Building Bridges to a Different Reality: Caring for Adults with Schizophrenia

While hearing the news that doctors have diagnosed a loved one with schizophrenia is anxiety provoking, new medications and treatment have made it possible for adults with this disorder to live in the community.

As with all mentally illnesses, the diagnosis of schizophrenia carries a fair amount of stigma because of the way the media portrays people diagnosed with this psychiatric illness. Since people with this disorder often perceive the world in a manner that differs from what the majority of other people experience as reality, it can be difficult to communicate and related to a schizophrenic. At one time, a diagnosis of schizophrenia was synonymous with spending one’s life in an institution. Today, thanks to advances in neuroscience, psychopharmacology, and psychosocial therapy, the majority of people with schizophrenia can live in the community, either independently or with the support of family members.

Acting as a support for a person with schizophrenia is rewarding, but like caring for anyone else with a chronic condition, it is physically and emotionally draining at times. Many families arrange to have a home health personal care assistant (PCA) help them care for their loved one in their home, while others have the PCA acts as a support for the schizophrenic to live independently in their own home. In order to decide what is best for your family, it helps to understanding the disease and the treatment options available.

The Reality of Schizophrenia

Much of the reason for the stigma associated with schizophrenia relates to the fact that people do not understand the disease. Schizophrenia is a disorder characterized by changes in the structure and chemistry in the brain causes by either genetic or environmental influences. The abnormalities in brain function and structure result in a variety of symptoms that vary in intensity and severity in the individuals affected by the disease.

The categories of symptoms associated with schizophrenia are as follows:

Positive Symptoms of Schizophrenia

• Hallucinations: The person see, hears, feels, smells, or tastes things that others people do not perceive. When a voice tells a person to do something, this is referred to as a command hallucination. If you loved one is experiencing command hallucinations, you need to inform his or her treatment provider as soon as possible because it is a sign that the person’s condition is possibly worsening.
• Delusions: A person will often perceive the world that is consistent with reality. For example, an individual with paranoid schizophrenia might believe that a government agency is tracking his movements through radio or television waves. Others might think that they are a historic figure or a celebrity.
• Disorganized Speech: People with schizophrenia will talk in ways that do not make sense because they connect unrelated concepts and thoughts. Other times they invent words that only have meaning to them.   

Negative Symptoms of Schizophrenia

•  Absence of Emotional Expression: Often referred to as “emotional blunting” or “flat affect,” people coping with schizophrenia tend not to smile, grimace, or show other outward expressions of emotion,.
•   Lack of Pleasure in Everyday Activities: People with schizophrenia find little joy or reward in what they do, which means they lack motivation to take care of themselves, their surroundings, or belongings.
•  Inability to Stay on Task or Finish Activities: Due to their difficulty organizing their thought or the challenge of discerning between what is real and not real, schizophrenics often have difficulty planning their day, or if they have a schedule, following through on the activities they have arranged,.
•  Challenges with Social Connections: Since a person with schizophrenia deals with an “internal reality” as well as the outside world, it is difficult for some to relate to other people. Some people with this illness do not respond when another person talks to them; others are concerned that they are going to say the wrong thing.

What to Expect When a Loved One is Diagnosed with Schizophrenia

Often the symptoms of schizophrenia develop so gradually that both the individual and his or her family and friends miss the early signs of the disorder. Since the typical age of onset of schizophrenia is late adolescence and early adulthood, which is usually a time of rapid change for most people, it is easy to dismiss the early signs of the disease as related to stress or just teenage angst. Eventually, the symptoms overwhelm the person, which leads to a crisis and hospitalization to stabilize the person and start treatment.

Prognosis and Course of Schizophrenia

With a combination of medication and psychotherapy, most people with schizophrenia can live in the community. The non-profit support and educational website Schizophrenia.com reports that 22 percent of people diagnosed with this disease only have one episode where they experience symptoms and then have no recurrence of the disease. About 35 percent of people living with schizophrenia have several episodes during their lives, with periods where they function without any impairment. Another 35 percent of patients experience recurrent episodes that increase in severity and they do not return to their pre-illness level of functioning. Only eight percent have only one episode that results in life long impairment and no return to baseline functioning.

Treatment Options for Schizophrenia

Most people diagnosed with schizophrenia respond to a combination of medication and therapeutic interventions. Usually, doctors prescribe one or more antipsychotic medications that lessen or eliminate the hallucinations and delusions associated with the disease. At one time, the only medications available to treat schizophrenia caused patients to gesture strangely, grimace and move their mouth in a bizarre chewing motion, and have limited range of movement. The latest generation of these medications does not have these side effects.

While medication take the “edge” off the symptoms of schizophrenia, people with this disorder also need psychotherapy to develop insight into their disorder and learn how to distinguish between reality and the world that their mind has created. They often attend psychosocial rehabilitation programs that teach them the skills they need to cope with their illness, work on communication and interpersonal skills, and life management training. In most case,  people diagnosed with schizophrenia who follow their treatment plans are able to live independently with periodic support from family members.

Caring for a Loved One with Schizophrenia

When a person is first diagnosed with schizophrenia, doctors recommend that their families provide supervision and care for the individual to ensure that he or she is able to manage their disease independently. Often the greatest challenge for caregivers is making sure the person takes their medication since many times the schizophrenic does not think it is necessary. Other challenges include dealing with the communication difficulties, prompting the person to attend to hygiene and self-care, and transporting the person to and from various appointments.

A PCA can help adults diagnosed with schizophrenia, and their family members, immensely by assisting the individual with daily living skills, homemaking, transportation to appointments, and prompts to take medication. Personal care assistants have specialized training so they know how to communicate effectively with schizophrenia and they are able to assist the person manage their behavior. To learn more about how PCA services can help, contact a Minnesota home health care agency.