Monthly Archives: March 2014
As a family member of someone who has schizophrenia, the caregivers might struggle with a plethora of emotions, fears, guilt, anger, frustration and hopelessness. It is difficult to accept the illness. And it is equally difficult to separate the illness from the sufferer. Family members are often worried about the stigma of schizophrenia or confused and embarrassed by strange behaviors you don’t understand. As a caregiver, you need to understand that it is important to accept the illness and its difficulties and be realistic in what you expect of the person with schizophrenia and of yourself.
Following suggestions can be followed in order to achieve a better quality of life while living with a person with schizophrenia:
- Educate yourself: Learning about schizophrenia and its treatment will allow you to make informed decisions about how best to manage the illness, work toward recovery, and handle setbacks.
- Reduce stress: Stress can cause schizophrenia symptoms to flare up, so it’s important to create a structured and supportive environment for your family member. Avoid putting pressure on your loved one or criticizing perceived shortcomings.
- Set realistic expectations: It’s important to be realistic about the challenges and limitations of schizophrenia. Help your loved one set and achieve manageable goals, and be patient with the pace of recovery.
- Make time for yourself: Schedule time into your day for things you enjoy, whether it be spending time in nature, visiting with friends, or reading a good book. Taking breaks from caregiving will help you stay positive and avoid burnout.
- Look after your health: Neglecting your health only adds to the stress in your life. Maintain your physical well-being by getting enough sleep, exercising regularly, eating a balanced diet, and staying on top of any medical conditions.
- Cultivate other relationships: It’s important to maintain other supportive, fulfilling relationships. Don’t feel guilty for looking after your social needs. You need support, too. These relationships will help buoy you in difficult times.
- Practice acceptance: The “why me?” mindset is destructive. Instead of dwelling on the unfairness or life, accept your feelings (even the negative ones). Your burdens don’t have to define your life unless you obsess about them.
- Seek out joy: Taking out time for fun is a necessity. It isn’t the people who have the least problems who are the happiest, it’s the people who learn to find joy in life despite adversity.
- Recognize your own limits: Be realistic about the level of support and care you can provide. You can’t do it all, and you won’t be much help to a loved one if you’re run down and emotionally exhausted.
- Avoid blame: In order to cope with schizophrenia in a family member, it’s important to understand that although you can make a positive difference, you aren’t to blame for the illness or responsible for your loved one’s recovery.
- Provide options: Your loved one may be more willing to see a doctor if he or she can control the situation somewhat. If your relative appears suspicious of you, suggest another person to accompany him or her to the appointment. You can also give your family member a choice of doctors.
- Focus on a particular symptom: A person with schizophrenia may resist seeing a doctor out of fear of being judged or labeled “crazy.” You can make the doctor less threatening by suggesting a visit in order to deal with a specific symptom such as insomnia or a lack of energy.
- Seek help right away: Early intervention makes a difference in the course of schizophrenia, so don’t wait to get professional help. You family member will need assistance finding a good doctor and other effective treatments.
- Encourage independence: Rather than doing everything for your family member, encourage self-care and self-confidence. Help your loved one develop or relearn skills that will allow for greater independence of functioning.
- Be collaborative: It’s important that your loved one have a voice in his or her treatment. When your family member feels respected and acknowledged, he or she will be more motivated to follow through with treatment and work toward recovery.
- Take side effects seriously: Many people stop taking their schizophrenia medication because of side effects, so pay attention to your loved one’s drug complaints. Bring any distressing side effects to the attention of the doctor. The doctor may be able to reduce adverse effects by reducing the dose, switching to another antipsychotic, or adding another medication that targets the troublesome side effect.
- Encourage your loved one to take medication regularly:Even with side effects under control, some people with schizophrenia refuse medication or take it irregularly. This may be due to a lack of insight into their illness and the importance of medication, or they may simply have trouble remembering their daily dose. Medication calendars, weekly pillboxes, and timers can help people who are forgetful.
- Track your family member’s progress: You can help the doctor track treatment progress by documenting changes in your family member’s behavior, mood, and other symptoms in response to medication. A journal or diary is a good way to record medication history, side effects, and everyday details that might otherwise be forgotten.
