Psychosis or psychotic episodes can be very difficult for caregivers
to know how to handle in just the right way. These episodes can be
frightening for everyone, especially the person experiencing them,
triggering extreme stress and fear which can make their symptoms
escalate. Psychosis is defined as a loss of contact with reality,
unable to distinguish between what is real and what is imaginary,
and includes delusions (false ideas about what is taking place or
who one is) and hallucinations (seeing or hearing things which
aren't there). Many times when someone is experiencing a psychosis,
they may actually be unaware that anything is wrong. It’s important
for caregivers to know how to recognize the early-warning signs
indicating that a psychosis is developing, and to know where or from
whom to seek assistance.
Some of the early warning signs to look for include: anxiety,
depression or irritability; suspicion, hostility or fearfulness;
difficulty sleeping, or unusual waking hours; appetite changes; loss
of energy, motivation and interest, or hyperactivity, or alternating
between the two; concentration or memory problems; preoccupation
with certain ideas (such as religion); social withdrawal - not
wanting to spend time with friends and family members; thinking
problems such as racing thoughts or slowed down thoughts; difficulty
meeting responsibilities such as work or study; deterioration in
self-care and personal hygiene; appearing perplexed; and personality
becoming different in some way. None of these signs by themselves
necessarily mean that a psychotic episode is about to happen,
because some may be caused by a physical illness, or by the stress
and strain of work or school, or problems with important
relationships. However, if a loved one shows several of these signs
without them going away fairly soon, or if they become more
pronounced over time, then it would be a good idea for them to seek
assistance from their mental healthcare specialist.
Knowing what to do for the symptoms of psychosis can be very
difficult because you may not know what to say or do. This can be a
very stressful and confusing time for everyone, so just know that
there isn’t really a “right” thing to say or a “correct” way to
behave or react. There are some things that you can keep in mind
that may be helpful. Try and understand what the person may be
experiencing, like hallucinations or delusions, which will seem very
real to them. Try not to take anything that they may say personally,
keeping in mind that they aren’t behaving and talking as they
normally would. Avoid long debates in which you try to convince them
that their delusions or hallucinations aren't real, because this
will make them feel like they can't talk to you about what they’re
going through. Try to find things to talk about that are neutral,
instead of concentrating on their mistaken beliefs; this will most
likely not upset them or get you frustrated. As tempting as it may
be, don’t go along with their delusions or hallucinations, just
listen and sympathize with what the person is experiencing. You
might want to say something like, although you’re finding it
difficult to understand what they are going through, you do realize
that they must be very scared, frustrated, or angry. If it’s at all
possible, try and minimize the stress and stimulation around the
home during these times. Also, when someone is experiencing or
recovering from a psychosis, they can almost seem child-like, and
may need your help in making decisions. Show your concern and care
for the person by avoiding confrontations, and not criticizing or
blaming them.
Another very important risk-factor to be aware of is that a person
who is experiencing, or who has experienced, a psychotic episode has
an increased potential for depression and suicidal thoughts. Any
threats or gestures of self-harm must be taken very seriously. Seek
medical and/or mental healthcare assistance immediately if you think
that your loved one might harm themselves. Don't be afraid to talk
to them about how they’re feeling, asking them if they feel safe, or
if they’ve been thinking about hurting themselves. To talk about
suicide does not make it happen, but can, in fact, make it possible
to take action in preventing it from happening. Another issue to
this risk-factor is that of confidentiality. Often when dealing with
someone who is mentally ill, you be placed in an ethical quandary on
what to do when the person shares “secret” thoughts or information
with you, especially regarding suicide or possible harm towards
others. This can put a huge emotional strain on you, deciding
between maintaining their confidence or looking after their best
interest. Although everyone’s experience is different, one thing
that every caregiver must do is to make sure and pass along any
information received suggesting that a person is at risk of harming
themselves or somebody else, to a doctor or other healthcare
professional, and get that person to a health professional as soon
as possible. Even if a loved one seems to be angry or feels
betrayed, you have a clear duty of care that overrides any suicidal
or homicidal pacts or plans.
Just make sure that you don’t make them any promises that can’t be
kept, but remain supportive, compassionate, and firm as to where
actual confidentiality must end. Things that you might want to say
when finding out about such plans include: "I would like to help
you”; "I can’t imagine what you’re going through, but I am ready to
listen"; "I care about you and I think it might be a good idea to
talk things over with your doctor"; "I would like to help you,
however, you need to tell me how I can best go about this"; "I can’t
keep your suicide plan to myself. I would like to arrange for us to
go and see a doctor together". Be sure to not say things like: "You
need to pull your self together and snap out of it"; "Let me tell
you about my problems, which I’m sure will help you to forget about
yours". These remarks aren’t supportive, helpful, or compassionate,
and may be dangerous.
With medication, therapy and time, your loved one may show signs of
being able to handle more responsibility, once the psychotic
episodes subside and no longer pose a constant threat. Talk to them
about how they feel when it comes to doing more things, and a good
place to begin is with self-care tasks like personal hygiene,
getting dressed, and eating scheduled meals. Start assigning simple
household chores, and observe whether they want to work alone or
with others. For example, they may like to clean the living room,
but they may not like someone else dusting in there at the same
time.
Try to encourage them gently, never forcefully, to be a part of
social gatherings when appropriate. Keep gatherings small and
intimate, with one or two relatives or friends over for dinner
instead of an all-day affair with the entire clan, like a wedding or
family picnic; this may cause frustration and stress, helping to set
the stage for another episode. Always discuss your plans with them,
and suggest going on an outing once a week, like a drive or a walk
in the country; go somewhere peaceful and quite, not hectic and
noisy like a city. If you want to take them out to eat, find a nice,
small restaurant and go during the least busy part of the day. Don’t
ask too many questions, like, "What are you thinking about?” or “Why
are you doing that?" Talk about outside events that aren’t too
emotional, perhaps discussing a movie or Television program, instead
of world affairs and politics. Know too, that it may be difficult
for them to talk about anything, but that they still enjoy your
company. In this case, consider watching television, listening to
music, playing cards, or even reading to them. Begin to encourage
them to take some responsibility, such as leaving them instructions
about starting dinner in case you’re going to be late getting home
that night. Help them learn how to deal with the stress of being out
among society by suggesting that they accompany you to a washroom if
they begin to feel panicky in a public place, until the feeling
passes.
Remember that family caregivers are often times the only friends a
loved one has, so try to be a friend as well, by inviting them to
come with you when you do different things, but never force them to
have to go. Last, but not least, always respect your loved one’s
concerns about their illness. If they ask you not to share the
nature of their disease with other family members or friends, then
don’t, even if you feel you have a lot of experience that may help
other caregivers going through the same thing. Respect, patience,
compassion and gentleness will go a long way to help you both take
control of the disease, and begin living life to its fullest again.
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