As the saying goes: three parts treatment, seven parts care. Family care and attention, as well as active participation in psychological and spiritual rehabilitation, is one of the most critical factors for patients to remain stable for a long time without relapse and thus recover and return to society.
Schizophrenia is a group of severe mental illnesses of unknown etiology and a high relapse rate. Schizophrenia treatment is a long-term, long course of treatment, and patients’ families need to understand the relevant disease knowledge, support patients in their treatment, and help them choose the right treatment path. Patients and family members must also acquire basic self-management skills for the disease to prevent recurrent episodes and maintain long-term stability of the disease. Only when patients, families and medical workers establish a good therapeutic alliance and work together to cope with the disease can they control it more effectively and improve the quality of life of patients and their families. Now we are guiding the implementation methods of the patient’s family members’ cooperation in three aspects.
First, the responsibility of the guardians of schizophrenia patients.
At the onset of schizophrenia, patients have significantly impaired social competence and lack legal capacity. These patients are civilly incompetent or partially civilly competent, and they should be protected by a guardian who will act on behalf of the patient in legal matters. The General Principles of Civil Law of the People’s Republic of China stipulate that the guardian of a mentally ill person is, in order, the spouse, parents, adult children and other family members of the patient. The guardian’s duties are to represent the patient in legal matters; to take care of the patient’s property and to protect the patient’s personal safety. The guardian has the responsibility to send the patient for custodial treatment when the patient is exempted from liability because the patient has violated the criminal law due to his or her illness. When the patient violates the interests of others, or when the patient’s interests are violated by others, giving rise to a civil lawsuit, the guardian has the responsibility to represent the patient in court and to pay and accept compensation on behalf of the patient in accordance with the court’s decision.
Patients with schizophrenia in the onset are a high-risk group with a tendency to commit crimes. The safest way to treat a patient with a tendency to commit crimes is to take him or her to a hospital, which will effectively treat the patient and protect their safety, while possibly preventing innocent acts of harm from occurring.
Not all schizophrenics are not legally responsible for breaking the law; only those identified as criminally incompetent may not be criminally responsible, and those with partial criminal responsibility are not exempt from legal punishment. Some schizophrenics are in recovery, at which point they should be held fully criminally responsible for their crimes, as ordinary people are. The perception that as long as one has suffered from schizophrenia, one is not legally responsible is wrong. There are two reasons for this error: first, some people believe that schizophrenia is a disease that cannot be cured, and that patients are not normal anyway. This misconception carries the discrimination of not recognizing the fact that, in fact, with proper treatment, the vast majority of schizophrenics can be cured or basically remitted; second, some people believe that having There is no such provision in the law, and if the speaker is a friend of the offender, there is inevitably a suspicion of excusing the offender.
Second, patients in the various states of schizophrenia state of the family note.
1, schizophrenia patients in the onset of the disease, first of all, the patient’s family must accompany the patient to the hospital as soon as possible, do not delay the condition.
You should also actively cooperate with the doctor during the consultation and describe to the doctor the symptoms of the patient with a time sequence. Because medication can relieve the vast majority of symptoms, antipsychotic medication should be the treatment of choice. Medication should be an important part of their long-term treatment, so patients need to be treated with adequate dosage and duration of therapy. During the onset period, it is inevitable that many patients will refuse to take medication. If the discontinuation is due to drug-induced side effects, it is important for family members to provide timely feedback to the treating physician to facilitate adjustments in the use or dosage of medication; if it is due to the patient’s conviction that he or she is not suffering from a psychiatric disorder, colorless and tasteless antipsychotic medication can be used and mixed with food to enable the patient to take medication on time and stabilize his or her condition.
2. Patients with schizophrenia are likely to become relatively calm on the surface during the remission period, but inwardly out of step with their environment.
This is due to the fact that they have experienced the intense disease process during the onset period and have various mental disorders left over from the onset process. Many of the concepts, behaviors and attitudes of such patients are not shared by ordinary people, but this does not mean that we cannot understand them. When we understand that behind those things that the patient cannot be identified with, it is the schizophrenia disorder that is at work. If further analysis is done based on the patient’s condition, it is possible to find out which mental disorders govern the patient’s performance. In this way it will be easier to understand the patient. Only with understanding can one truly care. The most important thing in this process is to grasp a degree of concern, neither to be overly caring nor indifferent to the patient. Don’t be blindly sad or angry about the patient’s behavior, but use your energy for the patient’s care and treatment. Work effectively with medical workers to create an environment that is conducive to patients’ recovery, so that they can move step by step toward health in an atmosphere of relative pressure.
