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This article provides many hotlines and online resources for crises, including those regarding mental health.

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Need to talk to someone? Specialists are available for confidential telephone counseling and longer-term help.

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The article provides many resources for various crises, mainly originating in Georgia.

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If you or a loved one are experiencing a Mental Health Crisis:

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This article gives an insight into Schizophrenia as a disease and what it can look like in different individuals.

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Learn more about schizophrenia, including symptoms, risk factors, treatment options, and answers to your questions.

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The article by the National Institute of Mental Health gives an insight on what Schizophrenia is and the research done by the corporation further understand the disease.

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National Institute of Mental Health (NIMH)

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Learn about schizophrenia, including onset & symptoms, risk factors, treatments and therapies, how to help a loved one, & resources for more information.

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This article gives an overview on Schizophrenia and how the World Health Organization has supported the community.

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Fact sheet on schizophrenia: key facts, symptoms, causes, support, WHO response

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This article goes over different methods for those with Schizophrenia to cope and live their everyday lives.

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Substance Abuse and Mental Health Services Administration

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When schizophrenia is treated with medication and therapy, in many cases, people with the disorder can pursue their goals, have relationships, keep jobs, and be productive members of their communities.

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This article gives helpful tips to loved ones in order to support their family or friends who have Schizophrenia.

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Schizophrenia can be managed with treatment and support. You can help your loved one by being compassionate and encouraging them to stay on their care plan. This can help lead to symptom relief and better quality of life.

Schizophrenia is a mental health condition that involves a disconnect from reality.

Along with symptoms that affect concentration and memory, people living with schizophrenia experience psychosis, which includes hallucinations and delusions.

They might lose interest in their usual activities, have difficulties with self-care, and withdraw from loved ones.

These symptoms can have a far-reaching impact. Not only do they often make daily life difficult and contribute to emotional distress, but they can also lead to isolation, sleep problems, or substance use - any of which can affect well-being and complicate treatment.

If your loved one lives with schizophrenia, you might wonder how you can best offer support. Here's a look at seven ways to help, along with some tips on what to avoid.

When you recognize and understand the symptoms of schizophrenia, your loved one's behavior may seem less confusing or frightening.

There's a lot of stigma around schizophrenia, much of which relates to key symptoms of psychosis:

Delusions, or beliefs not supported by factual evidence. They might believe someone is poisoning their food, that they have special powers, or that some outside organization controls their behavior.

Hallucinations, or seeing, hearing, and feeling things no one else can. They might hear music, voices that say cruel things, or see and touch animals that aren't really there.

Cognitive symptoms, including trouble concentrating, speaking clearly, or answering questions. They might use words or phrases that don't make sense, say things you can't understand, or repeat the same phrases.

Someone with schizophrenia might believe they're really a celebrity or a historic or religious figure.

They might also make unusual or jerky motions and move restlessly. And they might seem agitated or upset.

It's a myth, though, that schizophrenia automatically makes someone violent or dangerous.

When your loved one describes their hallucinations or delusions, you might feel uncertain about how to respond.

It's natural to not know what to say, but you can still validate their confusion, frustration, and fear - even when you don't fully understand their experience.

Instead of dismissing these symptoms as lies or stories, remember the things they see, hear, and believe are completely real to them.

Consider how you'd feel and how you'd want others to support you if you firmly believed something that everyone else denied.

They might seem disinterested in talking and offer "flat" responses, but difficulty expressing emotion is a common schizophrenia symptom.

You might also notice their speech patterns seem unusual or unfamiliar, and you might not always understand what they're trying to say.

All the same, give them time to express themselves in their own way. Let them talk without trying to finish their sentences or fill in blank spaces. It may take more time to have a conversation, but making the effort can help them feel supported and connected.

You might want to do whatever you can to make things easier for your loved one. Maybe you have plenty of suggestions or advice for changes they can make to improve their well-being.

They're still their own person, though, and they might not need or want you to take complete charge.

Instead, ask, "What can I do to help you out?"

Or try making suggestions that still leave them in control:

"I noticed you don't have many clean clothes left in the closet. Would it help if I threw in a load of laundry for you?"

"Do you need groceries? I can take you to the store today."

"I was thinking we could make dinner together, but why don't we do the dishes first?"

If they say they don't need help, it's best to respect that - as long as their safety isn't at risk.

You might think getting some fresh air or tidying up would do wonders for their health. When you insist they do something they don't want to do, though, they might feel frustrated and pull back instead.

