Mental Health Care

Even though there is no definite cure for schizophrenia, the use of antipsychotic medicines can dramatically improve the quality of life. They can check or eliminate the disturbing symptoms, and allow the person to lead a relatively trouble-free life. With their help, a large majority of people with schizophrenia can return to active social life. They usually, however, need to take medicine for a long time if not for the rest of their lives. This is necessary to prevent a relapse.

There are many antipsychotic medicines which are effective. These include clozapine, risperidone, olanzapine, haloperidol, thioridazine, chlorpromazine, fluphenazine, and trifluoperazine.

Many people with schizophrenia stop taking medicines because they do not understand that they are ill. Some may also have a delusion that the family and the physician are conspiring against them. In that circumstance, the family has to take some difficult decisions. Either the person has to be placed in institutional care, or the family has to take the responsibility of administering the medication. Some antipsychotic medicines are also packaged in liquid form. After due consultation with the physician, they may be given mixed with foods and beverages. This is a difficult ethical issue, although the benefit it holds out for a loved one should make the decision easier.

Some families become careless about the treatment as soon as the person shows improvement. This can undo the good effect of medication and the symptoms can worsen.

However, medication can sometimes lead to unpleasant side effects. Minor side effects include dry mouth, constipation, dizziness, blurred vision and drowsiness. These can often be overcome with some little changes in lifestyle, or by substituting one medicine for another. Difficulty arises when the side effects are more serious and debilitating. These may include muscle spasms or cramps, tremors, and tardive dyskinesia, a condition marked by uncontrollable movements of the lips, mouth and tongue. Newer medications, such as risperidone, clozapine and olanzapine, produce fewer of these side effects, but the search for a better trouble-free medication is still not over.

Some people continue to experience difficulties despite taking medication and may suffer from overriding suicidal thoughts. These people require other types of treatments, including electro-convulsive therapy, to get better. They may have to be committed to institutional care, so that the risk of suicide can be nullified.

Suitable attention should be paid to individual and group psychotherapy, family counseling and vocational rehabilitation in order to maximize the benefits of the treatment and to restore the person to useful public life. Training in social and behavioural skills can help them conduct and manage themselves better.

The Role of the Family

The family of the patient has a major role in the management and the eventual outcome of the illness. Each family member must take part in active counselling. This enables them to develop a proper understanding of the illness and treatment, and they can learn to monitor the progress and create a low-stress environment for the patient.

The family must realize that it is pointless to discuss and debate the logicality of thoughts and actions with the patient. Any attempt at this is likely to complicate matters, simply because the patient lacks insight and cannot be expected to be logical. The situation may become further complicated because of the delusions and hallucinations that occupy the mind of the patient.

The first and foremost duty of the family is to ensure that the patient gets the best possible treatment. If the situation carries risk of self-harm, suitable preventive measures must be initiated. Those people with schizophrenia who express suicidal thoughts require immediate medical attention.

Many families may fail in their duty if they blame themselves and feel guilty for the illness, or simply put the blame on others for it. For this kind of illness, nobody really is at fault. The family should therefore never waste time, effort and resources discussing such trivialities. Rather, they should work cohesively and ensure that the treatment of the patient is not hampered.

The effort must also be geared towards maintaining the patient’s passion for life. The patient must be encouraged to take up the chores of daily living, and when appropriate, suitable responsibilities may be given such that he may find confidence and faith in self and feel that he still has a useful role to play. A home filled with hostility, criticisms, and emotional over-involvement can result in a relapse and affect the outcome adversely.

The family must never disparage the benefits of medication. Many people think that it can be substituted by yoga, meditation, diet, and (or) naturopathy. This belief is misguided. The long-term prospects for people with schizophrenia depend on a family that understands the illness and takes cogent decisions about its management. The illness can be conquered provided the family acts rationally and offers love and care and trust and encouragement to the patient and is ready to raise its own threshold of tolerance.

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