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Schizophrenia

Schizophrenia Treatment - Hospitalization

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Hospitalization

In the past, many with schizophrenia ended up in hospitals for long stays. Due to medication treatments today, the frequency and length of hospital stays have been greatly reduced. It may still be needed for the most severe cases. Typically, inpatient hospitalization is generally only needed for short periods of time. This allows for acute psychotic episodes and crises to be intensively managed. Hospitalization is a time to get new patients started on medications, to evaluate or change existing medications, or to re-introduce medications to patients who have stopped taking them. Usually, people remain hospitalized for the shortest amount of time necessary to make these changes and to ensure that they will likely be safe when leaving the hospital. If the patient is unresponsive to treatment, he or she will remain hospitalized for a longer period of time. This allows for different treatments to be tried until a successful one is found.

hospital room While in the hospital, patients are generally free to walk around their hospital unit and interact with other patients. However, the unit itself may be "locked" so that they cannot easily leave without going through a proper and approved discharge. Rarely, restraints may be used on patients who become extremely agitated. This may be necessary to ensure their safety and the safety of others on the unit. Given the effectiveness of antipsychotic medications, agitated states do not tend to last very long.

In the hospital environment, medications are only one part of the therapeutic program. Other therapies offered to patients include psychiatric consultation, and group or individual psychotherapy. Psychiatric consultation provides an opportunity for patients to speak directly with doctors, who monitor symptoms and create or adjust treatment plans as needed.

During group therapy, therapists help patients to help each other with reality testing and interpersonal problems they may have. The highly-structured schedule of hospital life provides another type of therapy called "milieu" therapy. In this therapy, order and structure are placed upon patients who cannot do this for themselves. This may include making sure patients eat and sleep on a regular schedule. Milieu therapy was more important in the past when hospital stays were longer and there were no medication treatments. However, but it remains a benefit of hospitalization. Sometimes after a patient leaves the hospital, a therapeutic community residence offering continuing milieu therapy may be available, so that patients can live in a well-controlled environment all the time. Though expensive, this type of therapy can be very valuable and can mean the difference between recurring episodes and a normal life.

Based on having seen movies like "One Flew Over The Cuckoo's Nest", many people expect that lobotomy may happen during hospitalization. This is not the case. Lobotomy was an early 1900s surgical technique during which a patient's frontal cortex was destroyed. This was done to make the patient peaceful and compliant. This practice was discredited and is never practiced in a modern psychiatric facility.

Forms of electric shock therapy (electroconvulsive therapy or ECT) are still performed. However, it is done in a much more refined form than in the past. ECT involves the passage of an electric current through the brain to artificially create a seizure. It is mostly reserved for treatment resistant forms of depression today. Patients are given muscle relaxants prior to ECT sessions to prevent damage from shaking or biting. The electrical current used to induce the seizure is also very different from the original process. Though the procedure has the side effect of causing temporary short term-memory loss, it can work be very effective when other treatments have failed. The most important thing to know about ECT is that when it is used, it is used as a treatment, not as a punishment.

 

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