Patient Caregiver Program Schizophrenia

FOR INTERNAL USE ONLY

Agenda
What is Schizophrenia? Goals in Management Psychotherapy Dos and Don'ts

Questions

What is Schizophrenia?

FOR INTERNAL USE ONLY

For Internal Use Only

For Internal Use Only

For Internal Use Only

Schizophrenia
Schizo split Phrenia brain Mostly characterised by Delusions Hallucinations Bizarre behaviour

Schizophrenia
Positive Symptoms Delusions Hallucinations Bizarre behaviour Positive formal thought disorder Negative Symptoms
Psychomotor slowing Affective blunting (lack of emotional reactivity to situations) Passivity and lack of initiative Poverty of speech Poor non-verbal communication as shown by lack of facial expression, abnormal eye contact and lack of voice modulation.

Management Goals
Pharmacotherapy,
Psychotherapy, Rehabilitation and Electroconvulsive therapy

For Internal Use Only

Treatment Goals:
Reduction and elimination of symptoms
Maximization of quality of life and adaptive functioning Reintegration into social life Maintenance of recovery from the debilitating effects of illness

For Internal Use Only

Duration of Treatment
Indefinite maintenance treatment is advised for patients with multiple previous episodes or at least two relapses in the past 5 years. In the absence of maintenance treatment, 6070% of patients relapse within 1 year and 90% of patients relapse within 2 years Discontinuation of treatment can be considered after one year of continuous remission or optimal response has been achieved.

For Internal Use Only

Psychotherapy

FOR INTERNAL USE ONLY

How to Handle?
Psychosis or psychotic episodes can be very difficult for caregivers to know how to handle in just the right way.

Its important for caregivers to know how to recognize the early-warning signs indicating that a psychosis is developing, and to know where or from whom to seek assistance.

Early Warning Signs

anxiety, depression or irritability; suspicion, hostility or fearfulness; difficulty sleeping, or unusual waking hours; appetite changes; concentration or memory problems; preoccupation with certain ideas (such as religion); social withdrawal - not wanting to spend time with friends and family members;

Early Warning Signs

difficulty meeting responsibilities such as work or study; deterioration in self-care and personal hygiene; appearing perplexed; personality becoming different in some way. thinking problems such as racing thoughts or slowed down thoughts; loss of energy, motivation and interest, or hyperactivity, or alternating between the two;

Dos and Don'ts

Knowing what to do for the symptoms of psychosis can be very difficult because you may not know what to say or do. There isnt really a right thing to say or a correct way to behave or react. There are some things that you can keep in mind that may be helpful.

Dos and Don'ts

Try and understand what the person may be experiencing, like hallucinations or delusions, which will seem very real to them. Try not to take anything that they may say personally, keeping in mind that they arent behaving and talking as they normally would.

Dos and Don'ts

Avoid long debates in which you try to convince them that their delusions or hallucinations aren't real, because this will make them feel like they can't talk to you about what theyre going through. Try to find things to talk about that are neutral, instead of concentrating on their mistaken beliefs; this will most likely not upset them or get you frustrated.

Dos and Don'ts

As tempting as it may be, dont go along with their delusions or hallucinations, just listen and sympathize with what the person is experiencing. Although youre finding it difficult to understand what they are going through, you do realize that they must be very scared, frustrated, or angry.

Dos and Don'ts

If its at all possible, try and minimize the stress and stimulation around the home during these times. Also, when someone is experiencing or recovering from a psychosis, they can almost seem child-like, and may need your help in making decisions. Show your concern and care for the person by avoiding confrontations, and not criticizing or blaming them.

Dos and Don'ts

Another very important risk-factor to be aware of is that a person who is experiencing, or who has experienced, a psychotic episode has an increased potential for depression and suicidal thoughts.

Any threats or gestures of self-harm must be taken very seriously. Seek medical and/or mental healthcare assistance immediately if you think that your loved one might harm themselves.