Self-isolation and social withdrawal are often early signs of schizophrenia. Your loved one might lose interest in things they used to enjoy: work or school, hobbies, and spending time with you and other loved ones.

Once they appear, schizophrenia symptoms can come and go throughout life. Creating a plan for what to do when this happens can make it easier to manage symptoms if they return or get worse.

This plan might include things such as:

key signs of a schizophrenia episode

numbers for their psychiatrist, therapist, and other professionals

strategies for coping with distress, including stretches, physical movement, or deep breathing

phone numbers for emergency contacts

their preferred first steps to getting help, such as checking in with their therapist or heading to the emergency room

a list of current medications, allergies, and other important health information

who should take care of their children or pets and look after their house

If you feel comfortable doing so, put your own number on the list and let them know they can call you in a crisis.

Also include numbers for crisis helplines that can provide immediate help and support, such as:

People with schizophrenia typically need long-term treatment and support from mental health professionals.

Medication for schizophrenia can improve symptoms and sometimes help keep them from coming back.

Therapy, on the other hand, can help people living with schizophrenia learn to recognize signs of an episode and explore strategies to manage symptoms and the distress they cause.

You can ask about treatment and offer support in positive, supportive ways without making them feel criticized or helpless.

Family therapy can also provide the opportunity for family members to get more information about treatment plans and productive ways to offer support.

Pushing them to make changes they aren't ready for, such as returning to full-time work, generally won't help.

Instead, encourage them to work toward small goals, especially things you can do together. You might try:

Many people have trouble accessing community support with finding work or living arrangements. With their permission, you can also offer support by acting as their advocate and making phone calls on their behalf.

If you're not able to offer that support, you could offer to contact someone else they trust instead.

There are plenty of ways to show support for someone with schizophrenia, but there are a few things you'll want to avoid doing.

Challenging or denying hallucinations and delusions

Many people think it's best to gently counter hallucinations or delusions by saying something like, "That's not real, or I would see it, too."

Yet these symptoms are very real to them, and denying their reality often just ends up pushing them away.

They may decide they can't trust or confide in you since you don't believe them. A lack of trust can make it more difficult to support them and encourage them to get help for symptoms.

Offering support doesn't mean pretending to believe in the hallucinations or delusions, though. You can simply say:

"It must feel so upsetting to hear those voices."

"That sounds so confusing and stressful."

Doing everything for them

When your loved one is unable to do chores, errands, or daily tasks, you might try to help by taking over those responsibilities.

But it's often more helpful to encourage them to take steps toward doing these things themselves and offering support when needed.

You can also ask if there's anything specific getting in the way of tasks:

If they haven't done laundry because they ran out of laundry soap and feel afraid of leaving the house, you could offer to do a grocery run.

If they can't prepare meals because a voice threatens them whenever they pick up a knife, you might help them chop a few days' worth of vegetables in advance.

You can also offer to help them plan and schedule out weekly responsibilities when you spend time together.

Blaming or judging

Your loved one can't help having schizophrenia, and they can't control the symptoms they experience. Even with medication and therapy, hallucinations, delusions, and other symptoms may never go away completely.

Offering compassion and respect is the best way to support them and maintain your connection, even when their behavior confuses or frustrates you.

If you feel overwhelmed or burned out, it's always OK to help them reach out to another support person or professional.

Signs of a severe episode of psychosis might include:

not recognizing their surroundings or loved ones

not knowing who they are

saying things that don't make sense

talking about hurting themselves or others

engaging in behaviors that put them in danger, such as trying to drive or go outside while disoriented

Check their crisis plan for emergency contact numbers and their preferred approach to treatment. Stay with them, if possible, or contact another support person to keep them company.

If you can't find their crisis plan and they seem very distressed, it may be time to call 911 or the nearest psychiatric hospital. Explain that your loved one has schizophrenia and that you believe they're having an episode of psychosis.

Give them space.

Avoid touching them without asking first.

Speak in a calm, quiet voice.

Keep any directions simple, clear, and easy to follow.

Narrate your actions, like, "I'm going to make a phone call now," and "Is it all right if I come to sit next to you?"

Schizophrenia is a mental health condition that may never fully go away.

Professional treatment and support can go a long way toward helping your loved one get relief from symptoms and build coping skills.

Don't forget, though, that your compassionate support can also make a big difference by motivating them to seek help for symptoms and keep up with their treatment plan.

Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she's committed to helping decrease stigma around mental health issues.

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How to Help Someone with Schizophrenia: 10 Do's and Don'ts

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Wondering how to help a loved one with schizophrenia? Here's what to do (and what to avoid), along with tips for recognizing when it's time to intervene.

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This article gives various tips to help those with Schizophrenia and reviews challenges and solutions for loved ones to aid them in their journey.

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Dealing with schizophrenia in the family isn't easy. This guide will help you navigate the challenges.

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Schizophrenic Aggression towards Family Members

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Schizophrenic Aggression towards Family Members

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This article reviews the aggressive behaviors sometimes associated with Schizophrenia and how this can appear in those diagnosed with the illness.

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Schizophrenia is a complex mental disorder characterized by abnormal thoughts, perceptions, and behaviors. One of the most challenging aspects of schizophrenia for families is dealing with aggression. In this article, we will explore strategies for managing schizophrenia-related aggression towards family members. Understanding the link between schizophrenia and aggression is crucial in developing effective approaches.

Understanding Schizophrenia and Aggression

Schizophrenia is a chronic brain disorder that affects how a person thinks, feels, and behaves. It is a complex condition that can have a profound impact on an individual's life. While not all individuals with schizophrenia display aggression, research suggests there is a correlation between the two. The exact reasons for aggression in schizophrenia are still being studied, but it is believed to be influenced by various factors such as genetic predisposition, brain chemistry imbalances, drug abuse, and environmental stressors.

Living with schizophrenia can be challenging, both for the individuals themselves and for their loved ones. It is important to approach the topic of aggression with empathy and understanding, recognizing that it is a symptom of the illness rather than a personal choice or character flaw.

The Link Between Schizophrenia and Aggressive Behavior

Aggression in schizophrenia can manifest in different forms, including verbal or physical aggression directed toward family members or caregivers. It can be a distressing experience for both the person with schizophrenia and those around them. The presence of aggression can significantly impact the quality of life and relationships of individuals with schizophrenia.

Understanding the triggers for aggression is crucial in managing and preventing such behavior. Aggression in schizophrenia can be triggered by a range of factors such as fear, frustration, paranoia, or delusions. These factors can contribute to a heightened sense of threat or a distorted perception of reality, leading to aggressive outbursts.

It is essential to remember that aggression is not a defining characteristic of schizophrenia, but rather a symptom that requires proper management. With the right support and treatment, individuals with schizophrenia can learn coping mechanisms and strategies to minimize the occurrence of aggressive behavior.

Identifying Signs of Aggression in Schizophrenia Patients

Recognizing the signs of aggression in individuals with schizophrenia is vital for both their safety and the welfare of family members. It is important to be aware of the warning signs and take appropriate measures to ensure everyone's well-being.

Increased irritability and agitation can be early indicators of potential aggression. Verbal threats, physical intimidation, or violent acts may follow if the underlying triggers are not addressed. Family members and caregivers should be vigilant in observing changes in behavior, as early intervention can help prevent escalation.

Creating a safe and supportive environment is crucial in managing aggression in schizophrenia. This can involve implementing strategies to reduce stress, such as providing a calm and structured routine, ensuring access to therapy and medication, and fostering open communication within the support network.

It is also important to involve mental health professionals in the management of aggression in schizophrenia. They can provide valuable guidance and support in developing personalized schizophrenia treatment plans that address the unique needs of each individual.

By understanding the link between schizophrenia and aggression, and by implementing appropriate strategies and support systems, it is possible to improve the quality of life for individuals with schizophrenia and create a safer and more harmonious environment for everyone involved.

The Impact of Schizophrenia-Related Aggression on Families

Living with a family member who displays aggression due to schizophrenia can have profound emotional consequences on other family members. It is not uncommon for individuals to experience feelings of fear, anxiety, and frustration. Witnessing aggression towards loved ones can lead to psychological trauma and strain family relationships.

Emotional Consequences for Family Members

Family members may experience a wide range of emotions, including sadness, anger, guilt, and a sense of helplessness when confronted with a loved one's aggressive behavior. The constant fear of unpredictable outbursts can create a constant state of anxiety within the household. This emotional rollercoaster can take a toll on the mental well-being of family members, leading to increased stress levels and a heightened risk of developing mental health issues themselves.

The sadness experienced by family members is not only a result of witnessing their loved one's aggressive behavior but also stems from the loss of the person they once knew. Schizophrenia-related aggression can drastically alter a person's personality, causing them to become unrecognizable to their family. This loss can lead to a deep sense of grief and mourning for the person they have lost, even though they are physically present.

