12. Managing Symptoms at Home

HALLUCINATIONS: sensory experiences not shared by others:

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• hearing voices or sounds when alone or that others do not hear
• seeing things that no one else can see
• a feeling of being touched
• smells or tastes with no reasonable explanation

Signs that someone may have hallucinations:

• Pacing
• Restlessness
• Increase social withdrawal
• Increased sleep
• Increased preoccupation with own thoughts
• Irritability



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• Talking to oneself, muttering

Coping Strategies once the person has been assessed and treated with medication:

• When the person is feeling relatively well, discuss with them what they find helpful and how you can work together to reduce the impact of the symptoms
• Provide comfort and reassurance
• Lower stimulation in person's environment, less people, turn off tv/radio. Remember that these are symptoms and perhaps remind the person of that
• Identify any current stressors that may have increased symptoms and help to reduce them (this could be as simple as a bus trip or a trip to a mall where being with crowds and strangers may increase stress levels, or perhaps, a personal problem or a family situation)
• If the hallucinations continue and are worrisome, call the mental health team or physician involved
• Provide distractions such as:
  
  • activities,

  

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  • discussion,
  • relaxation techniques (see section on stress management),
  • chores
  • competing stimuli such as television or a portable stereo (walkman or CD)

What doesn't work:

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• Attempts to reason
• Attempts to debate with the voices
• Remember that hallucinations are part of illness. Avoid emotional responses. Try to empathize with the fear, anxiety, distress. Try to ensure that the person is taking their medication.

DELUSIONS: Fixed, false beliefs:
e.g.:

• The radio/TV is sending messages to you



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• You are the Queen of England
• The RCMP are watching you, following you
• There is a plot to hurt you, etc.)

Signs that a person may have delusions:

• Fearfulness
• Suspiciousness
• Irritability
• Restlessness
• Pacing
• Preoccupation with one's thoughts



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• Refusal to maintain a routine or do activities

Coping Strategies once the person has been assessed and treated with medication:

• When the person is feeling relatively well, discuss with them what they find helpful and how you can work together to reduce the impact of the symptoms
• Provide comfort and reassurance, acknowledge their distress



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• Lower stimulation in the environment, less people, turn off tv/radio Remember that these are symptoms and perhaps remind the person of that
• Identify any current stressors that may have increased symptoms and help to reduce them (this could be as simple as a bus trip or a trip to a mall where being with crowds and strangers may increase stress levels, or perhaps, a personal problem or a family situation)
• Avoid attempts to reason or debate about the delusions



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• Avoid colluding with the delusion or joining in on it
• Avoid interpreting the delusion
• Identify the underlying feelings such as fear or anxiety and address that with the person. Say: "This is making you feel really anxious. What can we do to help that?" Or: Offer suggestions such as doing:
  
• stress management techniques



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• distractions such as activities, chores, music,
• talking about something else if possible

Again, call the physician or mental health team involved if this persists. Delusions are part of illness. Avoid emotional responses. Try to empathize with the fear, anxiety, distress. Try to ensure that the person is taking their medication.
THOUGHT DISORDER: Troubles with thinking, confusion, disorganized thoughts, racing thoughts, not enough thoughts in one's head
Signs that someone may have a thought disorder:

• Confusion
• Incoherence
• Illogicality



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• Inappropriate emotional response-e.g..laugh at something sad
• Difficulty communicating so that you may have trouble following their line of thought
• Long silences while in conversation
• Anxiety
• Restlessness
• Pacing
• Irritability

Coping Strategies once the person has been assessed and treated with medication:

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• Structure in one's day - having a daily routine
• Limits and expectations
• Using simple words, short sentences
• Ask the person to repeat instructions back to you
• Lower stimulation in the person's environment e.g. turn off tv, radio, less people
• Do not provide too many choices, simplify things
• Remember that these are symptoms

Again, call the physician or mental health team involved is this persists. Thought disorder is part of illness. Avoid emotional responses. Try to empathize with the fear, anxiety, distress, frustration. Try to ensure that the person is taking their medication
SUPPORTING MEDICATION REGIME
Medication is one way to reduce a person's vulnerability to stimulation. Many people are ambivalent about taking meds because of:

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• Side effects
• Others want to stop as soon as they feel better as the meds are associated with being sick
• Others may lack insight and not believe they have an illness
• Medication routine may be too complicated and confusing
• The person may forget
• The person may feel well again and not understand why they need to continue to take the medication
• Some people enjoy their symptoms and miss them when they are gone

What Helps:

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• Education about illness is the best way to prevent a reoccurrence of symptoms. People must become experts on their own illness when possible
• Listen to relatives complaints of side effects and take them very seriously. These are real and uncomfortable and there are remedies. See the doctor.
• Discuss what the meds are for and the implications of stopping them (not as a threat but as a reminder)



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• Forgetfulness: try blister packs from the pharmacy, docettes, simplified regime. Talk with the mental health worker or physician for suggestions

 

• Routine: Have the person take the medication at the same time everyday. Often associating taking the pills with an activity such as brushing teeth or eating a meal is helpful. Have them keep the pills in a very visible place, e.g. beside the toothpaste or on the kitchen table.

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• Injectable Meds: Available for some prescriptions. Usually given once every 2 weeks or once a month. An option to taking daily medication for some people.