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In some cases, behaviour caused by schizophrenia can be bizarre and threatening. If you are confronted with such behaviour, do your best to stay calm and non-judgemental, be concise and direct in whatever you say, clarify the reality of the situation and be clear about the limits of acceptable behaviour. Seldom, if ever, will a person suddenly lose total control of their thoughts, feelings and behaviour. Family members or close friends will become aware of a variety of behaviours which give rise to mounting concern: sleeplessness, ritualistic preoccupation with certain activities, being suspicious and unpredictable outbursts are all common early warning signs. During these early stages, a full-blown crisis can sometimes be averted. Often the person has ceased taking their medication. If you suspect this, try to encourage a visit to their healthcare provider. If this is not successful (and the more psychotic the person the less likely it is to be so), you should contact your provider by phone in order to get advice. You must also learn to trust your intuitive feelings. If you are truly frightened, the situation calls for immediate action. Call the Garda.
It may help you to know that the person is probably terrified by his/her own feelings of loss of control. Further, the ’voices’ may be giving life-threatening commands. In the person’s mind, messages may be coming from light fixtures, the room may be filled with poisonous fumes or snakes may be crawling on the window. Accept the fact that the person is in an ’altered reality state’. In extreme situations, the person may ’act out’ the hallucinations, for example shatter the window to destroy the snakes. It is imperative that you try to remain calm. It is also imperative that your relative gets medical treatment. While waiting for medical help to arrive (or before attempting to take your relative to hospital), the following suggestions may prove helpful:
1. Remember that sometimes you cannot reason with acute psychosis.
2. Do not express irritation or anger.
3. Speak quietly, firmly and simply.
4. Don’t criticize. It will only make matters worse.
5. Don’t bait your relative into acting out wild threats. The consequences could be tragic.
6. Don’t stand over your relative if they are seated. Instead, seat yourself.
7. Avoid direct, continuous eye contact or touching.
8. Comply with requests that are neither endangering nor beyond reason. This provides the person with an opportunity to feel somewhat in control.
9. Don’t block the doorway, however do try and keep yourself between your relative and an exit.
10. Decrease other distractions immediately. Turn off the television and radio.
11. Express understanding for what your relative is experiencing.
It is obviously far better, if possible, to have your relative go to the hospital voluntarily. If you do not think your relative will listen to you, see if a friend can talk the person into doing so. Some have found that presenting their relative with a choice seemed to work. "Will you go to the hospital with me, or would you prefer that John take you?" Such an approach may serve to reduce the person’s feeling of helplessness. Offering choice, no matter how small, provides some sense of being in control of the very difficult situation in which they find themselves.
However, in the rare event that the psychotic episode involves violence, there may be no time for all the above strategies and more direct measures need to be taken to protect both you and your relative from harm. Don’t be hesitant to call the Garda. Tell them that your relative has schizophrenia, explain what it is that your relative is doing and that you need the help of the police to obtain medical treatment and to control the violent behaviour. If you are alone, contact someone to come and stay with you until the police arrive. The doctor who has been involved with the care of your relative should be advised of the situation as soon as possible.
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