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Caring for a Loved One With Schizophrenia
Eric Sabo

Discovering that someone you care about has schizophrenia can be traumatic. Making things worse is the need for long-term treatment to calm symptoms. A person with schizophrenia often becomes confused and agitated, which some may mistake as behavior directed towards them.
All told, schizophrenia places a difficult burden on families. Fortunately, there are steps families can take to make the situation easier, says Noreen Brady, PhD, RN, a professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University. The key, she explains, is for families to understand what they face when a loved one has schizophrenia.

Is it easy to tell if a family member has schizophrenia?
Part of the problem is that schizophrenia often becomes evident in the person either in their late teen years or early 20s. And the normal curve for adolescence is so broad. You can be really unusual and eccentric and still not be ill and not have schizophrenia.

When you have someone with schizophrenia, however, you perceive symptoms through behavior, and most adolescents aren't terribly verbal with their parents during this time—even if you have the best relationship in the world.

Are there any obvious signs that a parent should pay attention to?

Even the best parents would be hard-pressed to notice the changes immediately. It isn't like the child goes to bed one night and then wakes up the next morning changed.

Normally, parents might look back and say, "You know, the last couple months, so-and-so has been really withdrawn, staying in their room, not wanting to come and eat with us or spend time with us." But that can be normal, too, and that doesn't necessarily mean a person has schizophrenia.

Often, the symptoms that will be very evident would be what we call the positive symptoms. These include hallucinations, hearing things that aren't there, seeing things, feeling, smelling, tasting, something that's perceived through the senses that isn't there.Big clues include if the person just stops eating from things that they don't open themselves (such as milk containers), or if they talk about somebody trying to poison them. Schizophrenia is easier to discover when the clues are obvious.

Has the treatment of schizophrenia improved?
In the past, you couldn't get a psychiatrist to give a diagnosis of schizophrenia for a teenager, because it had such a negative connotation. Now, the paradigm has shifted and the emphasis is on early diagnosis and treatment. This can make a world of difference.

What we know now that we didn't know ten or fifteen years ago is that each time there is a psychotic episode, there's damage done to a very sensitive part of the brain. As a result of many psychotic episodes, there are cognitive dysfunctions, poor decision-making, poor memory and poor concentration. I'm not saying there may not have been a little bit there to begin with, but you have to avoid the repeated psychotic episodes for the person to have the optimum outcome. We know this now; we didn't know it then. So early treatment really makes a difference.

The old medicines tended to be really toxic stuff. The term you'll hear for the old drugs are the "typicals" and the new ones are the "atypical" ones. And the atypical ones, they're a hundred times better. But even they are not perfect, so it's not like we have something that can take away the symptoms. We have drugs now that help the person manage the remaining symptoms.

What are the concerns with the newer drugs?
They do have side effects and you need to be careful. Olanzapine, for example, can cause some people to gain weight and increase their glucose.

For parents and families, the immediate thing is to get the psychosis under control. And that's what I explain to people, "Maybe we'll just take this medicine for two months and then we'll switch to something else, but you have to get those symptoms under control quickly. You don't have the luxury of time and you do need medicine." There's no longer any thought of letting the person just get through it and hope for the best.

How hard is it for families to make sure that a loved one stays on medications?
This is the main problem. It's an issue of power and control. Some family members think that, "Okay, you're on medicine now. This is over. We can move on with our lives, we don't want to talk about it any more." Other family members see all medications as drugs and evil, especially if there's any kind of chemical dependency history in the family.

We have to find what the best treatment is, and we have to make some adaptations in our life. And I try to get them to think of it like a vitamin. A vitamin doesn't cure you of anything, but a vitamin can help build up your stamina and it can build up your defenses against illness.

Ultimately, it's the person's decision. I just try to give them the information and I tell them, "If I were in your shoes or if this were my child, this is what I would do."

How do you handle someone who is hallucinating?
It would be the equivalent of a heart attack to me. Often, people see these behaviors as a matter of choice and really are not aware of what's going on inside the person. What they would need immediately from the parents would be the same thing as calling 9-1-1 if your kid clutched their chest and keeled over: it's a medical emergency.

Could a parent do anything to comfort the child?
You try to make the person feel safe. They may perceive their family members as the enemy and may not be clear on what the family member wants to do by taking them to a psychologist, a clinical nurse specialist or a psychiatrist for an evaluation. They may feel even more threatened.

A lot of times, the way these young people get their first treatment is they really have to be taken to a psychiatrist hospital against their will, which is horribly traumatic. It's just a devastating way to start, but that's what happens sometimes, unfortunately.

Is there any place a family can turn to for help?
I advise everyone to get in contact with the National Alliance for the Mentally Ill (NAMI). They are a wonderful resource for advocacy and education and they hold family group therapy sessions. It's helpful if they can find someone who they can trust, someone accessible that can help them through this process, because everybody needs help. The patient needs help, but the family needs help, too. And I would say, most times, people haven't a clue about schizophrenia, and they think it's like the measles; that you get over it.

We have to be positive, especially with the new medicines. But I would say, for the most part, if you can keep the psychotic exacerbations to a minimum, the odds are greatly increased for leading a more normal life.
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