Spotting the signs of an acute schizophrenic episode
Learning to recognise the signs that you're becoming unwell can help you manage your illness. Signs can include losing your appetite, feeling anxious or stressed, or having disturbed sleep.
You may also notice some milder symptoms developing, such as:
- feeling suspicious or fearful
- worrying about people's motives
- hearing quiet voices now and again
- finding it difficult to concentrate
You may also want to ask someone you trust to tell you if they notice your behaviour changing.
Recognising the initial signs of an acute schizophrenic episode can be useful, as it may be prevented through the use of antipsychotic medicines and extra support.
If you have another acute episode of schizophrenia, your written care plan should be followed, particularly any advance statement or crisis plan.
Your care plan will include the likely signs of a developing relapse and the steps to take, including emergency contact numbers.
Read about treating schizophrenia for information about advance statements.
Taking your medicine
It's important to take your medicine as prescribed, even if you start to feel better. Continuous medicine can help prevent relapses.
If you have questions or concerns about medicine you're taking or any side effects, talk to your GP or care co-ordinator.
It may also be useful to read the information leaflet that comes with the medicine about possible interactions with other drugs or supplements.
It's worth checking with your healthcare team if you plan to take any over-the-counter remedies, such as painkillers, or any nutritional supplements, as these can sometimes interfere with your medicine.
As well as monitoring your mental health, your healthcare team and GP should monitor your physical health.
A healthy lifestyle, including having a balanced diet with lots of fruit and vegetables and taking regular exercise, is good for you and can reduce your risk of developing cardiovascular disease or diabetes. You should also try to avoid too much stress and have a regular sleep pattern.
You should have a check-up with a GP at least once a year to monitor your risk of developing cardiovascular disease or diabetes. This will include recording your weight, checking your blood pressure, and having any appropriate blood tests.
Rates of smoking in people with schizophrenia are 3 times higher than in the general population. If you're a smoker, you're at a higher risk of developing cancer, heart disease and stroke.
Stopping smoking has clear physical health benefits, but it's also been shown to improve the mental health of people with schizophrenia.
Research has shown you're up to 4 times more likely to quit smoking if you use NHS support as well as stop smoking medicines, such as patches, gum or inhalators.
Ask your GP about this or go to the NHS Smokefree website to find out more.
If you take antipsychotic medicines and want to stop smoking, it's very important to talk to your GP or psychiatrist before you stop.
The dosage of your prescription drugs may need to be monitored and the amount you have to take could be reduced.
Avoiding drugs and alcohol
While alcohol and drugs may provide short-term relief from your symptoms, they're likely to make your symptoms worse in the long run.
Alcohol can cause depression and psychosis, while illegal drugs may make your schizophrenia worse. Drugs and alcohol can also react badly with antipsychotic medicines.
If you're currently using drugs or alcohol and finding it hard to stop, ask your care co-ordinator or GP for help.
Who is available to help me?
In the course of your treatment for schizophrenia, you'll be involved with many different services. Some are accessed through referral from a GP, others through the local authority.
These services may include:
- community mental health teams (CMHTs) – these provide the main part of local specialist mental health services, and offer assessment, treatment and social care to people living with schizophrenia and other mental illnesses
- trained peer support – this involves the support of someone who has had schizophrenia themselves and is now stable, and may be available through your CMHT
- early intervention teams – these provide early identification and treatment for people with the first symptoms of psychosis; your GP may be able to refer you directly to an early intervention team
- crisis services – specialist mental health teams that help with crises that occur outside normal office hours and allow people to be treated at home for an acute episode of illness instead of in hospital
- acute day hospitals – an alternative to inpatient care in a hospital, where you can visit every day or as often as necessary
- assertive outreach teams – deliver intensive treatment and rehabilitation in the community for people with severe mental health problems and provide rapid help in a crisis situation; staff often visit people at home, act as advocates, liaise with other services (such as your GP or social services), and can also help with practical problems (such as helping find housing and work) and daily tasks (such as shopping and cooking)
- advocates – trained and experienced workers who help people communicate their needs or wishes, get impartial information, and represent their views to other people; they can be based in your hospital or mental health support groups, or you can find an independent advocate to act on your behalf
Employment and financial support
Avoid too much stress, including work-related stress. If you're employed, you may be able to work shorter hours or in a more flexible way.
