Prof. Dr. Kemal Arıkan
Psikiyatrist

Schizophrenic Patients and Family Support

Having a lexical meaning of “division of the mind”, schizophrenia appears between the ages of 15-35 and causes changes in the appearance, emotions, thoughts and behaviors of the person.

A colorless expression, slowdown in movements, decreasing self-care, disinterest towards what’s going on, becoming introvert by abstaining from expressiveness, obscurity in the speech and in the choice of words are some of the changes observed. Not all of these symptoms may be simultaneously apparent. During the acute exacerbation period, the idea of the head being managed by the voice inside it, talking to the voice inside the head, apprehension of being harmed/harming others, the thought of being followed/harassed, the claim that the person’s ideas are stolen or that she/he as extraordinary talents may emerge. Nonetheless, seeing some of the symptoms is not enough for a diagnosis.

Medication is obligatory in the treatment. The desired recovery starts to occur two-three weeks following the start of the treatment. The symptoms settle down, their occurrences is brought under control, the patient’s social relationships start to recover, while recurrences become less frequent. On the other hand, the side effects of the drugs also become apparent. İncrease of movements in uneasiness, restlessness or the exact opposite with the slowdown of the movements, hypersensitivity to sunshine, blurred vision, increased salivation, and contraction in some parts of the body, etc. Additional drugs are administered to prevent the side effects. The drugs used in the treatment of schizophrenia are not addictive.

Schizophrenia is a disease having predominantly biological reasons. Hereditary and stress factors are also effective. While its biological aspects are brought under control with drugs, decent human relations and functionality are other issues needed to be included in the treatment process.

Families of the schizophrenic patients feel surprised, worried and disappointed in the initial phases of diagnosis of the disorder. In the upcoming years, however, they feel disgust, guilt and disappointment. These feelings of shame and guilt are consolidated by the fact that genetic transition and familial relations are given as the reason (Şizofreni Dostları Derneği, 2006). Nevertheless, it must be repeated once again that schizophrenia is now solely explained through the use of a tendency-stress model, not by the genetic transition and familial relations. Knowing that the biological reasons are the prominent ones decreases the feelings of guilt and shame suffered by the families, while making their expectations on the process of the disease realistic (Şizofreni Dostları Derneği, 2006).

Upon the understanding of the significance of the families during the process of treatment, supporting them also has become a part of this process. Particularly the admission and post-discharge period are the most suitable periods in order for the families to receive a specialist support (Gülseren, 2002).

Some families may act restrictively in order to control the patient. A repressive and controlling attitude causes stress in the patient, while increasing his/her dysfunction as his/her responsibilities are taken away. As the patient’s functionality decreases in social and occupational aspects, it becomes a material and moral burden for the family. An association was found to be present between the magnitude of this burden and the challenges faced by the relatives of the patient in coping with this situation. Although some sources claim that low socio-economic level is one of the causes of schizophrenia, it is considered to be a result, not a cause. Schizophrenic patients are provided with specific pecuniary facilities on receiving health services and drug use at hospitals. Information on this issue can be received from the related doctors or institutions (Şizofreni Dostları Derneği, 2006).

Each family has its own unique structure of relationship. Therefore, offering a standard method of behavior for the families may not be useful. After all, schizophrenic patients state that they get along best with those who treat them in a natural manner (Şizofreni Dostları Derneği, 2006). Then again, there might be some issues to be corrected regarding domestic communication. For instance, concise and true remarks and objective behaviors are recommended. Getting into arguments on the beliefs they stand for, or telling them to stop talking nonsense, or doing the exact opposite by agreeing with them, giving them hope, or supporting them despite knowing what they believe is wrong would not be useful. Instead, saying “you may believe it, but I don’t think so.” is a short and respectful expression that reminds them of being an individual. In terms of a domestic order, fixed meal and sleep hours may comfort the patient; however, the family must accept that the patient might violate this order. These violations generally occur during introversion periods. During the introversion periods, it is recommended to respect this condition of the patient and not to attempt to bring it under control (Şizofreni Dostları Derneği, 2006). On the other hand, if the introversion periods tend to be long and intense, it may be a sign of a period of exacerbation.

A decrease in the self-care and activity of the patient is one of the issues the families complain about the most. Aggressive, shameful and unpredictable behaviors have the second place as they are observed less; nevertheless, when they appear, it may be devastating for the patient’s relatives (Gülseren, 2002). Stopping the use of drugs without doctor’s approval may lead to a period of exacerbation. While decreasing the symptoms, the drugs also decrease the frequency of the exacerbation period; that’s why it is more advantageous to continue to use the drugs in terms of benefits-damages despite their side effects. It is possible to find a solution for unwanted side effects by consulting with the doctor. If the patients refuse to use drugs, it is required to refer the patient to an inpatient institution; the family’s approval is enough for this. The purpose is to prevent the patient from hurting himself/herself.

Schizophrenia associations and support groups play a significant role in enabling the patients to regain their functions, to look for social support and to express their feelings. The patient and his/her relatives may receive supportive information and recommendations from those who already experienced the processes they are facing now. In the studies carried out, it is reported that briefing the patient and the family make quite a positive impact on the treatment process.

In brief, schizophrenia, a challenging disease, affects not only the patients’ lives but also the lives of their families. The family receiving education and social support, along with the changing of the attitudes and the method of communication, will provide a bilateral benefit.

References:

Gülseren, L. (2002). Şizofreni ve aile: Güçlükler, yükler, duygular, gereksinimler. Türk Psikiyatri Dergisi, 13(2):143-151.

Şizofreni Dostları Derneği (2006) Şizofreni sorular ve yanıtlar (3rd edition). İstanbul: Şizofreni Dostları Derneği.

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