ANSWER
Coping with schizophrenia is difficult. However, if you, a family member, or a friend are experiencing difficulties, there is assistance available. NAMI and NAMI Affiliates are here to offer you and your family support as well as information about community resources. If you have any questions about schizophrenia or where to find support and resources, please contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org.

Taking Care of Yourself
If you have schizophrenia, it can take control of your thoughts, interfere with your functioning, and, if left untreated, lead to a crisis. Here are some suggestions to help you manage your illness.
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Control your stress. Stress can cause psychosis and exacerbate schizophrenia symptoms, so keeping it under control is critical. Understand your boundaries, both at home and at work or school. Don’t take on more than you can handle, and if you’re feeling overwhelmed, take some time for yourself.
Make an effort to get plenty of rest. When you’re taking medication, you probably need more sleep than the standard eight hours. Sleep problems are common in people with schizophrenia, but lifestyle changes such as regular exercise and avoiding caffeine can help.
Stay away from alcohol and drugs. Substance abuse reduces the effectiveness of medication and worsens symptoms. Seek help if you have a substance abuse problem.
Maintain contact. Including friends and family in your treatment plan can help you recover faster. People living with schizophrenia often struggle in social situations, so surrounding yourself with people who understand this can help you ease back into daily social life. Consider joining a schizophrenia support group or getting involved with a local church, club, or other organization if you feel you can.
Learn more about managing your mental health and getting the help you need if you have a mental health condition.

Providing Assistance to a Family Member or Friend
Learning about psychosis and schizophrenia will help you understand what your friend or family member is going through and how they are dealing with it. Living with schizophrenia is difficult. Here are some ways to show your support:

React calmly. Because the hallucinations appear real to your loved one, telling them they are imaginary will not help. Explain calmly that you see things differently. Respecting others while not tolerating dangerous or inappropriate behavior.
Keep an eye out for triggers. You can assist your family member or friend in understanding and avoiding situations that trigger his or her symptoms, cause a relapse, or interfere with normal activities.
Assist in ensuring that medications are taken exactly as prescribed. Many people wonder if they still need the medication when they’re feeling better, or if the side effects bother them. Encourage your loved one to take his or her medication on a regular basis to prevent symptoms from returning or worsening.
Recognizing a lack of awareness (anosognosia). Your family member or friend may be oblivious to the fact that he or she suffers from schizophrenia. Rather than attempting to persuade the person that he or she has schizophrenia, you can show support by assisting him or her in remaining safe, receiving therapy, and taking the prescribed medications.
Assist in the avoidance of drugs and alcohol. These substances have been linked to the worsening of schizophrenia symptoms and the onset of psychosis. Getting help if a loved one develops a substance use disorder is critical.
ASchizophrenia is a severe mental disorder which is characterized by a wide range of unusual behaviors: hearing voices (hallucinations) and distorted or false perception, often bizarre beliefs. They are unable to distinguish between reality and imaginative events. These unusual experiences seem real to the person whereas others assume that the person is lost in their own world.
Owing to the signs of schizophrenia, a person with the illness is likely to interpret reality in a way that seems abnormal to others. They may believe that others are trying to control them or harm them, and may feel compelled to act in ways to protect themselves that appear inexplicable to others – for instance, keeping all doors and windows closed to protect the family from the neighbors’ attempts to kill or harm them.

Persons with schizophrenia are not aware of the changes in their behavior. They may not accept that they are behaving differently. This is because for them, the lines between external and internal reality are blurred and they are unable to differentiate between the two. This lack of insight makes them withdraw from family and friends, and refuse medical support.

QWhat are the misconceptions about schizophrenia?
A
For most of us, the term ‘schizophrenia’ conjures up images of a person with unkempt appearance, disheveled hair and torn clothes; a person who is unable to control his or her actions and whose behavior is unpredictable and violent; someone who communicates with UFOs, or acts as if possessed. Movies have depicted persons with schizophrenia as eccentric geniuses or deranged and aggressive people who need to be locked up in a mental asylum for the rest of their lives.
In India, the common stereotype of a person with schizophrenia is being a crazy, out-of-control psychopath who is a threat to himself and others around him. Doctors say that the media portrayals of this disorder is not correct.