Dos and Don'ts

Don't be afraid to talk to them about how theyre feeling, asking them if they feel safe, or if theyve been thinking about hurting themselves. To talk about suicide does not make it happen, but can, in fact, make it possible to take action in preventing it from happening.

Dos and Don'ts

Another issue to this risk-factor is that of confidentiality. Often when dealing with someone who is mentally ill, you be placed in an ethical quandary on what to do when the person shares secret thoughts or information with you, especially regarding suicide or possible harm towards others.

Dos and Don'ts

Although everyones experience is different, one thing that every caregiver must do is to make sure and pass along any information received suggesting that a person is at risk of harming themselves or somebody else, to a doctor or other healthcare professional, and get that person to a health professional as soon as possible. Even if a loved one seems to be angry or feels betrayed, you have a clear duty of care that overrides any suicidal or homicidal pacts or plans.

Dos and Don'ts

Just make sure that you dont make them any promises that cant be kept, but remain supportive, compassionate, and firm as to where actual confidentiality must end.

Dos and Don'ts

Things that you might want to say when finding out about such plans include: "I would like to help you "I cant imagine what youre going through, but I am ready to listen "I care about you and I think it might be a good idea to talk things over with your doctor "I would like to help you,

Dos and Don'ts

However, you need to tell me how I can best go about this

"I cant keep your suicide plan to myself. I would like to arrange for us to go and see a doctor together".

Dos and Don'ts

Be sure to not say things like: "You need to pull your self together and snap out of it

"Let me tell you about my problems, which Im sure will help you to forget about yours".

These remarks arent supportive, helpful,or compassionate, and may be dangerous.

Remember
With medication, therapy and time, your loved one may show signs of being able to handle more responsibility, once the psychotic episodes subside and no longer pose a constant threat.

Dos and Don'ts

Talk to them about how they feel when it comes to doing more things, and a good place to begin is with self-care tasks like personal hygiene, getting dressed, and eating scheduled meals.

Start assigning simple household chores, and observe whether they want to work alone or with others. For example, they may like to clean the living room, but they may not like someone else dusting in there at the same time.

Dos and Don'ts

Try to encourage them gently, never forcefully, to be a part of social gatherings when appropriate. Keep gatherings small and intimate, with one or two relatives or friends over for dinner instead of an all-day affair with the entire clan, like a wedding or family picnic; this may cause frustration and stress, helping to set the stage for another episode.

Dos and Don'ts

Always discuss your plans with them, and suggest going on an outing once a week, like a drive or a walk in the country; go somewhere peaceful and quite, not hectic and noisy like a city.

If you want to take them out to eat, find a nice, small restaurant and go during the least busy part of the day.

Dos and Don'ts

Dont ask too many questions, like, "What are you thinking about? or

Why are you doing that?"

Talk about outside events that arent too emotional, perhaps discussing a movie or Television program, instead of world affairs and politics.

Dos and Don'ts

Know too, that it may be difficult for them to talk about anything, but that they still enjoy your company. In this case, consider watching television, listening to music, playing cards, or even reading to them.

Dos and Don'ts

Begin to encourage them to take some responsibility, such as leaving them instructions about starting dinner in case youre going to be late getting home that night. Help them learn how to deal with the stress of being out among society by suggesting that they accompany you to a washroom if they begin to feel panicky in a public place, until the feeling passes.

Remember
Remember that family caregivers are often times the only friends a loved one has, so try to be a friend as well, by inviting them to come with you when you do different things, but never force them to have to go.

Dos and Don'ts

Last, but not least, always respect your loved ones concerns about their illness. If they ask you not to share the nature of their disease with other family members or friends, then dont, even if you feel you have a lot of experience that may help other caregivers going through the same thing.

Respect, patience, compassion and gentleness will go a long way to help you both take control of the disease, and begin living life to its fullest again.

A Caregivers Dilemma: Staying on the Meds

FOR INTERNAL USE ONLY

Dilemma
One of the most frustrating and difficult tasks for a caregiver of someone with schizophrenia is to help make sure that the medications prescribed by the physician are taken according to directions or sometimes even taken at all.