Furthermore, family members may also experience feelings of guilt. They may question if they have done something to trigger or contribute to their loved one's aggressive behavior. This self-blame can be incredibly burdensome and can further exacerbate the emotional strain experienced by family members.

It is crucial for family members to prioritize their emotional well-being and seek support to cope with the challenges they face. Therapy, support groups, and counseling can provide a safe space for family members to express their emotions, gain insight, and develop effective coping strategies.

Strains on Family Relationships and Dynamics

Schizophrenia-related aggression can strain relationships between family members. Siblings may feel neglected or overshadowed by the attention given to the aggressive family member. The constant need to prioritize safety and manage potential conflicts can leave little time and energy for siblings to receive the attention and support they need. This can lead to feelings of resentment and a sense of being overlooked within the family dynamic.

Spouses, on the other hand, may become overwhelmed with the responsibility of managing the situation. The strain of living with a partner who displays aggression can put a significant strain on the marital relationship. The constant need to navigate potential triggers, diffuse conflicts, and ensure the safety of themselves and their children can create a high-stress environment within the household. This can lead to a breakdown in communication, increased tension, and a sense of isolation for the spouse.

It is essential for family members to communicate openly, seek understanding, and establish a support network to maintain healthy relationships. Family therapy can provide a safe and structured environment for family members to address their concerns, improve communication, and develop strategies to support each other. Additionally, seeking respite care or involving other trusted individuals in the caregiving process can help alleviate some of the burdens on family members and provide them with much-needed breaks to recharge and take care of their own well-being.

In conclusion, living with a family member who displays aggression due to schizophrenia can have far-reaching effects on other family members. The emotional consequences can be overwhelming, leading to a range of emotions such as sadness, anger, guilt, and helplessness. Furthermore, the strain on family relationships and dynamics can create additional challenges for family members. It is crucial for families to prioritize their emotional well-being, seek support, and establish open lines of communication to navigate the complexities of living with schizophrenia-related aggression.

Strategies for Managing Aggression in Schizophrenia Patients

Managing aggression in individuals with schizophrenia requires a multi-faceted approach involving effective communication techniques and appropriate medical interventions.

Communication Techniques for Diffusing Aggression

When faced with aggression, it is crucial to stay calm and avoid becoming defensive. Using non-confrontational language, active listening, and expressing empathy can help diffuse tense situations. Providing reassurance and offering an opportunity for the individual to express their concerns can also help prevent escalation.

Role of Medication in Controlling Aggressive Behavior

Medication plays a critical role in managing aggression in individuals with schizophrenia. Antipsychotic medications prescribed by healthcare professionals can help reduce symptoms such as aggression, irritability, and impulsivity. It is important for individuals with schizophrenia to adhere to their prescribed medication regimen and regularly communicate with their healthcare provider to monitor their progress.

Coping Mechanisms for Family Members

Family members supporting an individual with schizophrenia-related aggression must prioritize their own well-being. Self-care is crucial, and there are several strategies that can help family members cope with the challenges they face.

Self-Care Tips for Family Members

Engaging in self-care activities such as exercise, meditation, or pursuing personal interests can provide much-needed respite and stress relief. Taking breaks from the caregiving role, setting boundaries, and seeking support from friends and support groups can also contribute to overall well-being.

Seeking Support from Professional Services

Family members should not hesitate to seek professional help when needed. Mental health professionals, such as therapists or counselors, can provide guidance in managing the emotional impact of aggression and offer coping strategies tailored to individual circumstances. Support groups specifically designed for families of individuals with schizophrenia can also offer valuable support and understanding.

Preventing Schizophrenia-Related Aggression

While it may not be possible to completely eliminate aggression in schizophrenia, early recognition and intervention can help prevent or minimize its occurrence.

Recognizing and Responding to Early Warning Signs

Family members should be vigilant in recognizing early signs of aggression. These may include increased irritability, withdrawal from social interactions, or changes in speech patterns. By observing and addressing these warning signs promptly, families can potentially reduce the risk of escalating aggressive episodes.

Importance of Regular Mental Health Check-ups

Scheduling regular mental health check-ups for individuals with schizophrenia allows healthcare professionals to monitor their symptoms and make any necessary adjustments to their treatment plan. Regular check-ups provide an opportunity for open communication between the individual, their family, and healthcare providers, helping to ensure the ongoing management of aggression.

