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Schizophrenia is not a Fear Factor….

By Jose Thomas

Schizophrenia is a mental illness where people might withdraw from people, feel confused, lose interest in things and be prone to angry outbursts. Schizophrenia symptoms can include slower thinking, talking and movement, jumbled thoughts, emotional flatness or a lack of thought processes, reduced motivation, changes in sleeping patterns and body language, and an indifference to social contact. Symptoms might also include hallucinations (seeing, hearing and smelling things others don’t) and delusions (strong beliefs or experiences that are not in line with generally accepted reality).

Schizophrenia is a maldevelopmental disorder of the brain that manifests in positive, negative, cognitive and affective symptoms. Currently, the mainstay of treatment involves pharmacotherapy. The limitations of antipsychotic treatment are that they can only control symptoms and cannot cure the illness, and 20% of patients do not respond, thus leading to the requirement of maintenance treatment. Patients that do respond continue to have disabling residual symptoms such as amotivation and isolation, maladaptive behaviour, and impaired social functioning. These symptoms prevent patients from attaining educational, occupational, and social roles. Psychosocial interventions and models of quality of life in schizophrenia are based on the notion that increases in psychosocial functioning will be related to improvement in subjective experiences, such as self-esteem and satisfaction with life. The comparative effect of specific treatment methods and the additional benefits of multiple treatments need to be explored. Diversified techniques have also been employed, such as shaping, cognitive process therapy, mastery-oriented skill training, motivation and enhancement.

The rehabilitation process doesn’t end in a psychiatric hospital or nursing home or a rehabilitation centre. It is a lifelong process was the family and the person affected with it hold hand in hand towards managing with the disability owed by the problem. A proper rehabilitation requires well understanding of the problem from family and the client side.

Here are some tips which will help in implementing rehabilitation process at home.

Schizophrenia and the family: How to help your loved one

If a family member or someone close to you has schizophrenia, you may be struggling with any number of difficult emotions, including fear, guilt, anger, frustration, and hopelessness. The illness may be difficult for you to accept. You may feel helpless in the face of your loved one’s symptoms. Or you may be worried about the stigma of schizophrenia, or confused and embarrassed by strange behaviours you don’t understand. You may even be tempted to hide your loved one’s illness from others.

In order to deal successfully with schizophrenia and help your family member, it’s important to:

  • accept the illness and its difficulties
  • be realistic in what you expect of the person with schizophrenia and of yourself
  • maintain a sense of humour

Do your best to help your family member feel better and enjoy life, pay the same attention to your own needs, and remain hopeful.

Tips for helping a family member with schizophrenia

  • Educate yourself. Learning about schizophrenia and its treatment will allow you to make informed decisions about how best to manage the illness, work toward recovery, and handle setbacks.
  • Reduce stress. Stress can cause schizophrenia symptoms to flare up, so it’s important to create a structured and supportive environment for your family member. Avoid putting pressure on your loved one or criticizing perceived shortcomings.
  • Set realistic expectations. It’s important to be realistic about the challenges and limitations of schizophrenia. Help your loved one set and achieve manageable goals, and be patient with the pace of recovery.
  • Empower your loved one. Be careful that you’re not taking over and doing things for your family member that he or she is capable of doing. Try to support your loved one while still encouraging as much independence as possible.

Encourage and support treatment

The best way to assist the recovery of a family member with schizophrenia is to get them into treatment and help them stick with it. Often, the first challenge of treatment is convincing the ill relative to see a doctor. To people experiencing delusions, hallucinations, and paranoia, there is no need for medical intervention because the voices and conspiracy theories are real.

If a family member with schizophrenia is reluctant to see a doctor, the following strategies might help:

  • Provide options – Your loved one may be more willing to see a doctor if he or she can control the situation somewhat. If your relative appears suspicious of you, suggest another person to accompany him or her to the appointment. You can also give your family member a choice of doctors.
  • Focus on a particular symptom – A person with schizophrenia may resist seeing a doctor out of fear of being judged or labeled “crazy.” You can make the doctor less threatening by suggesting a visit in order to deal with a specific symptom such as insomnia or a lack of energy.

Monitor medication

Once your family member is in treatment, careful monitoring can ensure that he or she is staying on track and getting the most out of medication. You can help out in the following ways.

  • Take side effects seriously. Many people stop taking their schizophrenia medication because of side effects, so pay attention to your loved one’s drug complaints. Bring any distressing side effects to the attention of the doctor. The doctor may be able to reduce adverse effects by reducing the dose, switching to another antipsychotic, or adding another medication that targets the troublesome side effect.
  • Encourage your loved one to take medication regularly. Even with side effects under control, some people with schizophrenia refuse medication or take it irregularly. This may be due to a lack of insight into their illness and the importance of medication, or they may simply have trouble remembering their daily dose. Medication calendars, weekly pillboxes, and timers can help people who are forgetful. Two typical antipsychotics, Haldol and Prolixin, are also available in a long-acting injectable form, given as shots every 2 to 4 weeks, eliminating the need for a daily pill.
  • Be careful to avoid drug interactions. Antipsychotic medications can cause unpleasant and dangerous side effects when combined with other substances, including certain prescription drugs, over-the-counter medications, vitamins, and herbs. Help your family member avoid any problems by giving the doctor a complete list of the drugs and supplements he or she is taking. Mixing alcohol or illegal drugs with schizophrenia medication is also harmful, so talk to the doctor if your relative has a substance abuse problem.
  • Track your family member’s progress. You can help the doctor track treatment progress by documenting changes in your family member’s behavior, mood, and other symptoms in response to medication. A journal or diary is a good way to record medication history, side effects, and everyday details that might otherwise be forgotten.