Under the Equality Act 2010, all employers must make reasonable adjustments for people with disabilities, including people diagnosed with schizophrenia or other mental illnesses.
Several organisations provide support, training and advice for people with schizophrenia who wish to continue working.
Your community mental health team is a good first point of contact to find out what services and support are available for you.
Mental health charities such as Mind or Rethink Mental Illness are also excellent sources of information on training and employment.
If you're unable to work as a result of your mental illness, you're entitled to financial support, such as Incapacity Benefit.
Talk to others
Many people find it helpful to meet other people with the same experiences for mutual support and to share ideas. It's also an important reminder that you're not alone.
Charities and support groups allow individuals and families to share experiences and coping strategies, campaign for better services, and provide support.
Useful charities, support groups and associations include:
There are also other places that offer support to people with schizophrenia and other mental illnesses.
Even if you do not have a job or are unable to work, it's still important to go out and do everyday things and give a structure to your week.
Many people regularly go to a day hospital, day centre or community mental health centre. These offer a range of activities that allow you to get active again and spend some time in the company of other people.
These provide training to help you develop your work skills and support you back into work. They often have contacts with local employers.
This could be a bedsit or flat where there's someone around who is trained to support you and help you deal with day-to-day problems.
You may be offered the chance to meet regularly with a trained peer support worker who has recovered from psychosis or schizophrenia themselves.
What can family, friends and partners do to help?
Friends, relatives and partners have a vital role in helping people with schizophrenia recover, and make a relapse less likely.
Do not blame the person with schizophrenia or tell them to "pull themselves together", or blame other people. It's important to stay positive and supportive when dealing with a friend or loved one's mental illness.
As well as supporting the person with schizophrenia, you may want to get support to cope with your own feelings. Several voluntary organisations provide help and support for carers.
Friends and family should try to understand what schizophrenia is, how it affects people, and how they can help. You can provide emotional and practical support, and encourage people to get appropriate support and treatment.
As part of someone's treatment, you may be offered family therapy. This can provide information and support for the person with schizophrenia and their family.
Friends and family can play a major role by monitoring the person's mental state, watching out for any signs of relapse, and encouraging them to take their medication and attend medical appointments.
If you're the nearest relative of a person who has schizophrenia, you have certain rights that can be used to protect the patient's interests.
These include requesting that the local social services authority ask an approved mental health professional to consider whether the person with schizophrenia should be detained in hospital.
Depression and suicide
Many people with schizophrenia experience periods of depression. Do not ignore these symptoms. If depression is not treated, it can worsen and lead to suicidal thoughts.
Studies have shown people with schizophrenia are at an increased risk of suicide.
If you've been feeling particularly down over the last month and no longer take pleasure in the things you used to enjoy, you may be depressed. See your GP for advice and treatment.
Immediately report any suicidal thoughts to your GP or care co-ordinator.
The warning signs of suicide
The warning signs that people with depression and schizophrenia may be considering suicide include:
- making final arrangements – such as giving away possessions, making a will or saying goodbye to friends
- talking about death or suicide – this may be a direct statement such as, "I wish I was dead", or indirect phrases such as, "I think that dead people must be happier than us", or "Wouldn't it be nice to go to sleep and never wake up?"
- self-harm – such as cutting their arms or legs, or burning themselves with cigarettes
- a sudden lifting of mood – this could mean a person has decided to try to end their life (suicide) and feels better because of their decision
Helping a suicidal friend or relative
If you see any of these warning signs:
- get professional help for the person, such as from a crisis resolution team or the duty psychiatrist at your local A&E department
- let them know they're not alone and you care about them
- offer your support in finding other solutions to their problems
If you feel there's an immediate danger of the person attempting to end their life (suicide), stay with them or have someone else stay with them. Remove all available means of suicide, such as sharp objects and medication.