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It would be reassuring if the medication used to treat schizophrenia removed all the distressing signs of the illness but this unfortunately is not always the case, with some negative symptoms usually remaining (although newer antipsychotics appear to be more effective in dealing with these) and in some circumstances, positive symptoms reappearing. Following are some practicalities which others have found helpful in living effectively with schizophrenia.
Providing structure
Encourage your relative to develop manageable routines and expectations. A structured environment means providing familiar and manageable routines and expectations. Agree on house rules and acceptable behaviour. Be consistent in your own attitudes and behaviour.
Helping with motivation
It is a good idea to encourage your relative to participate in activities wherever possible but try to keep these activities familiar in the beginning. Gradually introduce more stimulation through newer routines, people and activities, as a sudden or rushed approach may seem disturbing or even threatening. If possible, start where the person shows any interest in an activity, and where they might become involved with encouragement.
Keeping it simple
Schizophrenia can affect some people’s ability to make decisions: people may change their minds frequently or they may take what seems to you to be a long time in coming to simple decisions. While this may seem to be an act of stubbornness or a deliberate attempt to irritate others, it’s important to remember that a mental illness can impair the decision-making functions of the brain, and that someone who is affected is likely to have genuine difficulty with what seems so easy to others. It may be tempting to make the decision for the person but try not to do so.
Maintaining information and sticking with treatments
Help your relative to keep a record of information on what symptoms have appeared, what medications are taken (including dosages) and the effects of various types of treatments. It’s also useful to keep a note about your relative’s future health appointments, so that you can remind them when the time comes. Medication is almost always necessary in the treatment of schizophrenia but taking medication can often become problematic for people and this can escalate into a serious problem if left unattended. People stop taking their medication for a number of reasons, some of which include: a lack of insight about the illness, unwanted side effects, forgetfulness or a feeling of being well again.
Being patient and letting the person make up their own mind (in their own time) will help to develop confidence and independence.
Dealing with persistent symptoms
Many people who have long-term schizophrenia are left with what are called ’residual’ symptoms. Many of these residual symptoms centre around distrust and bizarre thinking; the best way of dealing with these symptoms is to ’reality-base’ the person who is experiencing them. The term ’reality-base’ means bringing the person back to the here and now by telling them the reality of the situation as you see it. ’Reality-basing’ can be very successful but it is important to remember that its success depends on a positive level of communication and trust between you and your relative, which can take time to build.
The statements should always be simple and direct. When you have reality-based someone, move on to the next point of conversation. Never agree with bizarre thinking as this only reinforces the truth in their mind. Never argue about a piece of bizarre thinking, just reality-base the person in a firm but calm manner.
An example:
"I don’t need medication because I am now well".
A response:
"Yes, I agree you are much better now but that is due to the effects of medication. If you don’t continue to take it, you may become ill and end up in hospital again".
Following are some suggestions, which may help you to keep your relative on track with medication:
1. First and foremost, realise that it is each individual’s choice to decide to take medication or not. Talk to the doctor about changing either the dosage or the type of the medication to reduce unwanted side-effects.
2. Explain to your relative that they are feeling well again precisely because they have been taking their medication. Remind them that once the medication stops taking effect (usually a couple of weeks after cessation), the symptoms are likely to return and this could mean future hospitalisation.
3. Discuss with your relative the option of buying a weekly pillbox, which can be helpful for people who simply forget to take their medication.
4. Discuss the option of injectable medications with your relative and with the treating specialist. These ’depot’ injections are usually given fortnightly and because they are administered intramuscularly, you can be sure that your relative is getting it (it can’t be spat it out, hidden under the tongue etc.).
5. Never sneak pills into a person’s food. If paranoia exists, this will only increase it and eliminate any existing trust between you.
Persistent hallucinations are distressing. If the optimal use of medication has been assessed, there are still other ways of minimising the disruptive effect of hallucinations. This includes learning to try and focus the attention on something else, such as TV, radio or an interesting activity. Some people use headphones to block out the hallucinations, while others plan their week so that they have to concentrate on some occupational activity or rehabilitation programme. Physical exercise is another avenue to explore. There are many other ways of tackling this problem (discussed elsewhere in this guide) so discuss the subject with health workers and with relatives in your local support group.
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