Watch for signs of relapse

Stopping medication is the most frequent cause of relapse in schizophrenia, so it’s extremely important that your family member continues to take all medication as directed. Many people whose schizophrenia is stabilized or in remission still require medication to maintain their treatment gains and keep symptoms at bay.

Unfortunately, even if a person is taking medication as prescribed, relapse into an acute psychotic episode of schizophrenia can occur. But if you learn to recognize the early warning signs of relapse and take immediate steps to deal with them, you may be able to prevent a full-blown crisis. The warning signs of relapse are often similar to the symptoms and behaviours that led up to the person’s first psychotic episode.

Common warning signs of schizophrenia relapse

       Insomnia

Social withdrawal

Deterioration of personal hygiene

Increasing paranoia

       Hostility

Confusing or nonsensical speech

Strange disappearances

Hallucinations

If you notice any warning signs of relapse or other indications that your family member’s symptoms of schizophrenia are getting worse, call the doctor right away.

Prepare for crisis situations

Despite your best efforts to prevent relapse, there may be times when your family member’s condition deteriorates rapidly and drastically. During a schizophrenia crisis, you must get help for your family member as soon as possible. Hospitalization may be required to keep your loved one safe.

Emergency planning

It’s important for the family members of people with schizophrenia to prepare for such crisis situations. Having an emergency plan ready for an acute psychotic episode will help you handle the crisis safely and quickly. A good emergency plan for a family member with schizophrenia includes:

  • A list of emergency contact information for your loved one’s doctor, therapists, and the police.
  • The address and phone number of the hospital you will go to in case of emergency for psychiatric admission.
  • Friends or relatives who will take care of other children or dependents while you deal with the crisis.

It’s also wise to go over the emergency plan with your family member. The crisis situation may be less frightening and upsetting to your loved one If he or she knows what to expect during an emergency.

10 Tips for Handling a Schizophrenia Crisis

  • Remember that you cannot reason with acute psychosis
  • Remember that the person may be terrified by his/her own feelings of loss of control
  • Do not express irritation or anger
  • Do not shout
  • Do not use sarcasm as a weapon
  • Decrease distractions (turn off the TV, radio, fluorescent lights that hum, etc.)
  • Ask any casual visitors to leave—the fewer people the better
  • Avoid direct continuous eye contact
  • Avoid touching the person
  • Sit down and ask the person to sit down also

Source: World Fellowship for Schizophrenia and Allied Disorders

Explore housing options

Treatment for schizophrenia cannot succeed if your family member doesn’t have a stable, supportive place to live. But finding the right living situation for a person with schizophrenia can be challenging. When considering housing options, think about the individual needs of the person with schizophrenia:

  • Can your family member care for him or herself?
  • How much support does he or she need with daily activities?
  • Does your family member have a drug or alcohol problem?
  • How much treatment supervision does he or she require?

Living with family

For many families, the most difficult choice involves whether or not the relative with schizophrenia should live at home. Living with family can be a good option for people with schizophrenia if their family members understand the illness well, have a strong support system of their own, and are willing and able to provide whatever assistance is needed.

At-home arrangements are less likely to be successful if the person with schizophrenia uses drugs or alcohol, resists taking medication, or is aggressive or uncooperative.

Choosing the Right Housing Option for a Person with Schizophrenia
Adapted from: Schizophrenia: A Handbook For Families, Health Canada

Residential options outside the family home

If an at-home living arrangement isn’t the right fit, make contact with local mental health facilities, social service agencies, support groups, and public housing authorities. These organizations can help you explore the residential facilities in your community and put your family member’s name on the appropriate waiting lists.

Options in your area may include:

  • Residential treatment facilities or 24-hour care homes – A more structured living environment for those who require greater assistance with medications and daily living tasks or for those going through an acute psychotic episode.
  • Transitional group home – An intensive program that helps individuals transition back into society and avoid relapse after a crisis or hospitalization. Includes skills training and rehabilitation services.
  • Foster or boarding homes – A group living situation for people with schizophrenia who are able to function relatively well on their own. Foster and boarding homes offer a certain degree of independence, while providing meals and other basic necessities.
  • Supervised apartments – An option for those whose condition is less severe or well-managed with medication. Residents live alone or share an apartment, with staff members available on-site

Schizophrenia is not an end to the life but if the person develops a proper insight to the problem and if the family has proper understanding towards managing and helping the person with the problem a proper rehabilitation process can bridge all the gaps which has been created by the social stigma. Hope this article will could help you to understand the various tips and options which will ease your mind while thinking about treating Schizophrenia.

References:

http://www.psychguides.com/guides/living-with-schizophrenia/

http://www.webmd.com/schizophrenia/guide/living-with-schizophrenia

http://psychcentral.com/blog/archives/2014/02/15/living-with-schizophrenia-2/

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