Navigating Treatment Challenges for Family Members with Schizophrenia

Issues related to family members with schizophrenia seeking medical care?

Hello Doctor, my mother is 56 years old.
Her past medical history includes hypertension, and there is a family history of cancer.
Her current condition started about a year ago with olfactory and visual hallucinations (smelling and seeing toxic gas from neighbors), a constant feeling of being followed wherever she goes, and sudden outbursts of anger towards strangers.
Family members have suggested seeking medical help, but she has strongly refused and blamed them (showing complete lack of insight).
Six months ago, auditory hallucinations began, and she often struggles to communicate normally with family members.
She has episodes of laughing and crying uncontrollably, talking to herself, and feels that household items are constantly going missing, prompting her to take notes.
Family members discovered search history on her phone related to lethal drug dosages.
Recently, she has developed hostility towards her husband and children, preventing anyone from getting close or returning home, severing all ties with family (throwing away all belongings, not contacting or answering calls).
Her hostility towards her husband is particularly intense, and she believes he is involved with another person (a political figure).
Additionally, she seems to think she is pregnant (despite being postmenopausal for several years), purchasing numerous baby items and recording her husband's (the political figure's) birthday and death date, as well as her own birthday and death date (left blank).
Currently, she is able to care for herself but has not exhibited self-harming or violent behavior.
Previously, we contacted a health center to see if a doctor could visit her at home, but she was unreachable, refused to open the door, and viewed the only two family members as enemies, resulting in failure.
Over a year has passed without any treatment, and we are very concerned about the ongoing harm to her.
I would like to ask the doctor if, in this situation, we really have to wait until she becomes more severely affected and exhibits self-harming or violent behavior before she can receive medical attention, or if there are any other ways to assist her in getting treatment? Thank you very much.

jane, 20~29 year old female. Ask Date: 2022/12/20

Dr. Li Guanying reply Psychiatry

From your letter, it is clear that you are experiencing discomfort and distress due to concerns about your family member's delusions and hallucinations, as well as the associated mental health symptoms.

1.
Schizophrenia, like chronic conditions such as diabetes and hypertension, can coexist peacefully with proper medication management to stabilize the condition.
Notably, there are long-acting injectable options available now, which alleviate worries about medication adherence and reduce the burden of frequent hospital visits, leading to a more secure lifestyle.
2.
If schizophrenia is left untreated, the brain may deteriorate more rapidly, potentially leading to a state where self-care becomes impossible.
Therefore, early intervention is crucial.
Treatment for schizophrenia is multifaceted, with pharmacotherapy being a vital component.
Medications are absorbed into the bloodstream and reach brain cells, helping to improve neurotransmitter function and restore brain activity, thereby alleviating symptoms such as auditory hallucinations, visual hallucinations, and delusions.
Rehabilitation therapy focuses on cognitive rehabilitation through activities designed to enhance attention, memory, and social skills, enabling individuals to regain normal functioning and reintegrate into society.
3.
As with all illnesses, early intervention is beneficial.
Generally, the first five years following the initial episode are considered a critical treatment period, during which interventions tend to be more effective.
However, if this golden period is missed, it is still important to continue treatment, as deciding to pursue active treatment at any time can positively impact disease management.
When choosing between oral medications and long-acting injectables, physicians will communicate with patients and their families to determine the most suitable treatment approach.
Oral medications offer convenience for patients at home but require multiple daily doses, necessitating daily adherence, which can significantly impact daily life.
Long-acting injectables are administered by healthcare professionals on a regular basis, with options for monthly or quarterly injections, providing more stable medication management and better prevention of relapse.
Additionally, home treatment services are available, allowing healthcare professionals to administer injections at home, further reducing the risk of missed doses.
4.
It is important to recognize that caregivers also need support, in addition to the patients.
Therefore, Chia-Nan Psychiatric Hospital regularly holds family education seminars, where healthcare professionals provide caregivers with insights on various topics and allow them to express their feelings and seek emotional support during the challenging caregiving process.
Our outpatient services are available Monday through Friday, both in the morning and afternoon.
We recommend considering having a community health visitor accompany the patient to the hospital for a personal assessment by a physician, to collaboratively discuss the best decisions for your family member.
Wishing you mental and physical well-being.

Reply Date: 2022/12/20

More Info

Navigating the challenges of caring for a family member with schizophrenia can be incredibly difficult, especially when the individual exhibits a lack of insight into their condition, as is often the case with this disorder. Your mother's symptoms, including hallucinations, delusions, and significant changes in behavior, suggest that she is experiencing a severe episode of schizophrenia. Here are some insights and recommendations based on your situation.

Understanding Schizophrenia
Schizophrenia is a chronic and severe mental health disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they've lost touch with reality, which can be distressing for both them and their loved ones. Symptoms can include:
- Hallucinations: Hearing, seeing, or feeling things that are not there.

- Delusions: Strongly held false beliefs, such as feeling persecuted or believing in conspiracy theories.

- Disorganized thinking: Difficulty organizing thoughts, leading to incoherent speech or behavior.

- Negative symptoms: Lack of motivation, withdrawal from social interactions, and diminished emotional expression.

The Importance of Treatment
Treatment for schizophrenia typically involves a combination of antipsychotic medications and psychotherapy. Early intervention can significantly improve outcomes, but as you noted, your mother currently lacks insight into her condition and refuses treatment. This is a common challenge, as many individuals with schizophrenia do not recognize that they are ill (a phenomenon known as "anosognosia").

Strategies for Encouraging Treatment
1. Engage in Open Communication: Approach your mother with empathy and understanding. Avoid confrontational language that may lead to defensiveness. Instead, express concern for her well-being and safety. Use "I" statements, such as "I feel worried when I see you upset," to convey your feelings without sounding accusatory.

2. Involve Trusted Individuals: If there are family members or friends whom she trusts, consider involving them in discussions about her health. Sometimes, hearing concerns from someone other than immediate family can make a difference.

3. Educate Yourself and Your Family: Understanding schizophrenia can help you and your family members respond more effectively. Knowledge about the disorder can also help you manage your expectations and reduce frustration.

4. Explore Community Resources: Since your mother is resistant to in-person visits, consider reaching out to community mental health services that may offer home visits or telehealth options. Some organizations specialize in outreach for individuals with severe mental illness.

5. Crisis Intervention: If her behavior escalates to a point where she poses a danger to herself or others, it may be necessary to involve emergency services. In many jurisdictions, mental health crisis teams can provide immediate support and facilitate hospitalization if needed.

6. Legal Options: If her condition continues to deteriorate and she refuses treatment, you may need to explore legal avenues for involuntary commitment. This process varies by location but typically requires demonstrating that the individual poses a danger to themselves or others.

7. Support for Family Members: Caring for someone with schizophrenia can take a toll on your mental health. Consider seeking support for yourself and other family members through therapy or support groups. This can provide you with coping strategies and emotional relief.

Conclusion
While it may feel like you are waiting for a crisis to occur before your mother can receive help, proactive measures can be taken to encourage her to seek treatment. It is essential to balance compassion with the need for safety and care. Remember that you are not alone in this journey; many families face similar challenges, and there are resources available to support both you and your mother.
If you have further questions or need specific resources in your area, please don't hesitate to ask. Your concern for your mother's well-being is commendable, and taking steps to address her condition is crucial for her health and safety.

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