QHow does schizophrenia occur?
A
The onset of schizophrenia usually occurs between puberty and early adulthood. It is a condition that develops gradually, often over a period of weeks to months. Symptoms in the early stages of schizophrenia may be similar to other mental health issues: adjustment problems, depression or anxiety.
In the initial stages of the illness, the person may show ‘negative symptoms’ such as remaining aloof and withdrawn, preferring to stay away from friends and family. They may lose interest in daily activities and hobbies they enjoyed earlier, and ignore personal grooming or hygiene, even if they were very particular about it before. Their behavior changes too – they may smile or laugh to themselves for no apparent reason.

If not detected and treated, the problem may become more severe and the person may turn aggressive verbally and physically.

Across the world, schizophrenia affects approximately one per cent of the population, and is observed in both men and women. The common age of onset is 15 to 25 years, though there are cases in which the disorder can develop in people beyond this age group as well.

QWhat are the symptoms of schizophrenia?
AA person with schizophrenia is not likely to behave strangely all the time. The symptoms can be unpredictable in when they appear and disappear, and the intensity of the unusual experience fluctuates. The most common symptoms are:
Hallucinations: Seeing or hearing people or things that do not exist. The person may also have the experience of tasting, touching or smelling something that isn’t there. Most people also report they hear voices speaking to them, commanding or abusing them.

Delusions: These are beliefs that can persist even after they have been proved to be false or unreasonable. Some people believe that someone they know is trying to control them or poison them; some may believe that someone is communicating with them through a secret code on television. The person may feel everyone is talking about him/her and may be very suspicious all the time. In rare cases, the person may believe that he or she is a celebrity or a historical figure.

Disorganized thinking: Sometimes, the person is unable to think clearly. Their talk appears illogical, irrelevant or disconnected and this makes no logical sense to people around them. The person may stop abruptly before finishing a sentence, give irrelevant answers to questions, or occasionally they make up their own nonsensical words.

The symptoms listed so far are referred to as ‘positive symptoms.’

Cognitive problems: The person’s impaired thinking makes it difficult for them to focus on simple tasks for longer durations. They have trouble paying attention to what other people are saying, and may forget even to do simple routine tasks which most people take for granted. This usually results in their poor performance at studies or at work. This problem is seen in the early stages of illness but family and friends may fail to identify the problem due to lack of awareness about the illness.

Disruption of normal behavior: The person may tend to avoid spending time with others, instead they prefer being alone. They speak in a flat monotonous tone, often in monosyllables, and their facial expressions are mask-like, displaying little or no emotion.

QWhat is psychosis and what are psychotic episodes?
A
The term psychosis is used frequently with reference to schizophrenia, and some other serious mental disorders. The word refers to a mental condition in which the person may lose touch with reality (being unable to differentiate between real and imaginative events) (being unable to differentiate between real and imaginative events). This affects their mood and behavior, causing them to be withdrawn or depressed. A person with schizophrenia experiences hallucinations and delusions that cause fear, suspicion, agitation, and depression.
A psychotic episode is an instance in which the person has strong delusions or hallucinations. The severity and frequency of these psychotic episodes may vary from one person to another. The person may also remain entirely unaffected or appear normal during other times.

Sometimes, the person may get very violent or aggressive and be a physical threat to themselves or others. In such cases, the hospital allows caregivers to admit the person against his or her will with a Magistrate’s order.

Contact a doctor if you think the situation is getting out of control and you are concerned about the safety of the patient and his or her family.

QWhat causes schizophrenia?
A
Medical researchers have not been able to find the exact causes of schizophrenia. Research now tells us that the disorder is linked to abnormalities in the structure of the brain. There are also some factors that are believed to put a person at a greater risk of developing schizophrenia:
Genetic factors: Having a parent or sibling with schizophrenia puts the person at increased risk

A chemical imbalance in the brain

Problems during pregnancy: The child may develop schizophrenia if the mother does not receive proper nutrition, or is exposed to viral illnesses during pregnancy

Extreme stress and overuse of drugs and alcohol can worsen any existing symptoms of schizophrenia.

QHow is schizophrenia diagnosed?
A
There is no single test for diagnosing schizophrenia. Due to the range of different symptoms that may be seen in the patient, the psychiatrist makes a diagnosis after a thorough clinical examination. As part of the examination the psychiatrist tries and unravels the changes in their behavior and biological functions (sleeplessness, lack of interest in eating or socializing) (sleeplessness, lack of interest in eating or socializing). Information about the deviations in the patient’s behavior is also collected from the family or caregivers.
A person is diagnosed with schizophrenia only if he or she has exhibited a combination of the above mentioned symptoms for at least a month.

