“Schizophrenia is not the dreaded disease it was about 30 years ago. Now, with early diagnosis, speedy initiation of treatment, careful monitoring of medication, regular follow-up, proper residential, vocational and rehabilitative support systems in place, the long-term outcome is quite favourable.” -- Psychiatric professional
"HOW CAN WE FIND APPROPRIATE MEDICAL HELP?"
Many families are shocked when they try to find a doctor for a relative with schizophrenia. It seems that very few doctors either know about, or have any interest in, schizophrenia. There is no easy solution to this problem.
First of all -- schizophrenia can resemble other diseases, so assessment and treatment must involve well-qualified people. Furthermore, since schizophrenia is a chronic illness, continuing medical care and prescription medications are needed. As prominent psychiatrist Fuller Torrey says, "There is no avoiding the doctor-finding issue."
One way to start is to ask someone in the medical profession who they would go to if someone in their family had schizophrenia. Another way is by talking with other families who have an ill relative. They will often be able to put you in touch with the best resources in your community, and save you a lot of time and frustration. Sharing this type of information is one of the most valuable assets of your local B.C. Schizophrenia Society branch, and is an important reason to join the organization.
Besides finding someone who is medically competent, you need to find someone who is interested in the disease, has empathy with its sufferers, and is good at working with other members of the treatment team.
As Dr. Torrey points out:
“Psychologists, psychiatric nurses, social workers, case managers, rehab specialists and others are all part of the therapeutic process. Doctors who are reluctant to work as team members are not good doctors for treating schizophrenia, no matter how skilled they may be in psychopharmacology.”
Specifically, you need to find a doctor who:
- Believes schizophrenia is a brain disease
- Takes a detailed history
- Screens for problems that may be related to other possible illnesses
- Is knowledgeable about antipsychotic medications
- Follows up thoroughly
- Adjusts the course of treatment when necessary
- Reviews medications regularly
- Is interested in the patient's entire welfare, and makes appropriate referrals for aftercare, housing, social support, and financial aid
- Explains clearly what is going on
- Involves the family in the treatment process
In order to get enough information to make informed decisions, you will have to ask the doctor some direct questions: What do you think causes schizophrenia? What has been your experience with the newer medications like risperidone, clozapine or olanzapine? How important is psychotherapy in treating schizophrenia? What about rehabilitation?
If you are uneasy or lack confidence in the medical advice you receive, remember -- you do have the right to another opinion from other doctors, even if from another city.
"HOW IS SCHIZOPHRENIA TREATED?"
Although schizophrenia is not yet a "curable" disease, it is treatable. The proper treatment of schizophrenia includes the following:
Medication -- Most patients with schizophrenia have to take medication regularly to keep their illness under control. It is not possible to know in advance which medication will work best for an individual. Many medication adjustments may be required. This period of trial and error can be very difficult for everyone involved. Some medications have unpleasant side effects -- dry mouth, drowsiness, stiffness, restlessness, etc.
Education -- Patients and their families must learn all they can about schizophrenia. They should also be directly included in planning the treatment program. Families should find out what assistance is available in their community -- including day programs, self-help groups, and work and recreation programs. It is most important for the patient and the family to accept the fact of the illness, and begin to learn how best to manage it.
Family Counselling -- Since the patient and the family are often under enormous emotional strain, it may be advantageous to obtain counselling from professionals who understand the illness.
Hospitalization and Regular Follow-up -- If someone becomes acutely ill with schizophrenia, they will probably require hospitalization. This allows the patient to be observed, assessed, diagnosed, and started on medication under the supervision of trained staff. The purpose of hospitalization is proper medical care and protection. Once the illness is stabilized and the patient is discharged from hospital, regular follow-up care will reduce the chances of relapse.
Residential and Rehabilitation Programs -- Social skills training, along with residential, recreational, and vocational opportunities tailored to people with mental illness are very important. Used as part of the treatment plan, they can result in improved outcomes for even the most severely disabled people.
Self-Help Groups -- Families can be very effective in supporting each other and in advocating for much-needed research, public education, and community and hospital-based programs. People with mental illness can also provide consultation and advocacy in these areas, as well as offering peer support to other individuals with schizophrenia.
Nutrition, Rest and Exercise -- Recovery from schizophrenia, as with any illness, requires patience. It is aided by a well-balanced diet, adequate sleep, and regular exercise. However, the illness and the side effects of medication can interfere with proper eating, sleeping, and exercise habits. There may be appetite loss, lack of motivation, and withdrawal from normal daily activity. Someone who is ill may simply forget to eat, or become very suspicious about food, so supervision of daily routines may be required. If you are a family member or friend who is trying to help -- be patient. Above all, don't take seeming carelessness or disinterest personally.
Electroconvulsive Therapy (ECT) -- ECT is not normally used for patients with schizophrenia unless they are also suffering from extreme depression, are suicidal for long periods, and do not respond to medication or other treatments.