3. Several common ways of coping with patient pathology.
(1) Abnormal patient excitement: The patient’s psychiatric symptoms may manifest as severe disorganized thinking, disorganized speech, lack of purpose in behavior, and possible self-injury or injury to others and destruction of objects. Since the patient’s excitement and agitation is continuous, family members need to be fully prepared for it and it is generally easier to prevent. Family members should keep knives, scissors, fire, gas and other dangerous items in the home, but the most fundamental way to control the patient’s excitement is to use medication. If caring for the patient at home is really difficult, the patient can be forced to be hospitalized.
(2) Delusions of victimization: This is a common symptom of schizophrenia. Most patients choose to avoid it, while a few may actively attack their “imaginary enemy”. In this regard, it is most important to clarify the object of the patient’s delusions. If the object of delusions is a family member, try to keep the family member away from the patient, or at least do not leave him alone with the patient. To avoid causing unnecessary trouble.
(3) Patient depression: Patients with schizophrenia may become depressed and even pessimistic at different times in the development of the disease. It is particularly important to note that a significant proportion of patients who succeed in committing suicide do so during the recovery period of the disease. After the elimination of psychiatric symptoms, the patient carries a heavy burden of thought because of his illness, and cannot properly deal with the realities of higher education, employment, marriage, etc., and feels desperate, so he chooses to live lightly. In this regard, the family must prevent the problem before it happens, to find the patient’s psychological distress as early as possible, timely guidance.
(4) Patient anxiety: One of the side effects of antipsychotics is that they may cause inexplicable restlessness, confusion and panic, sweating, and fear. These manifestations are mostly episodic, mostly occurring in the afternoon to early evening, and some patients also experience these manifestations within 2 – 3 days after the long-acting injection. This temporal regularity helps the family to determine whether the patient’s anxiety is due to the drug, i.e., pharmacogenic anxiety. In their eagerness to get rid of this intense pain, patients may experience impulsive injuries or self-injury, which are only for venting and relief and do not have death as the ultimate goal.
4. Patients with schizophrenia should learn to live peacefully with certain psychotic symptoms.
Schizophrenia symptoms are generally divided into two categories: positive symptoms and negative symptoms. Here, we discuss the need for patients to live peacefully with certain positive symptoms, or with positive symptom characteristics. After treatment during the onset of schizophrenia, most of the positive symptoms may be controlled, but this control may not be complete and the patient may have residual partial symptoms such as hallucinations and also a feeling of being convinced, but no longer convinced, that someone is persecuting him or her. The former is called residual symptoms (hallucinations) and the latter is called a disorder with delusions (not enough delusions, delusions should be convinced). The obvious delusions are eliminated, but a tail remains; a large number of hallucinations are controlled, but not completely eliminated, to the regret of both the patient and the family and medical workers. In such cases, some patients adopt the attitude of living peacefully with their symptoms. After a long illness, the patient learns: hallucinations are something alien. Although patients are bored with the small number of hallucinations, they are not dominated by them and continue to work and study. When the frequency of hallucinations increases, they also take the initiative to see a doctor. Regarding the sensitivity and paranoia of a delusional nature, it may affect the patient’s relationship with others, a problem that is not conducive to the patient’s peaceful coexistence in life, at least not with the person who is suspected. What can coexist peacefully with psychotic symptoms should be only a partial residual of positive symptoms, mainly verbal hallucinations, which, as mentioned earlier, the patient knows to be illusory and non-real. Peaceful coexistence with positive symptoms is a remedy for unsatisfactory treatment during the onset period, a last resort, a second choice for schizophrenic patients, and a remedy for unsuccessful treatment. Patients in this situation of peaceful coexistence should be on high alert for relapse of the patient’s condition. There are no conditions for peaceful coexistence with negative symptoms.
Third, help patients with schizophrenia to resume interpersonal interactions.