Managing schizophrenia-related aggression towards family members is a challenging task that requires patience, understanding, and a comprehensive approach. By promoting effective communication, prioritizing self-care, and seeking professional support, families can navigate this difficult journey and work towards maintaining a supportive and nurturing environment for all family members.

Get Help You Need

At Compassion Behavioral Health, we recognize the immense challenges faced by families dealing with schizophrenia-related aggression. Our team of dedicated professionals is committed to providing evidence-based treatments and individualized care plans tailored to address both the symptoms of schizophrenia and the associated aggressive behaviors. We believe in a holistic approach, emphasizing not just medication management but also therapeutic interventions, education, and continuous support for both patients and their families. If you or a loved one are grappling with schizophrenia and its complexities, reach out to us today. Let us walk this journey with you, offering guidance, support, and the compassionate care you deserve.

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Schizophrenia-Related Aggression & Violence Towards Family Members

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Learn strategies for managing schizophrenia-related aggression in family members. Discover the link between schizophrenia and aggression.

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Family and Friends' aid in Schizophrenic cases

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Family and Friends' aid in Schizophrenic cases

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This article gives insight on how family are friends can help their loved one that has been diagnosed with Schizophrenia.

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How can I help someone with schizophrenia?

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Find out what you can do to support someone with schizophrenia.

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This article goes over the importance of a care team for those with schizophrenia and tips for those who are a part of the care team, such as family and friends.

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Your Schizophrenia Care Team: Who Should Be on It?

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Schizophrenia treatment is effective when it includes a care team. Support teams often include family members, peers, friends, and providers.

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This article gives loved ones an encyclopedia that reviews various aspects of schizophrenia and what it looks like throughout the process of identifying the illness.

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During an episode of schizophrenia, the person may need to stay in the hospital for safety reasons.

MEDICINES

Antipsychotic medicines (antipsychotics) are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help regulate symptoms.

These medicines can cause side effects, but many side effects can be managed. Side effects should not prevent the person from getting treated for this serious condition.

Common side effects from antipsychotics may include:

Dizziness

Feelings of restlessness or jitteriness

Sleepiness (sedation)

Slowed movements

Weight gain

High cholesterol

Long-term use of antipsychotics may increase the risk for a movement disorder called tardive dyskinesia. This condition causes repeated movements that the person cannot control. Contact your health care provider right away if you think you or your family member may have this condition due to a medicine.

When schizophrenia does not improve with antipsychotic medicines, other medicines may be tried.

Schizophrenia is a life-long illness. Most people with this condition need to stay on antipsychotic medicines for life.

SUPPORT PROGRAMS AND THERAPIES

Support therapy may be helpful for many people with schizophrenia. Behavioral techniques, such as social skills training, can help the person function better in social and work situations. Job training and relationship-building classes are also important.

Family members and caregivers are very important during treatment. Therapy can teach important skills, such as:

Coping with symptoms that continue, even while taking medicines

Following a healthy lifestyle, including getting enough sleep and staying away from recreational drugs

Taking medicines correctly and managing side effects

Watching for the return of symptoms, and knowing what to do when they return

Getting the right support services

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Schizophrenia is a mental disorder that makes it hard to tell the difference between what is real and not real.

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This article provides insight into the emotional burden that loved ones may feel when caring for those with schizophrenia and the effects on family members including siblings.

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How does schizophrenia impact on families? A diagnosis of schizophrenia can have a large impact not only on the affected individuals, but also on the people closest to them. This topic considers the impact of schizophrenia on family members, and on the family as a unit. Sometimes the family of a…

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This article covers the burdens family and friends may feel due to their loved one's diagnosis of schizophrenia.

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Schizophrenia in a member of the family: Burden, expressed emotion and addressing the needs of the whole family

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How often do we find ourselves concentrating so much on treating a patient with schizophrenia that we forget about the needs and difficulties of the family members who take care of that patient? This article highlights the global and specific…

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This article covers the emotional, social, and financial loads placed upon loved ones of those with schizophrenia.

