Psychiatrist Zafar Sharif of Columbia University talks about caring for a loved one with schizophrenia.

So as a family member or a loved one who’s taking care of a patient with Schizophreniaor who’s involved in the care of these individuals, sometimes it can be really frustrating because it seems that the patients don’t want to help themselves, that the patient is “lazy,” doesn’t want to do anything, refuses to take medications. It’s important to understand that much of this is the disease – it’s not the individual. Schizophrenia makes you lose the desire to interact with people, it makes you lose pleasure in activities, it makes you lose motivation, it makes it more difficult for you to remember things and to solve complex or even simple problems.

In addition to those obvious symptoms, of delusions or hallucinations, there are all these other symptoms of the disease that impair the ability of the person afflicted with this illness to actually function in a meaningful way in society. It’s important for family members to separate the disease that the patient is afflicted with and what the consequences of that disease are in terms of behaviours, from what the person is actually doing. So it’s commonplace for family members to at times get annoyed with patients because they think they’re not doing all they could do to get better.

Non-compliance, or poor adherence, not taking your medications as you’re supposed to, is extremely common in patients with this illness. Many of them don’t think they’re sick or they don’t need the medication. Again, they’re not doing this to give their clinicians a hard time or give their family members a hard time, they actually don’t believe they need the medication. So if somebody doesn’t believe that they need the medication, why would they take it? If you think of it in that way it may help you to understand why many patients are resistant to taking medications. And then of course they forget, they’re much more likely to forget because of the illness, what the illness does to their faculties. So as family members taking care or helping with the care of these patients, it’s important to monitor them without making it look like you’re spying on them, for example, you don’t want to make it look like you’re checking up to see if they’re taking their medicines, but in a subtle way just to keep track of what they’re doing to make sure they are taking their medication as they’re supposed to, to do that in a supportive and non-confrontational way so that the patient perceives you as an ally and not as an adversary.

It’s really an ongoing process, part of this is just trial and error, learning how to do it, and it takes time for some people to figure out what works and what doesn’t work, but really focusing in on the patient taking the medications as they’re supposed to: that’s the single most important thing that family members can do in impacting on the outcome of the illness. So if the patient is taking their medicines they’re less likely to relapse and if they’re less likely to relapse the more likely they are to do better long term.

And if you notice that the patient isn’t taking the medication as they’re supposed to, the first thing I would do is communicate with the treatment team rather than directly confronting the patient and making it into a disagreeable situation. I think it’s more important for you to contact the clinical team, provide them with that information, get their guidance and help in how to then approach it with the patient. The best way to do this is to do it in a collegiate manner, a cooperative manner, as opposed to a paternalistic or confrontational situation, which almost never works. So the first thing to do when you notice that is to contact the clinical team, some member of the clinical team, tell them what you’re observing, ask for a meeting, get their guidance on how best to approach this. One solution, if the patient is willing to do this, is to switch them over to an injectable antipsychotic. Then you won’t have to battle with the patient everyday to take a pill. It moves more to the clinical team. If the injection is given once every 2 weeks or once a month, the only thing that has to be done is to take the patient to the clinic with that frequency and at that point they get the medication and it lasts for 2 to 4 weeks.

Thank you for listening. I wish you all well. Keep working at it: it’s a long process, long haul, and you have got to keep your spirits up.

More information

Psychiatrist Zafar Sharif This is the last of three videos. To watch the first video in the series, see Schizophrenia 1: About Schizophrenia.
Schizophrenia For more information on schizophrenia and its treatments, and some useful tools, animations and videos, see Schizophrenia.