Schizophrenia and Medications

(From: Manitoba Schizophrenia Society Newsletter - Volume 19, Number 1, Winter 2007)

Schizophrenics taking medication every day can be tough to remember, hard to manage, and cause side effects, but it helps in avoiding psychotic episodes.

Like diabetes or high blood pressure, schizophrenia is a chronic disorder that needs constant management.The rate of recurrence of psychotic episodes can be decreased significantly by staying on medication. Although responses vary from person to person, most people with schizophrenia need to take some type of medication, plus use other approaches, such as supportive therapy or rehabilitation.

Update your Schizophrenia medication, side effects can be troublesome, and it's “tempting” to stop when the condition is under control because the person may think he/she doesn’t need the prescription meds anymore. Sometimes, an alcohol or drug problem makes it hard to stay on schedule.

Unfortunately, the person generally needs to take schizophrenia medication on schedule for as long as the doctor recommends to help keep psychotic symptoms to a minimum. No antipsychotic medication should be discontinued without talking to the doctor who prescribed it. And when the doctor does agree that you don't need a medication, you'll need to taper off it slowly under your physician's supervision, not stop it all at once.

There are many strategies that can help a person stay on their schizophrenia medication schedule. Talk to the doctor about these options:

• Long-acting, injectable forms of medications, which eliminate the need to take a pill every day.

• Medication calendars or pillboxes labeled with the days of the week to help you remember.

• Electronic timers on clocks or watches can be programmed to beep when you need to take your pills.

• Pairing medication with routine daily events, like meals, can help you stay on schedule.

• When side effects are a problem, ask your doctor to help you find a medication or dosage that helps minimize unpleasant reactions.

Getting Help for a Loved One with Schizophrenia in a Crisis

People with schizophrenia often resist treatment for a variety of reasons.They may believe their delusions or hallucinations are real and psychiatric help is not required. If a crisis occurs, family and friends may need to take action to keep their loved one safe.

The issue of civil liberties enters into any attempt to provide treatment. Laws (Mental Health Acts) concerning involuntary commitment have been revised in the last decade.Trying to get help for someone who is mentally ill can be frustrating. These laws vary from province to province, but generally speaking, when people are a danger to themselves or others because of mental illness, as with schizophrenia, and refuse to seek treatment, family members or friends can go to a magistrate for an order.Taken by the police to the emergency room, a mental health professional will assess the patient and determine whether a voluntary or involuntary admission is needed.

A person with schizophrenia who lacks insight may hide strange behavior or ideas from a professional; therefore, family members and friends should ask to speak privately with the person conducting the patient's examination and explain what has been happening at home. The professional will then be able to question the patient and listen for distorted thinking for himself. Professionals must personally witness bizarre behavior and hear delusional thoughts before they can legally recommend involuntary treatment.

Caring for Someone with Schizophrenia

Family and friends play an important role in a person’s recovery:

Help the person write a list of attainable goals, including the steps for reaching them. For example, what activity would help to move him or her toward independence? And what steps would need to be accomplished to fulfill that goal.

Review the list on a weekly basis, or whatever feels comfortable, to mark off progress or identify areas that need more work.

Encourage your loved one to maintain a regular daily schedule and get enough sleep each night.

Provide support and encouragement, but do not take over any of the tasks on the list, such as household chores.

Do not criticize or pressure — it will only lead to regression and a worsening of symptoms. Concentrate on what the person is doing right.

Caring for Yourself While You Care for Others

It can sometimes feel draining to be a caregiver, so it's important to also maintain your own vitality rather than sinking into depression. Boredom can sap your intellect and spirit, leaving you depressed and less able to manage your duties as a caregiver.To maintain your vitality, look for activities that you can share with others.

• Check the TV listings and choose your favorite programs to watch each day.

• Get talking books from the library.

• Look for special events that are low-cost or free. Invite a friend or family member to join you.

• Go out to lunch.Try the early-bird specials at restaurants.

• Visit an art-hobby store for a craft project that you enjoy.

• Invite family or friends over for dinner or lunch. If you have limited funds to entertain or do not have time to prepare food, have them over for dessert or snacks, host a potluck, or ask them to chip in on a carryout meal.

• Plan day trips to local places of interest. Again invite a friend or family member to join you.

• If you can afford it, go on a mini vacation. You can share the adventure and expense with other family members or friends. Many places offer senior discounts. Make sure that they can accommodate your needs. Large hotel and motel chains will generally go out of their way to help if you make your needs known to them. In addition, there are companies and organizations that plan trips for people with mobility limitations. Many travel books have special sections on accommodations, travel, and activities for those with limited mobility.

• If you have the room, invite friends or family members to come and stay with you for awhile in your home.

• Check colleges, faith organizations, and community centers for free courses and other activities. These groups can be a great way to extend your circle of friends and supportive network.

• Visit museums, galleries, botanical and zoological parks or a petting zoo.

• If possible, get a pet.Your local shelter or humane society has many appropriate pets available for adoption.

• Get a computer with Internet access so that you can e-mail friends, join in chat rooms, learn about things that are of interest to you, and enjoy computer games.

• Ask your local area agency on aging about friendly visitor, volunteer, and telephone reassurance programs.

