The effects of the unprecedented coronavirus will be felt by all for a currently unknown period of time. The fear-driven behavioral responses that this pandemic has been producing is a reflection of how deep and strong our survival response goes. And, yet, at some point, relief will come in the form of a vaccine. However, there is another health challenge that stirs fear in the hearts of many, the life-long diagnosis of the severe mental disorder of schizophrenia.
One of my very first clients that I saw as a Marriage and Family Therapist Trainee carried a diagnosis of schizophrenia. My client challenged me to learn more about this disorder in order to provide the best quality of service I could at that point in my training. I learned that schizophrenia, although not as common as other mental disorders, affects feelings, thinking, and behaviors and the symptoms can be very disabling. Symptoms of schizophrenia are categorized using the medical terms of either positive, negative, or cognitive. Positive symptoms add and negative symptoms take away.
For example, positive symptoms might include hallucinations, delusions, or repetitive movements that are hard to control. Negative symptoms include reduced feelings of pleasure, reduced speech, apathy, reduced social drive and social interest, and loss of motivation. The underlying cause or causes of this severe mental disorder are still unknown and available treatments focus on eliminating the symptoms of the disease. The first line of attack as far as treatment is concerned is antipsychotic medications. Once a medication is found to work, then psychosocial treatments, such as therapy, is offered to help individuals learn and use coping skills. Research has shown that participating in such psychosocial treatments reduces relapses and/or hospitalizations; however, the most challenging aspect of treatment is nonadherence to medication. Therefore, a focus on increasing treatment adherence could have a positive effect on all impacted by this severe mental disorder.
Individuals with schizophrenia struggle to live life independently and improving this situation is a significant mental health priority. It seems as though the negative symptoms of this disorder are associated with poorer functional status and quality of life than are the positive symptoms and this may be because primary negative symptoms generally do not respond well to the antipsychotic medications currently available. Research has suggested that up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. With this information it then becomes more easily understandable why these individuals may not be compliant with their medications – because those medications don’t work for them. The question now is what is being done to support these individuals and address this unmet medical need?
Well, there is hope on the horizon. An article recently published in the Journal of the American Medical Association Psychiatry looked into the use of transcranial direct current stimulation (AKA direct neurofeedback) as an add-on therapy for negative symptoms of schizophrenia. In this double-blind randomized clinical trial of 100 individuals diagnosed with schizophrenia with predominant negative symptoms, results showed that this non-medication treatment was effective and safe in ameliorating negative symptoms.
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