Relapse can occur if the person is not taking medicines. However, learning to recognize early signs of relapse can help prevent crisis. The warning signs of relapse are often similar to the symptoms and behaviors that led up to the person’s first psychotic episode.
Common warning signs of schizophrenia relapse:
- Social withdrawal
- Deterioration of personal hygiene
- Increasing paranoia
- Confusing or nonsensical speech
- Strange disappearances
Despite your best efforts to prevent relapse, there may be times when your family member’s condition deteriorates rapidly and drastically. During a schizophrenia crisis, you must get help for your family member as soon as possible. Hospitalization may be required to keep your loved one safe. It’s also wise to go over the emergency plan with your family member. The crisis situation may be less frightening and upsetting to your loved one if he or she knows what to expect during an emergency.
Tips for handling your loved one during a schizophrenia crisis:
- Remember that you cannot reason with acute psychosis
- Remember that the person may be terrified by his/her own feelings of loss of control
- Do not express irritation or anger
- Do not shout
- Do not use sarcasm as a weapon
- Decrease distractions (turn off the TV, radio, etc.)
- Ask any casual visitors to leave—the fewer people the better
- Avoid direct continuous eye contact
- Avoid touching the person
- Sit down and ask the person to sit down also
For more help in dealing with family members who may have schizophrenia or other mental health needs; contact World Brain Center Hospital today.
Good Sleep Hygiene Handout
The most common cause of insomnia is a change in your daily routine. For example, traveling, change in work hours, disruption of other behaviors (eating, exercise, leisure, etc.), and relationship conflicts can all cause sleep problems. Paying attention to good sleep hygiene is the most important thing you can do to maintain good sleep.
1. Go to bed at the same time each day.
2. Get up from bed at the same time each day. Try to maintain something close to this on weekends.
3. Get regular exercise each day, preferably in the morning. There is good evidence that regular exercise improves restful sleep. This includes stretching and aerobic exercise.
4. Get regular exposure to outdoor or bright lights, especially in the late afternoon.
5. Keep the temperature in your bedroom comfortable.
6. Keep the bedroom quiet when sleeping.
7. Keep the bedroom dark enough to facilitate sleep.
8. Use your bed only for sleep (and sexual activity). This will help you associate your bed with sleep, not with other activities like paying bills, talking on the phone, watching TV.
9. Establish a regular, relaxing bedtime routine. Relaxing rituals prior to bedtime may include a warm bath or shower, aromatherapy, reading, or listening to soothing music.
10. Use a relaxation exercise just before going to sleep or use relaxing imagery. Even if you don’t fall asleep, this will allow your body to rest and feel relaxed.
11. Keep your feet and hands warm.
12. Designate another time to write down problems & possible solutions in the late afternoon or early evening, not close to bedtime. Do not dwell on any one thought or idea—merely jot something down and put the idea aside.
1. Exercise just before going to bed. Try to keep it no closer than 3-4 hrs before bed.
2. Engage in stimulating activity just before bed, such as playing a competitive game, watching an exciting program on television or movie, or having an important discussion with a loved one.
3. Have caffeine in the evening (coffee, many teas, chocolate, sodas, etc.)
4. Read or watch television in bed.
5. Use alcohol to help you sleep. It actually interrupts your sleep cycle.
6. Go to bed too hungry or too full.
7. Take another person’s sleeping pills.
8. Take over-the-counter sleeping pills, without your doctor’s knowledge. Tolerance can develop rapidly with these medications.
9. Take daytime naps. If you do, keep them to no more than 20 minutes, 8 hrs before bedtime.
10. Command yourself to go to sleep. This only makes your mind and body more alert.
11. Watch the clock or count minutes; this usually causes more anxiety, which keeps you up.
12. Lie in bed awake for more than 20-30 minutes. Instead, get up, go to a different room (or different part of the bedroom), participate in a quiet activity (e.g. non-excitable reading), and then return to bed when you feel sleepy. Do not turn on lights or sit in front of a bright TV or computer; this will stimulate your brain to wake up. Stay in a dark, quiet place. Do this as many times during the night as needed.
13. Succumb to maladaptive thoughts like: “Oh no, look how late it is, I’ll never get to sleep” or “I must have eight hours of sleep each night, if I get less than eight hours of sleep I will get sick.” Challenge your concerns and avoid catastrophizing. Remember that we cannot fully control our sleep process. Trying too hard to control it will make you tenser and more awake.