If you suspect someone you know has schizophrenia, it is best to consult a doctor. There are other mental health disorders such as addiction, bipolar disorder and depression that can be confused with schizophrenia because they also may cause delusions, hallucinations, and social withdrawal. Only a psychiatrist will be able to accurately diagnose whether the person has schizophrenia, or is suffering from another disorder.

Getting treatment for schizophrenia

Though there is no known cure for schizophrenia, there are several treatments that can help the person live his or her life independently. Schizophrenia is a chronic disorder and needs management, just like diabetes or blood pressure.

The goal of treatment is not only to control symptoms, but also to ensure that the person is able to lead a functional life.

“The rule of thumb is that one-third of people with schizophrenia get back to normal functioning; one-third of them return to a level of functioning that is just below normal, and are able to cope. The remaining one-third need more assistance to lead a functional life. No one can predict when exactly a patient will return to a normal level of functioning. The key lies in early diagnosis: the earlier you identify the problem and get a diagnosis, and the more scrupulously you follow the treatment, the greater are the chances of good outcome. Sticking to the treatment plan is the key to recovery,” says psychiatrist Dr S Kalyanasundaram, MD, CEO of the Richmond Fellowship Society (Bangalore branch) (Bangalore branch).

Antipsychotic drugs and ECT

Depending on the symptoms and progress of the disorder, the doctor may prescribe a combination of drugs, therapy and rehabilitation. The prescribed drugs are called antipsychotic drugs that help in reducing positive symptoms such as hallucinations, delusions and paranoia. In some cases, the psychiatrist may prescribe Electro Convulsive Therapy (ECT) (ECT).

There are a lot of myths about anti-psychotic drugs and their side effects. Any medicine is bound to have certain side effect. But the anti-psychotic drugs used today have more desirable effects and minimal side effects – the patient may experience rigidity, stiffness or shivering. We do prescribe drugs, when necessary, to manage the side effects too.
Dr Laxmi V Pandit, professor at KIMS, Bangalore
Contrary to popular belief, ECT is a safe procedure when performed by trained professionals. “This is the safest therapy we can give to patients who are acutely disturbed, or are not responding to medication. The therapy is performed under anesthesia. It is mild and can relieve the positive symptoms, and does not cause any distress to the patient,” says Dr Pandit.

The management of schizophrenia requires a holistic approach, of which medicine is just one aspect. The caregivers’ support and structured rehabilitation also play a vital role in aiding recovery.

Caring for someone with schizophrenia

Caring for a loved one who has schizophrenia can be very challenging. It can be shocking and disheartening to see your loved one’s odd and unpredictable behavior. Caregivers – particularly parents – are very likely to have feelings of grief and guilt when they learn of the diagnosis. Common reactions include: “Why me?” “Where did I go wrong?” “Am I a bad parent?”

If you suspect that a loved one has schizophrenia, observe the changes in their behavior and give the doctor complete information. Speak to the doctor and get a thorough understanding of the diagnosis. If you need support to overcome your shock, grief or guilt, ask your doctor about a support group or counselor in your area. It will be easier for you to take care of the patient if you are correctly informed, and have received support for what you’re going through.

Doctors say that expressed emotion plays a huge role in the person’s recovery. The person can, whether consciously or subconsciously, pick up emotional cues from the way the family is dealing with the illness. They are likely to recover sooner when then family provides support and care. If the family criticizes the person or blames him or her for the illness, the person may have to struggle harder for recovery, and a person who is recovering may suffer a relapse.

As a caregiver, it is important to remember that the person may not have an insight into the symptoms – they do not know or understand why their behavior is not normal. Their brain is sending them signals that make them believe that the hallucinations and delusions are real experiences. This makes the person resist treatment as they believe that there’s nothing wrong with them. They do not know that they are mentally ill. Some caregivers, out of concern for their loved one, may tell the person that the delusions are not true, and force them to seek help. This isolates the person from the caregivers and may increase the fear and paranoia caused by the delusions. You can help your loved one by:

Asking them about their experiences (hallucinations, delusions) (hallucinations, delusions).

Acknowledging that the experience is true for them, and that it disturbs them (instead of denying their beliefs) (instead of denying their beliefs).

Encouraging and supporting the person to take decisions related to treatment.