Dilemma
Dont be surprised if they completely refuse to do so, and there are, according to experienced family caregivers, several reasons why a loved one would be so resistant:

Reasons
a) they may lack the needed understanding and insight into their illness; b) they may not believe that they are ill, so medication is unnecessary; c) some may believe that the medication is whats causing their illness; d) if your loved one is experiencing paranoia, they may think the medication is part of a plot to keep them from functioning;

Reasons
e) they may be having unpleasant side effects as a result of the medication, and think that they feel better when they arent taking anything; f) they may have to follow a very complicated medication regimen that involves taking several pills a day, and it may be too confusing to stick with it; g) your loved one may begin to feel so good that they begin to forget to take their medication, or think that its not necessary any more;

Reasons
h) a loved one may even welcome the return of certain symptoms, like voices that say nice things, making them feel comforted and special, giving them incentive not to take their medication.

Dos and Don'ts

For obvious reasons, your loved one needs to take their medication as prescribed. When dealing with the initial dose of medication, it must be continuously monitored, so listen closely to your loved ones complaints about any possible side effects. Do your best to empathize with any problems they may be experiencing from the medications.

Dos and Don'ts

Keep-in-mind that "bad" symptoms (hallucinations, voices, delusions) will not reappear immediately if a loved one should go off of their medication. Anti-psychotic drugs stay in the system between six weeks to three months. You do have some time to deal with the problem before their extreme symptoms return, however, after the three month mark, getting them back on a maintenance dosage may mean "starting over" at a higher maintenance level than before.

Dos and Don'ts

When a loved one balks at taking their medicine, explain to them that they may end up back in the hospital if the medication is not taken (this should not be a threat). Dont be surprised if they dont accept this warning, or if they actually want to return to the hospital.

Dos and Don'ts

One thing that might help is if other people in your family are on medication, you can make taking pills a positive, group event. Everyone takes their medication at the same time (even if its a vitamin pill).

This will encourage your loved one to take their medicine regularly, and they wont necessarily assume that they are being monitored if everyone else has to take their medication as well.

Dos and Don'ts

If your loved one must take several pills, it can make the process much more difficult. Find out from their doctor if there is a simpler form in which your loved one can receive all their medications.

Dos and Don'ts

For those who keep forgetting to take oral medications, you can get them an attractive and easy-to-work weekly pill box. Be sure to never sneak pills into their food, even if paranoia doesnt exist. If they are already experiencing paranoia, you will never be able to regain their trust again if you do this with their medication.

Dos and Don'ts

More people go off oral medication than injectable medication. With an injectable, you know the person is receiving it, and that they can't spit it out or hide it under the tongue. Discuss the pros and cons of switching from an oral to an injectable form with their doctor.

Dos and Don'ts

Be advised that some medical professionals believe there is a "down" side to injections, because a loved one may experience possible feelings of humiliation, or a loss of control on their part.
Injectable medication may have a different dosage schedule than an oral medication and may be given once a week or once every few weeks, depending upon the type of medication.

Dos and Don'ts

Let your loved one know that youre proud of the way they are handling the need for medication. Also, do your best to be calm and reasonable when getting them to take medication. If you push them too hard, you may make it more difficult for them to move toward greater independence. Realize that a period of learning through experience and adjustment is needed for both of you in order to get into some sort of regular routine.

Remember
Through it all, your most important role is to encourage your loved one to stick with their treatment program. Treatment of this disease isnt just through medication alone, but will involve attending daily or regularlyscheduled medical appointments, and attending therapy or day programs as well.

Remember
Remember that the time spent with mental health professionals on a week-to-week basis will be quite minimal when compared to the amount of time that your loved one will spend with you.

This is why caregivers are usually in the best position to provide the everyday encouragement and support needed to help them stick with their treatment and help them on a successful road to rehabilitation.

Any Questions???

THANK YOU & ALL THE BEST

FOR INTERNAL USE ONLY