14. Change your daytime routine the next day if you didn’t sleep well. Even if you have a bad night sleep and are tired it is important that you try to keep your daytime activities the same as you had planned. That is, don’t avoid activities or stay in bed late because you feel tired. This can reinforce the insomnia.
15. Increase caffeine intakes the next day, this can keep you up again the following night.
All children can be naughty, defiant and impulsive from time to time, which is perfectly normal. However, some children have extremely difficult and challenging behaviours that are outside the normal and expected behavior for their age.
The most common disruptive behaviour disorders include oppositional defiant disorder (ODD), conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD). These three behavioural disorders share some common symptoms, so diagnosis can be difficult and time consuming. A child or adolescent may have two disorders at the same time. Other factors that can worsen these symptoms can include emotional problems, mood disorders, family difficulties and substance abuse.
Oppositional defiant disorder (ODD)
Around one in ten children under the age of 12 years are thought to have oppositional defiant disorder (ODD). More boys than girls end up having this problem.
Behavior pattern of children with ODD:
- Easily angered, annoyed or irritated
- Frequent temper tantrums
- Argues frequently with adults, particularly the most familiar adults in their lives, such as parents
- Refuses to obey rules
- Seems to deliberately try to annoy or aggravate others
- Low self-esteem
- Low frustration threshold
- Seeks to blame others for any misfortunes or misdeeds.
Conduct disorder (CD)
Children with are often judged as ‘bad kids’ because of their delinquent behaviour and refusal to accept rules. Around five per cent of 10 year olds are thought to have CD. Gain, more boys than girls end up having this disorder.
Behavior pattern of children with CD:
- Frequent refusal to obey parents or other authority figures
- Repeated truancy
- Tendency to use drugs, including cigarettes and alcohol, at a very early age
- Lack of empathy for others
- Being aggressive to animals and other people or showing sadistic behaviours including bullying and physical or sexual abuse
- Keenness to start physical fights
- Using weapons in physical fights
- Frequent lying
- Criminal behaviour such as stealing, deliberately lighting fires, breaking into houses and vandalism
- A tendency to run away from home
- Suicidal tendencies – although these are more rare.
Attention Deficit Hyperactivity Disorder (ADHD)
Around two to five per cent of children are thought to have attention deficit hyperactivity disorder (ADHD), with boys outnumbering girls by three to one.
Behaviour pattern of children with ADHD:
- Inattention – difficulty concentrating, forgetting instructions, moving from one task to another without completing anything.
- Impulsivity – talking over the top of others, having a ‘short fuse’, being accident-prone.
- Overactivity – constant restlessness and fidgeting.
Diagnosing behavioural disorders:
Disruptive behavioural disorders are complicated and may include many different factors working in combination. For example, a child who exhibits the delinquent behaviours of CD may also have ADHD, anxiety, depression, and a difficult home life.
Diagnosis methods may include:
- Diagnosis by a specialist service, which may include a paediatrician, psychologist or child psychiatrist
- In-depth interviews with the parents, child and teachers
- Behaviour check lists or standardised questionnaires.
It is important to rule out emotional, physical or family stressors that might be disrupting the child’s behaviour. For example, a sick parent or bullying by other children might be responsible for sudden changes in a child’s typical behaviour and these factors have to be considered initially.
Watch out this space on more information about behavioural disorder and their management. Or if you feel that your child is suffering from any of the above mentioned behavioural patterns, contact Word Brain Center Hospital today!
Caring for family members with OCD
Living with someone who has OCD can be a taxing experience. Family members not only are unable to handle problematic behaviours, they also end up feeling stressed out themselves at times. It is important to strengthen relationships between patients and their families. Keeping in mind the following points would empower families dealing with obsessive –compulsive behaviours:
Family members should learn to recognize the warning signs of OCD. Changes in behaviour are easily observable, even thoughts which are not expressed freely can lead to behaviour changes. Taking long time to finish tasks, such as in bathroom, getting dressed, doing self study, repeating certain things, repeated questioning, staying up late to get things done, inability to sleep properly, avoiding certain activities, and extreme emotional reactions to small things are signs that should be watched out for.
