Life After Psychosis: The Rehabilitation of Patients with Schizophrenia

Schizophrenia is the descriptive term for a group of psychotic disorders in which personal, social and occupational functioning deteriorate as a result of unusual emotional states, disturbed thought processes, strange perceptions and motor abnormalities. As of December 2023, the prevalence of schizophrenia in India is 1.41%. Schizophrenia is a debilitating disorder that worsens over time, but early identification and treatment can significantly improve the conditions of the patient.

Most cases of psychosis require medical or psychiatric care rather than therapies alone, as the functioning of the brain is affected. Although the patients respond well to the treatment, several studies indicate that some residual effects of the treatment persist. These effects are often overlooked, highlighting the strong need for rehabilitation care for these patients. This article aims to understand the concept of rehabilitation for a mentally ill individual.

Read More: Understanding Delusions of Control in Schizophrenia

Why Rehabilitation for the Patients with Schizophrenia?

• Premorbid factors: Premorbid handicapping factors are common in schizophrenic patients, such as declining occupational status, social impairment, and a tendency towards socially isolated living conditions even before the onset of symptoms. In such cases rehabilitation is necessary.
• Psychiatric Care Need: Hospitals can provide shelter against everyday stressors for schizophrenic patients, studies also prove that the symptoms of patients with schizophrenia tend to worsen at home. But to avoid symptom relapse psychiatric care units also need to balance between understimulation and overstimulation. Stress management and overall well-being are ensured by the rehabilitation program for these patients.
• Negative symptoms: Negative symptoms like slowness, lack of motivation and withdrawal can be worsened by poor social environments, highlighting the need for appropriate support and understanding in rehabilitation.

Treatment and Intervention for Schizophrenia Spectrum Disorder

The treatment of schizophrenia primarily focuses on the reduction of symptoms in order to ensure the well-being of the patients. Here are some treatments that are commonly used:

• Medication management: The first treatment for schizophrenia involves the use of antipsychotic medications to reduce symptoms such as hallucinations, delusions, and disorganized thinking. Typical and atypical antipsychotics are common, efficient choices based on factors like efficacy and side effect profile.
• Psychotherapy and counselling: After the symptoms are reduced to an extent Various psychosocial techniques and therapies are applied, including cognitive-behavioural therapy, family therapy, and supportive therapy, which can help individuals with schizophrenia manage symptoms, improve functioning, and enhance coping strategies.
• Hospitalization: In acute or severe cases of schizophrenia, hospitalization may be necessary to ensure safety, stabilization of symptoms, and initiate treatment. Inpatient psychiatric care provides intensive monitoring and support until the individual’s condition improves.

Read More: Physical Health Challenges Affect One in Four Individuals with Schizophrenia or Bipolar Disorder

Role of Rehabilitation in Treatment and Recovery

Treatment and Intervention has three goals i.e. reduction of symptoms, improving the level of functioning and quality of life. In disorders like anxiety, depression or phobia, reduction of symptoms often ensures quality of life and generally the patient returns to their daily functioning. However, in the case of severe mental disorders such as schizophrenia, bipolar, and psychotic depression, reduction of symptoms may not be associated with an improvement in the quality of life. Many patients suffer from negative symptoms such as Alogia and lack of energy to do work or to interact with people.

Rehabilitation is required to help such patients become independent. The aim of rehabilitation make the patient self sufficient and effective member of society to the extent possible, these rehabilitation program are:

• Occupational Therapy:  In occupational therapy, the patients are taught skills such as candle making, paper bag making and weaving to help them to form a work discipline.
• Cognitive Rehabilitation: Cognitive Rehabilitation is given to improve the cognitive functions of attention, memory and helps in the improvement of cognitive distortion.
• Social Skill Training program: Most of the time schizophrenic patients show immense difficulties in social interaction and social communication because of the features of negative symptoms. Social skill training uses certain activities like imitation, role playing to improve the social skills of patients.
• Vocational Training: Vocational Training is given to the patients, wherein the patient is helped to gain skills necessary to undertake productive employment. It includes teaching basic job skills such as punctuality, communication, and workplace etiquette, as well as developing specific vocational skills aligned with the individual’s capabilities and interests.

Read More: The Integral Role of Rehabilitation Psychology

Challenges and Barriers to Rehabilitation

Rehabilitation of a mentally ill individual is a complex and multifaceted process which often encounters challenges. Understanding these barriers is important to develop strategies to resolve them and ensure successful recovery of the patients:

• Lack of Awareness and Education: People specifically in India are unaware of the concept of rehabilitation, often associating it with treatment and care for people who have different types of addiction. Rehabilitation care for the person with disabilities or mental illness are often overlooked.
• Family Environment: Most of the time patients with schizophrenia do very well in the hospital setting, but after recovery the exposure to negative attitudes from family or the public can contribute to the development of personal habits that are hard to change, posing additional challenges to rehabilitation.
• Social Attitudes and Stigma: Patients may experience changes in personal habits, self-esteem, and social interactions due to illness, leading to stigma and altered attitudes from family, employers, healthcare providers, and the general public.

Understanding difficulties present in schizophrenic patients, such as occupational decline, social impairment, and tendencies towards isolated living before symptom onset, is crucial for effective rehabilitation strategies. Rehabilitation programs can be very effective in making the person self sufficient to carry their daily routine efficiently.