When faced with the possible diagnosis of schizophrenia in our daughter a few years ago, the thought was overwhelming at first. We found ourselves asking, "How is this treated, and how do we handle this?" Due to the stigma associated with mental illness in the past, this can be a very difficult diagnosis to deal with, especially for the person with the diagnosis.
However, with the knowledge we have now, people are becoming more understanding that this is a physical disorder and is much more common than once thought. It's no different than illnesses that affect other organs of the body. This one just happens to affect the brain. The more we understand and are educated about this disorder and how to treat it, the fewer stigmas there will be associated with it, and that is very important in regard to treatment and recovery.
One of the first things that the family is faced with is what to do should the person become a danger to himself or herself or others. When the person is first recognized as having a brain disorder that is not yet being treated and is in crisis, he or she may already be a danger. According to the law in many places, the family cannot get the person treatment unless the person agrees to it, or he or she becomes a "danger" and acts on it. It's a very fine line. Many people with schizophrenia symptoms don't agree to treatment because they don't think anything is wrong with them, and they are usually understandably afraid or depressed, which can lead to serious situations.
As family members, we find ourselves not only dealing with how to care for this loved one who is not able to reason, but we also must deal with our own fears and emotions. Especially in the beginning, family members usually don't have the knowledge they need to cope with these things. Our family has learned over the past few years that current treatments are nothing like the horror stories we've heard about in the past, and hospitalization in a safe environment is exactly what is sometimes needed to get the illness under control.
Our first step in treating this illness was with God! Prayer and asking God for divine healing in the manner of James 5:14 make a real difference as God is a loving and caring Father. Even though we find ourselves in trials such as this, there is much for us to learn along the way. Good can be found in every trial if we look for it, and these kinds of things do strengthen us in many ways, and they give us the ability to help others in similar situations.
The next very important step we discovered is to find a good and affordable outpatient program to determine the exact diagnosis, and to receive the crucial counseling and psychiatric services available for both the person and the family. Early recognition and intervention are very important. Some programs are quite costly, and a good mental health insurance plan is needed, although there are also excellent government-associated programs that are free of charge. At the recommendation of our local pastor, we contacted our county's adult mental health program. That turned out to be excellent advice!
In contacting your county, you will probably first be directed to the crisis counselor, or you can most likely find one in your local phone book. Part of his or her job is to weed out the behavior issues from the psychotic issues, and that is not always so easy to determine. Once you are able to convince your family member to talk to this counselor, and the determination is made, you can be set up with the mental health program in your county.
In our case, we were referred to the EAST program director. This director turned out to be an excellent psychologist. EAST stands for Early Assessment and Support Team. Not all counties will have this particular program, but many should have something similar. It is designed for people between the ages of 15 to 30 who have had their first episode of psychosis within the past year. If there is not a program like this available in your area, there should still be a free or low-cost, adult or youth mental health program within your county, and I suggest you start there. They should have access to the resources you will need.
There are several things that can cause psychotic symptoms, so it's very important to receive a solid diagnosis from a good professional, which can take six months or more to determine. Many of these illnesses or disorders share symptoms, but there are also differences, so knowing which one is the cause will help in determining the right treatment. Other than schizophrenia, schizophreniform or schizoaffective disorder, there are also cognitive disorders, personality disorders, depression, bipolar disorder, as well as severe stress, sleep deprivation, seizures, trauma, acute medical illnesses, medications and drug intoxication that can cause psychosis.
Good treatment plans will include antipsychotic medication, which will help alleviate the positive symptoms. Also mood stabilizers, antidepressants, and antianxiety medications may also be prescribed, depending on the symptoms presented. It's very important to treat these symptoms as early as possible, and somewhat aggressively to gain control of the illness. The newer medications available now are much better, with less difficult side effects, than the ones used in the past. Symptom response to medications and dosages can vary widely in different people, so if a particular medication doesn't work well or produces too many unwanted side effects, the doctor will probably want to try another type until the desired result is found. A medication should be found that works with few side effects so the patient will continue to take it. In some cases it may take a long time to sort this out.
Medicine is only part of the treatment plan because it alone may not completely control the symptoms of the illness. Therefore controlling environmental factors is also important in reducing the stress that makes the symptoms worse. A good program will provide intensive case management with help and support in regard to rehabilitation, which involves education and training, and help in finding needed services. It will provide ongoing assessments by a qualified psychiatrist and a mental health counselor (possibly a psychologist). It will provide cognitive behavioral therapy, mentoring individually and in groups, occupational therapy and support, and environmental management skills, which include health, diet and stress management.
The good program will also provide help with managing finances and other practical living logistics, as well as social and illness management skill training. If the person with schizophrenia is not able to work, he or she can also receive help in applying for Social Security Disability, Medicare and Medicaid to help with expenses.
A good treatment plan will involve the family. Members of the treatment team will not only educate and provide support for the family, but they will also help the family to become a support, an instiller of hope and an advocate for the person with the disorder. The family can do much to help the person with schizophrenia follow his or her treatment plan, and to stay on the medication. Having a case manager and regular appointments with a counselor will give stability to all involved. It will provide a reliable source of information, support, positive understanding and a hopeful environment to the person and the family, which is essential in living with and managing this illness. It's very important for the person and the family to be taught how to recognize warning signs, and how to use more effective coping skills to manage the symptoms from day to day.
It is also important for the person who is taking an antipsychotic medication to be monitored by a psychiatrist. A psychiatrist is a medical doctor with psychiatric specialty training. It's very common for a person with schizophrenia to stop taking the medication for a variety of reasons, and this often leads to a relapse, and quite possibly hospitalization. No antipsychotic medication should ever be stopped without consulting the doctor who prescribed it, and, if necessary, it should always be tapered off very slowly under the doctor's supervision.
Our daughter was hospitalized twice over the past few years due to this illness, and as a result she has a better awareness and is continuing to learn how to manage the symptoms. The hospital is not as scary a place as we once thought. Both times she was kept safe, and did get better and came home. She lives with us, and we are very thankful for the help that is out there. Throughout this entire experience we have seen God's hand right there taking care of her and us! He will be there for you too! All you have to do is ask. God will see us all through, and it will be okay. There is help, there is hope, and while very difficult, we can survive schizophrenia.
Yamhill County Adult Mental Health Schizophrenia Workshop presented by Sally Godard, MD; Bruce Neben, LPC, PsyD; and Betty Foufos, MA.
National Institute of Mental Health http://www.nimh.nih.gov/