This article is an endeavor to provide some necessary information regarding the home care management to be provided to the Schizophrenia patients. During my research at Institute of Mental Health and Neurosciences Rainawari Srinagar in 2017 on 100 study subjects (caregivers to Schizophrenia patients) more than 60% were found lacking knowledge regarding the home care management of such patients. Before I discuss some important measures to be followed while providing home care to these patients, I will through some light on what Schizophrenia actually is.
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and acts. People with the disorder may hear voices or see things that aren’t real or what we may call it as hallucinations. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them which we call as delusions. This can be scary and upsetting to people with the illness and make them withdrawn or extremely agitated. It can also be scary and upsetting to the people around them. People with schizophrenia may sometimes talk about strange or unusual ideas, which can make it difficult to carry on a conversation. They may sit for hours without moving or talking. Sometimes people with Schizophrenia seem perfectly fine until they talk about what they are really thinking. It even leaves an impact on families and society as well. Many people with Schizophrenia have difficulty holding a job or caring for themselves, so they rely on others for help. Stigmatizing attitudes and beliefs about Schizophrenia are common and sometimes interfere with people’s willingness to talk about and get treatment for the disorder. People with the disorder may cope with symptoms throughout their lives, but treatment helps many to recover and pursue their life goals. Researchers are developing more effective treatments and using new research tools to understand the causes of Schizophrenia. In the years to come, this work may help prevent and treat the illness in a better way.
It affects males more than females. It occurs in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30. Males tend to experience symptoms a little earlier than females. Most commonly, Schizophrenia occurs in late adolescence and early adulthood. It is uncommon to diagnose it after age 45. It rarely occurs in children. It can be difficult to diagnose this disorder in teens. This is because the first signs can include a change of friends, a drop in grades, sleep problems, and irritability—behaviors that are common among teens.
Suicidal thoughts and behaviors are very common among such people. People with Schizophrenia die earlier than people without a mental illness, partly because of the increased suicide risk.
Since the cause of the disorder is still unknown, treatment focuses on eliminating the symptoms of it, which include antipsychotic medications (like Clozapine, Quetiapineetc) and various psychosocial treatments (like illness management skills, rehabilitation, family education and support, cognitive behaviour therapy, etc). In our Kashmir valley we have a well-reputed Institute of Mental health and neurosciences at Rainawari Srinagar, where such patients get proper treatment and attention to overcome these conditions by expert psychiatrists, qualified registered nurses and other professionals.
How to help a person with Schizophrenia?
Family and friends as caregivers can help their loved one with schizophrenia by supporting or involvement in treatment and pursuit of their recovery goals. Positive communication approaches will be most helpful. It can be difficult to know how to respond to someone with the disorder who makes strange or clearly false statements. Remember that these beliefs or hallucinations seem very real to the person. It is not helpful to say they are wrong or imaginary, but allowing them to go with the delusions is not helpful either. Instead, calmly say that you see things differently. Tell them that you acknowledge that everyone has the right to see things his or her own way. These patients are lacking hygiene; they do not bath months and do not change clothes. They lack self-care in routine. The caregivers have to take part in maintaining the patient’s hygiene. They should assess patient’s ability to meet self-care activities and should provide assistance with self-care needs as required. Develop a structured schedule for patient’s routine for hygiene, toileting and meals. Praise the patient for completing an activity of daily living and give them positive reinforcement (such as verbal praising, providing gifts, offering patients’ favourite meals etc) so that they get motivated to mold their behavior step by step and over a period of time. The patient should be given enough time to complete a task. Gradually withdraw assistance and supervise patients grooming and other self-care skills.
Hospitalization can stabilize a person with Schizophrenia who has had a relapse or episodes of hallucinations and delusions. Healthcare professionals provide therapeutic support, social services, and education about the condition, while helping establish an effective treatment plan. But returning home can pose challenges for patients and their caregivers. After a hospital stay, these patients need help for following their treatment plan, including getting to doctor’s appointments and remaining compliant with prescribed medication regimens. Patients often don’t believe they’re ill, which can make them difficult to take their medicine properly. They have to be motivated for taking medications on time. Mix the medicine with their meals, milk, juice whatever food or drink they take.
The key for caregivers is “being supportive, respectful and kind in every way and helping their beloved one get back into the swing of his or her usual routine”. This requires a difficult balance between treating the person with respect and openness, while preventing any unhealthy or dangerous behaviors.
Psychiatric treatment in addition to medication include; individual talk therapy, family therapy, or group therapy; and an overall regimen for maintaining a healthy lifestyle. To relieve stress, these patients may benefit from relaxation techniques like deep-breathing, meditation, yoga, etc. Besides religion, depending on how patients view it, can be helpful to them if they are being involved in offering their prayers regularly. It may act as meditation for the patients. Religion can also be a very valuable tool in coping with the disorder, especially for those who are active in a religious community.
Psychotic episodes can be very frightening for the patients and those around them. As caregiver one should focus on. “Any change from the baseline behaviour pattern such as if the person is experiencing even some slight emotional detachment, mistrust or feel depressed.” In such cases patient’s doctor should be consulted to determine how to make crises management plan for them and how to deal with such situations.
A caregiver should explore options for becoming a more active member of their beloved one’s healthcare team, such as having the authority to communicate a patient’s wishes, making decisions about treatment and care–something which should be discussed in a family therapy session so that the caregiver can be available to help the patient with the decisions that make the most sense. As a caregiver you need to assess the patient for any hallucinatory behaviour like talking to self, laughing to self, stopping in mid-sentence while talking. Interrupt hallucinations by calling the patient, giving them any task , or moving them to other place or room, so that they get distracted. Schizophrenic patients withdraw themselves socially, hence help them to become social by making the patient visit friends and relatives frequently and by providing them rewards for that.
Diet modification of these patients is very essential. Reduce sugar, carbohydrate and caffeine intake. This will help in balancing the blood sugar. Many drugs prescribed to treat schizophrenia can mess with the patients’ blood sugar, so avoiding excess stimulants can help keep it at a desired level, foods to avoid include candy, soda, bread, crackers, some fruits like mango, vegetables like potatoes and coffee. Add foods containing essential fatty acids. Good sources include fish, nuts and olive oil. Increase the intake of antioxidants as antioxidants are responsible for counteracting oxidation in our body that can cause other health concerns, such as cancer. Specifically, people with Schizophrenia experience increased oxidation in the brain. Adding foods that contain vitamins A, C and E can help treat this issue. In addition, avoiding burnt and fried foods reduces the amount of oxidation which otherwise is likely to occur in our brain. Antioxidant rich foods include beans, berries, apples, plums, tomatoes etc. Provide the patients with multivitamin supplements as prescribed by doctor. Niacin or vitamin B3 deficiency can produce thought disorders, hallucinations and depression, so taking a mega dose of niacin daily can help to reduce these symptoms. Adequate intake of B vitamins.Zinc, and folic acid is responsible for maintaining the chemical balance in our brain. Foods containing these elements are green leafy vegetables, citrus fruits. beans, peas etc.
(The writer is a post graduate in Mental Health (Psychiatric) Nursing and teaches at Bibi Halima College of Nursing and Medical Technology Srinagar)