact on treatment outcomes in schizophrenia. Psychosocial interventions involve using psychological or social management strategies and techniques to reduce or eliminate cognitive, psychological, and social impairments, as well as disabilities, dysfunctions, and handicaps in order to facilitate social reintegration and psychosocial rehabilitation. In practical terms, psychosocial interventions aim to reduce both positive and negative symptoms, enhance insight and adherence to treatment, prevent relapse, improve social and communications skills, and provide coping skills and strategies to patients and relatives so that they can better deal with stresses. Psychosocial intervention is an ideal complement to drug therapies.
   The problems in living experienced by people with schizophrenia are social, personal, clinical, and sometimes political (e.g., discrimination). Because the impact of schizophrenia is felt in so many areas of life, effective treatment must address multiple problems, including early recognition of relapse, relapse prevention, improved insight and adherence to treatment, psychoeducation, family living, community care and care in other special settings, social and coping skills, and rehabilitation.
     Virtually every rigorous comparison of medical approaches and social rehabilitation has shown that medication combined with social rehabilitation leads to a better outcome than either approach alone. Medications are often a necessary but never a sufficient treatment, while social rehabilitation is almost always augmented by the use of carefully prescribed medications.
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