Q: When you first tell a patient that they have schizophrenia, do you tell them that this is a lifelong condition?

A: This would happen only after a therapeutic relationship has been established with the patient Once that has been achieved, I talk about the condition and the need for long-term treatment – and that is not only pharmacological, but includes psychotherapy, psychosocial and family interventions.  The analogy with diabetes or hypertension can be useful. But this discussion is not for the acute phase. It happens only when the process of rehabilitation is under way.

Q: What are the goals of treatment?

Patient autonomy and self-regulation, in the sense that they manage their own lives. The first step is the small activities of daily life, and then work and social relationships. Reducing risk of hospitalisations is also a key goal.

Q: And what helps achieve these goals?

The combination of psychopharmacology and psychotherapy and psychosocial interventions, since all contribute to autonomy and avoiding hospitalisation. It is also important that patients have a better understanding of their condition. But I do not actually use that term, or “disorder”. We speak about their lives and ways of improving it: work and how to return to it, and interpersonal relationships.

It is all about being realistic and helping patients make the best use of their resources, both internal resources and those in the environment. 

And for the psychiatrist, our best resource is the relationship with the patient. That is true even for the pharmacological element of treatment: patients will not take their drugs without a good relationship with us.