Because the patient’s experience during the onset of schizophrenia is detached from reality, ordinary people who have not experienced this experience cannot accept the thinking that arises during this experience and cannot understand what the patient says or does. Inability to understand does not mean inability to understand. We need to understand the meaning of the patient’s symptoms and the manifestation and regression of the patient’s illness. Unlike the onset of illness, patients in recovery are free to express their feelings. We can appreciate the patient’s feelings during the course of the disease and find ways to prevent a relapse, as well as analyze the patient’s current problems. Because of the experience of the onset period, many patients choose to withdraw. Withdrawal may reduce external stimuli and seem to protect the patient. In fact, this is not the case; external stimuli are a necessary mental demand for life. Withdrawal has the potential to impair the patient’s social functioning. The only way to learn to express oneself is to interact with people, to learn to accept other people’s ideas and opinions, and to learn from them what was unknown. In accepting other people’s ideas and opinions, it is possible to make progress by giving up or changing one’s wrong ideas and opinions. Pathological suspicion during the onset of schizophrenia is what the patient develops in a world of internal closure. It starts with suspicion of a person or an event, when it might be possible to reflect on one’s perceptions if one could communicate with people. Since there is no communication and no opportunity to receive correct opinions from others, the beginning doubts gradually expand and generalize until they are suspicious of everyone around them, at which point the opportunity to communicate with people is lost. Communication may not completely eliminate the creation of the disease, but at least it may significantly reduce the development of the disease in its early stages and provide the opportunity for timely treatment. In addition to preventing disease relapse, learning to communicate can rapidly improve a patient’s social functioning.
The extensiveness of schizophrenia’s damage to patients’ interpersonal skills far exceeds the damage to their ability to work and live. Many patients in recovery can work and live a basically normal life but are unable to interact with people normally. Psychological disorders that occur during recovery from schizophrenia, such as those addressed in the suicide question, also severely damage patients’ interpersonal skills. Correction of these problems is the basis for improving interpersonal skills. The interpersonal skills of human society are based on a common morality that is observed by all. Schizophrenia is not a morally problematic disease, and the moral standards of patients generally do not decline after the disease is controlled. The problem is that the altered personality and psychological disorders of the patient’s illness impede their ability to socialize. Removing these barriers is the only way to restore the patient’s interpersonal skills. In this regard, it is the task of the patient’s family and health care workers to create a relaxed yet stressful environment for the patient. In doing this, we should first reflect on our own interpersonal skills. If, ourselves, we do not have the qualities of responsibility, tolerance, helpfulness and sharing, how can we expect our patients to do so. There is no set model for restoring patients’ interpersonal skills. It is important to choose an approach that is tailored to the specific problem. A certain environment is needed to carry out this work, and interpersonal skills are expressed in a certain environment. This environment should be a human environment, and the family, as one of the patient’s environment, should set an example in interpersonal behavior and guide the patient into normal interpersonal interactions.
Fourth, how to get along with schizophrenia patients whose personalities have changed after the illness?
Patients with schizophrenia whose personality has changed after the disease have difficulties adapting to society. Recognizing the defects in their personality, analyzing these defects, and working to eliminate them are elements of a long-term effort.
1. Patients with withdrawal and dependency characteristics should be encouraged to make decisions independently, i.e., promptly affirm every achievement in the patient’s life and work and build up his self-confidence; for things that are possible for the patient to do, be sure to let go and let him do them himself. Social skills are exercised in the workplace, and parents should never become the object of dependence of the patient. Parents can help with things that the patient is really unable to do. Anything the patient can or may do through hard work, he should be encouraged to do. Only in this way can the patient’s characteristic of withdrawal and dependence be changed. Make it adapt to society.
2. For the emotionally unstable patient, his mental activities should be carefully analyzed. They always lose their temper, get furious at the slightest thing, and often fail to realize that it is they who are easily discontented. Get along with this kind of patients, do not argue with them tit-for-tat, after the patient has lost his temper, then discuss with him the problem of temper tantrums, especially analyze his inner discontent. Discontent is a motivation, and this motivation should be directed to a reasonable direction.
The patient’s shyness and avoidance is a manifestation of low self-esteem, which can seriously affect the patient’s social activities, thus weakening his social function. Encouraging the patient to engage in things he is good at and to participate in social activities is an indispensable way to solve the problem. This will help improve the patient’s self-esteem and overcome low self-esteem. If the patient agrees, cognitive psychotherapy is also available, and this treatment is more effective in eliminating such disorders.