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Schizophrenia Treatment - Hospitalization

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

Hospitalization

With today's widespread use of antipsychotic medications, the frequency and duration of hospital stays for schizophrenia patients has been substantially reduced. Except for the most severe cases, inpatient hospitalization is generally only needed for short periods of time so that acute psychotic episodes and crises can be intensively managed. Hospitalization is a time to get new patients started on medications, to evaluate or change current patients' existing medications, or to re-introduce medications to patients who have stopped taking medication. Usually, patients remain hospitalized for the minimal amount of time necessary to effect such changes and also to insure that they will likely be safe upon discharge. If the patient is unresponsive to treatment, he or she will remain hospitalized for a longer period of time as alternative treatments are attempted.

While in the hospital, patients are generally free to wander their hospital unit and interact with other patients. However, the unit itself may be "locked" so that patients cannot easily escape without going through a proper and approved discharge. Rarely, restraints may be used on patients who become extremely agitated as is necessary to insure their safety and the safety of other patients on the unit. Given the efficacy of antipsychotic medications, such agitated states do not tend to last very long.

In the hospital environment, medications are only one part of the therapeutic regimen. 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 accordingly. 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 avenue of therapy; termed "milieu" therapy in which benign and beneficial order is imposed upon patients who cannot generate this order themselves (such as making sure patients eat and sleep on a regular schedule). Milieu therapy was more important in years past when hospital stays were longer and medication options were non-existent, but it is still 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 exceptionally valuable and can mean the difference between re-current active phase psychosis and a normal life.

Based on having seen movies like "One Flew Over The Cuckoo's Nest", many people expect that lobotomy may occur during hospitalization. This is not the case. Lobotomy, an early twentieth century surgical technique during which a patient's frontal cortex was destroyed so as to pacify him or her has been discredited, and is never practiced in a modern psychiatric facility. Forms of electric shock therapy (electroconvulsive therapy or ECT) are still performed these days, but in a much refined form than was the case in the past and only when therapeutically indicated. 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 these days. Patients are given muscle relaxants prior to ECT sessions to prevent damage from shaking or biting, and the electrical current profile used to induce the seizure is highly refined from 50 years ago. Though the procedure has the side effect of causing temporary short term-memory loss, it can work wonders where other treatments fail, which is why it is still in use. The most important thing to know about ECT is that when it is used, it is used as a treatment, not as a punishment.