Schizophrenia is a disabling disease in which the patient loses contact with reality and does not know that that he is ill. This creates many problems for the patient, the patient’s family, friends and professionals working with the patient. Unlike the neurotically ill patient the schizophrenic patient believes that he is perfectly alright therefore he does not need help and will often reject all help, including medications, to his detriment.
The health care professional must introduce himself /herself to the patient even though the patient has chosen to ignore or refuse to communicate with you. His refusal to ignore you is a symptom of his disease and is not to be taken personally. Helping a schizophrenic patient is not easy but persistent efforts will pay dividends.
The first and most important intervention for all members of the family and treatment team is to treat the patient respect and courtesy. Labelling the patient and calling him names is counterproductive. The team first needs to build a trusting relationship with the patient. This is usually done by being available to the patient when he/she needs help, offering him help with activities of daily living and fluids as the need arises.
In helping the patient one has to vigilant to the fact that a schizophrenic patient’s sense of reality is different. If he/she hears voices which are telling him to “kill the nurse” those voices are real to this patient and he/she may act upon them. So the nurse needs to watch out for his/her safety at all times. This is best done by keeping the patient in a safe unit, free of sharp utensils and equipment. When one is on duty try not to wear a tie of uniform. Belts and restrictive articles can be used to strangulate. Most psychiatric units have “no uniforms” policies, ties are never worn and sharps are not usually allowed.
The schizophrenic patient is most likely to continue to reject this for quite some time so one needs to make the attempts repeatedly. The professional nurse must continue to be available to the patient. She can demonstrate this by holding the patient’s hand (after checking with the patient) or just by sitting closely to the patient. If the patient is not eating regular meals offer him finger foods which he may eat.
If the patient says that he is hearing voices, try and find out what those voices are telling him. It is alright to ask what those voices are telling him. However, do not reinforce those voices. If the patient says, “They are real!” the nurse’s/carer’s best response is, “They are real to you but I do not hear them”. This intervention will not alienate you from the patient. He / she will be reassured by the fact that you believe him/her.
Some patients, where the onset of the schizophrenia is due to substance abuse, will get better spontaneously as the drug is slowly metabolised. In the worst case scenario where the patient continues to lose weight, is a high risk to staff and other patients it may become necessary to certify the patient under the mental health act of the jurisdiction of the area. Generally speaking this is done by two medically qualified practitioners where at least one of them is a psychiatrist. This must only be done as a last resort.
Schizophrenic patients often hit care givers. The care giver cannot hit back. Self defence is not an excuse and will not be accepted in a court of law. Many a times a schizophrenic patient may spit at a carer. The carer is not allowed to spit at the patient. The carer’s best response is “That behaviour is not appropriate”. A response like this is very reassuring to the patient. It says that the behaviour is not satisfactory and it does not make the patient the bad guy.
Insertion of NG tube and force feeding after certification under the mental health act is sometimes used to save the life of a patient who is refusing to eat.
Placing the patient in four point restraints is also done sometimes. This procedure is usually commenced when a patient is violent and is a risk to himself / herself or to others. During this procedure, often referred to as a “take down” several member of the staff who are adequately trained restrain a patient. Sometimes, intramuscular, chemical restraints are used.
When the antipsychotic medication begins the work, the patient’s symptoms will subside to subside, the voices will get less, he / she will begin the gradual return to normality.
Patients who are compliant, generally those with family and other support, are able to lead a productive life.
Last but not least, many of our prisons are full of psychiatric patients for lack of adequate diagnosis and treatment. Adequate support and intervention can help schizophrenic patients be useful members of society.
It is unclear if schizophrenia is a genetic disease. Some research is showing that it is the result of “unhealthy lifestyles”. Still other researchers believe that schizophrenia is a learned behaviour and can be unlearned.
My experience, working with psychiatric patients suggests that both components (genetic and environmental) are present. Most have a family history of schizophrenia combined with substance abuse and high stress.