Maintaining a record of the person’s symptoms and medication because the person is unable to recall or convey the relevant information, and doctors rely on the family to gather information.

Speaking to other family members about your concern, and discussing how you can support each other while the person undergoes treatment.

Speaking to a counselor or joining a local group to seek emotional support for your loved one, and for you. Schizophrenia can cause immense stress and grief to the caregivers too. Paying attention to your own needs will help you take better care of the person.

Watching the person for signs of relapse (your doctor can help you with a comprehensive list) so that you can get help before a psychotic episode occurs. Research has shown that a relapse can hamper the person’s wellbeing, and can make recovery much harder, in addition to causing some adverse changes in the brain.

Related
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Schizophrenia is an uncommon illness. To be diagnosed with schizophrenia can be hard for both the patient and their family. For most people, the illness comes under control once the person starts taking medication. However, there are cases where the illness does not fully disappear despite medication. This affects the ability of an individual to function on a daily basis. Families at times feel that their relative is no longer the person they knew them to be.

For individuals and families, having a diagnosis of schizophrenia is challenging, and it can be devastating when the society reacts adversely. To be labelled “schizophrenic” can make one feel that one has lost their identity.

The mind of a person with schizophrenia does not work as quickly as it used to. The body does not have the reflexes it did prior to the onset of the illness, especially since the start of the medications. All these changes can affect one’s motivation.

The good news is that treatments are available; treatments are better than in the past decades and most people do well on them. Having to take medications every day can act as a reminder that all is not how it used to be. Yet, it is important, if not imperative, to not define oneself as being “schizophrenic” or having a mental illness. Schizophrenia is only a part who you are and not allowing the diagnosis to rule you is very important.

Living with the illness means doing as much as one did before the diagnosis, as much as possible. If the illness is affecting your ability to think, then wait until the medications help your thinking. The medications might clear up some of the confusion associated with the illness. Your goal should be to get back to life as before.

Some of the medications that help the illness can cause weight gain and other problems – so staying healthy becomes very essential. Even if you have never exercised before, now is the time to make exercise and a healthy diet a part of your routine. Looking healthy, and feeling fit can offer a great boost to how you feel about yourself. Waking up every day and reminding yourself that you are not your illness can help you and your mind take the focus off the diagnosis.

Making a routine helps. In the initial part of the illness, your routine can include things like waking up at an appropriate time, eating healthy meals at regular intervals, taking your medication at the prescribed time, exercising and helping around the house, spending time with your family and not spending too much time by yourself. Sometimes the illness can make you not pay attention to hygiene and cleanliness. Your routine should include taking a bath daily and grooming yourself so that you look neat and clean.

Once you start to feel better and your psychiatrist says you can get back to work, work on a routine that helps you work and do all of the above activities. None of the suggestions are any different from what anyone’s routine should look like, with or without the illness, minus the medications!

There might be family members who you trust, who can help when you get confused about what is reality and what is not. You can ask for help from your family to remind you to take your medications, until it becomes a part of your routine.

Sometimes, the job that you were in before the onset of the illness might be too stressful for you. Don’t be disheartened if you are advised to change your job or are asked to find something less stressful. The change might be short-term, lasting only until you feel you can handle higher levels of stress. Many types of jobs that are available these days require that you work night shifts. This would also be something you should consider staying away from. Good sleep is a large component of your recovery and stability.

Living with schizophrenia might mean you have to learn to be more organized than before. It could mean asking for help, when you never needed to before. Acceptance of the diagnosis might help you move beyond it. Remember, acceptance does not mean that you let the diagnosis overwhelm you, or define you.

People around you might notice that you needed to be hospitalized or that you had a period when you were “not yourself”. They might want to know what happened. Frankly, it’s none of their business! You can decide who should know what happened and who does not need to know. Some people truly care and want to help and you might consider telling them. On the other hand, you might choose to tell no one other than your immediate family. This should be your choice.

Keep talking to your psychiatrist about how you feel. This would be what someone with diabetes or high blood pressure would do, staying in touch with their physician. Just like these other illnesses, there may be times that you are doing everything right, yet you don’t feel great. Let your psychiatrist know.

Being diagnosed with schizophrenia is by no means an easy thing to accept or ignore, but small steps every day, using your own strengths and that of loved ones around you will help you move ahead, and maybe beyond what you thought were your limits.
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