Differentiating between OCD and the person
People with OCD usually report that their symptoms get worse the more they are criticized or blamed, because these emotions generate more anxiety. So, it is essential that the family learns to view these features as signals of OCD and not as personality traits. This way, the family can join the person with OCD to combat the symptoms rather than become alienated from them.
Having realistic expectations
People with OCD report that change of any kind, even positive change, can be experienced as stressful. It is often during these times that their symptoms tend to increase. Family can help in reducing stress by modifying their expectations during these times of transition. Family conflicts result in increasing symptoms. Validating that the person may be undergoing stress as his or her life is undergoing change is reassuring. The path of recovery is never a straight line. Even while improving the person with OCD may slip and needs support as well as encouragement. Suddenly expecting too much from the person who is showing improvement may prove to be counter-productive.
Recognize “Small” Improvements
Persons with OCD often complain that their family members do not understand what it takes to achieve even small improvement. Cutting down time taken to have a bath or starting buying groceries may involve huge efforts for the person. While these gains seem insignificant to family members, it is really a big step for the person suffering from OCD. Acknowledgment of these seemingly small accomplishments is a powerful tool that encourages them to keep trying. This lets them know that their hard work to get better is being recognized and can be a powerful motivator.
Support the person; not the illness
It is understandable that OCD can be unnerving for both the sufferer and family. However, please remember that the more you can avoid personal criticism, the better it is.
It is not so that acceptance and support means ignoring the compulsive behavior. Do your best to not participate in the compulsions. In an even tone of voice explain that the compulsions are symptoms of OCD and that you will not assist in carrying them out because you want them to resist as well. Make the person understand each time that you are against OCD and not against the person who is suffering.
Before you ensure that the person with OCD is regular with medicines, it is important to be convinced yourself that it is helpful to take these medicines. Passing comments such as “No matter how much money we spend, these medicines are doing no good to you!” will only propel the patient to leave medicines or undermine their importance. Also understand that medicines cannot make the symptoms evaporate overnight. Medicines take time to have effect on brain functioning and it is important to remember that periodical review with your Doctor is of utmost importance. Stopping the medicines or reducing the dosage on your own can prove to be counter-productive. Remind the patient of these facts when he or she loses hope.
During therapy/counselling, certain limits on obsessive and compulsive behaviours might be set. Family members can help the patient stick to these limits. As per the suggestions by the therapists, family members may find that they have to be firm about:
1) Prior agreements regarding assisting with compulsions;
2) How much time is spent discussing OCD;
3) How much reassurance is given; or
4) How much the compulsions infringe upon others’ lives.
Limit setting works best when these expectations are discussed ahead of time and not in the middle of a conflict.
Communicating with person suffering from OCD
It is beyond doubt that the family means well for the patient. However, it may not be possible to communicate your good intentions to the patient all the time. He or she might feel that the family does not understand what he or she is going through. Avoid lengthy explanations and rationales. It is likely to upset the person and thus might result in an increase in anxiety and consequently the symptoms. While communicating; separate the illness from the person. Instead of starting a sentence by saying “you always keep on checking the door”, try saying “I understand that you always feel like checking the door again and again”.
Individuals with OCD report that their mood determines the extent to which they can divert obsessions and resist compulsions. When the patient is having an irritable mood, or a low mood, it is best to back off, unless there are chances that the person might hurt himself or herself.
Family members often have the natural tendency to feel like they should protect the individual with OCD by being with him all the time. This can be destructive because family members need their private time, as do people with OCD. Give them the message that they can be left alone and can care for themselves. It may seem obvious that family members and individuals with OCD are working toward the common goal of symptom reduction, but the ways in which people do this varies. Creating goals as a team along with your treating team reduces conflict, preserves the household, and provides a platform for families to begin to “take back” the household in situations where most routines and activities have been dictated by an individual’s OCD. By improving communication and developing a greater understanding of each other’s perspective, it is easier for the individual to have family members help them to reduce OC symptoms instead of enabling them. It is essential that all goals are clearly defined, understood, and agreed upon by any family members involved with carrying out the tasks in the contract. Families who decide to enforce rules without discussing it with the person with OCD first find that their plans tend to backfire.
World Brain Center Hospital provides not only pharmacological and psychological treatment for OCD, but family counselling for family members of patients suffering from OCD as well.