5 Steps for Handling Schizophrenia Paranoia

Your friend or relative with schizophrenia may exhibit episodes of paranoia. Try these tips to cope with his or her paranoia.

1. Sit or stand next to the person, rather than face-to-face to deflect the paranoid fears away from you. Side-by-side, you and the person are facing the (hostile) world together. Standing directly in front of the person may be perceived as confrontational.

2.Avoid direct contact with your loved one when he or she is exhibiting signs of paranoia. Direct eye contact can make the paranoid person feel more so.

3. Speak indirectly to the person by using pronouns such as “it, he, she, and they” instead of the words “you and I.” Like the body positioning, the purpose is to deflect your loved one's paranoid projections away from you and toward general "real world" issues.

4. Identify with your schizophrenic friend or relative. Whenever possible, your attitudes and emotional expressions should parallel his or her attitudes and expressions. The goal is to make your loved one feel understood.

5.Don't try to rationalize beliefs that cannot be true, and don't try to correct or contradict your loved one. You can identify with the emotions the person is feeling: anger, sadness, fear, anxiety, etc. But don't encourage the delusions. Instead, if there is anything credible or believable you can agree on, focus on that. For example, if your loved one believes that he or she is the target of a police conspiracy, your response could be, "I sometimes don't trust the police." You haven't given credence to the conspiracy theory, but you haven't contradicted it either.

Schizophrenia: How to Establish a Crisis Plan

It is important to confront the possibility of a crisis, because despite good planning and assertive action on your own behalf, you could find yourself in a situation where others will need to take responsibility for your health care.Write a clear crisis plan that will instruct others how to care for you when you are not well. Doing so helps you maintain responsibility for your own care, it assures your family and friends that they are doing what you'd want.

It's best not to rush when developing your schizophrenic crisis plan. Decisions like these take time, thought, and often collaboration with health care providers, family members and other supporters. Once you have completed the document, give copies to the people who will act as your support team.

Your plan should include the following:

Symptoms

Describe the symptoms that should set the plan in motion. What will happen to indicate to others that they need to take over responsibility for your care and make decisions on your behalf? Ask your friends, family members, and other supporters for input, but always remember that the final determination is up to you. Be very clear and specific in describing each symptom. Don't just summarize — use as many words as it takes.Your schizophrenia symptoms might include:

• Being unable to recognize or correctly identify family members and friends.

• Uncontrollable pacing; inability to stay still.

• Neglecting personal hygiene (how many days should signal concern?).

• Not cooking or doing any housework (how many days should signal concern?)

• Not understanding what people are saying.

• Thinking your are someone you are not.

• Thinking you have the ability to do something you don't.

• Displaying abusive, destructive, or violent behavior, toward self, others, or property.

• Abusing alcohol and/or drugs.

• Not getting out of bed (how many days should signal concern?).

• Refusing to eat or drink

Supporters

In this next section of the crisis plan, list the people who should act on your behalf during a schizophrenic crisis. Before listing people, let them know what you'd like from them and make sure they agree and understand the plan.

If you have had past experiences in which health care providers or family members have made decisions that were not according to your wishes, you may want to specify that they be excluded from helping to care for you. If so, write on your plan, "I do not want the following people involved in any way in my care or treatment."

Health care providers and medications

Provide a list of the following:

• Names of your physician, pharmacist, and other health care providers, along with their phone numbers.

• Medications you are currently using, dosage, and why you are using them.

• Medications you would prefer to take if additional medications became necessary — like those that have worked well for you in the past.

• Medications that must be avoided — like those you are allergic to; those that conflict with another medication you're taking or cause undesirable side effects — give the reasons these drugs should be avoided.

• Any vitamins, herbs, alternative medications (such as homeopathic remedies), and supplements you are taking.

Treatments

You may know about particular treatments that you prefer to use during a crisis and others that you would want to avoid. The reason may be as simple as "this treatment has or has not worked in the past," or you may have some safety concerns. In this part of your crisis plan, list the following:

• Treatments you are currently undergoing and why.

• Treatments you would prefer if they became necessary.

• Treatments that would be acceptable to you if they were deemed necessary by your support team.

• Treatments that must be avoided and why.

Treatment facilities

Describe the treatment facilities you would like to use if family members and friends cannot provide your care or if your condition requires hospitalization. Check whether or not your options are limited by your insurance coverage. If you are not sure which facilities you would like to use, write down a description of the characteristics of the ideal facility.

What you need from others

Describe steps your supporters can take that will help you feel better.These might include listening to you without judgment; making sure you take your vitamins and medications; playing soothing music; or providing you with drawing or writing materials. List specific day-to-day tasks you would like others to do for you, who should perform which task, and specific instructions they might need.These tasks might include buying groceries, paying bills, feeding pets or taking care of children.

Update your schizophrenia crisis plan as often as you need to as based on new treatments, living situations, new caregivers, and other changes. Date your crisis plan each time you change it and give revised copies to your supporters. (Adapted from “EverydayHealth.”)

Grateful acknowledgement for this material goes to:

Manitoba Schizophrenia Society 100 - 4 Fort Street Winnipeg, MB R3C 1C4 Phone: 1 (204) 786-1616 Fax: 1 (204) 783-4898