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Noreen Brady PhD, RN, CNS, LPCC

Noreen Brady PhD, RN, CNS, LPCC

Noreen Brady PhD, RN, CNS, LPCC received a bachelor's degree in nursing and a PhD from Case Western Reserve University, and a master's degree in psychiatric nursing from Kent State University in Ohio. This manuscript is related to her recently completed doctoral dissertation about the lives of families who have members with schizophrenia. She is currently an Assistant Professor and Director, Hirsh Institute for Evidence Based Practice at the Frances Payne Bolton School of Nursing, Case Western Reserve University. In addition, Dr. Brady maintains an active practice as an advanced practice nurse with seriously mentally ill clients and their families at Murtis H. Taylor Multi-Service Center, Cleveland, Ohio.Gail C. McCain PhD, RN, FAANGail C. McCain PhD, RN, FAAN received a master's degree in child health nursing from the State University of New York, Buffalo, a master's degree in sociology from Kent State University, and a PhD from Case Western Reserve University. She holds the Sarah Cole Hirsh Professorship in Nursing and is Associate Dean for Community Affairs at Frances Payne Bolton School of Nursing, Case Western Reserve University.The Sarah Cole Hirsh Institute for Best Nursing Practices of the Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA http://fpb.cwru.edu/HirshInstitute The Hirsh Institute's mission is to build a repository of best nursing practices based on research findings. Institute activities include: disseminating the most current scientific evidence on best nursing practices to clinicians, educators, administrators, and policy makers; guiding nursing research by identifying areas where scientific evidence is lacking; and conducting certificate programs for nursing staff to identify and implement evidence based practice.Acknowledgement: We thank our Hirsh Institute students, Arax Balian and Bette Idemoto, for their help with database searches and creation of the tables.

The lifetime emotional, social, and financial consequences experienced by individuals with schizophrenia have significant effects on their families. Family responses to having a family member with schizophrenia include: care burden, fear and embarrassment about illness signs and symptoms, uncertainty about course of the disease, lack of social support, and stigma. Study findings about families in which parents are hostile, critical, or overly involved are equivocal about whether this negative environment contributes to patient relapse. This review summarizes the studies related to the family responses and emotional environment of families who have a member with schizophrenia.

Key words: schizophrenia, family, behavior, expressed emotion, mental illness

Purpose
Symptoms of the condition diagnosed as schizophrenia usually first appear when an individual is an adolescent or young adult. The course of the young person's life is forever changed at this time. Frightening experiences, such as hearing voices or seeing people and scenes that seem real but are not; feeling threatened by dangerously powerful but unknown forces; losing the ability to concentrate, remember, and follow the topic in normal conversations or a TV show; as well as losing the "will" or energy to accomplish activities of daily living, are often expressions of this condition. Trying to cope with these experiences often results in behaviors leading to social isolation and withdrawal, and interferes with individual development and family life. While 20 to 25% of those diagnosed with schizophrenia will experience remission, about 50% of affected adolescents or young adults will continue to have persistent or intermittent symptoms.

Although newer medications contribute to some optimism related to prognosis, few of these individuals will overcome significant cognitive, interpersonal, and occupational deficits. Over time, most will assume the social role of chronic mental patient. About 10 to 15 % of individuals diagnosed with schizophrenia will eventually commit suicide, often within the first ten years of illness ( Melzter, 2001; Pillmann, Balzuweit, Haring, Bloink, & Marneros, 2003). The lifetime emotional, social, and financial consequences experienced by individuals with schizophrenia have significant effects on their families. The purpose of this review is to describe the state of the research evidence about families who have an adult member with schizophrenia, and to make recommendations for nursing practice to improve care for these families.
Search Strategy
Research evidence from 1990 through February, 2004 was located through searches of MEDLINE (666 manuscripts), CINAHL (106), PsycINFO (20 manuscripts), and Social Work Abstracts (33 manuscripts). Key search terms were schizophrenia, family, and behavior. This review focuses on families' experiences of living with a member diagnosed with schizophrenia. The research related to family interventions in the case of schizophrenia is beyond the scope of this review and is not included. There are a total of 63 research reports from 1990 to 2004 and additional references to seminal works included in this review. The 63 family studies from 1990 to 2004 are detailed in Tables 1, 2, and 3.
Symptoms of Schizophrenia
Positive and negative symptoms may be conceptualized as one continuum of symptoms ( Andreasen & Olsen, 1982), or as a dichotomy of subtypes of symptoms ( Crow, 1989). As one continuum, positive symptoms anchor one end of the continuum and negative symptoms anchor the opposite end ( Andreasen & Olsen). As a dichotomy, positive and negative symptoms are unique constructs with differing pathology and prognoses ( Crow). Positive symptoms are thought to be related to dopaminergic neural transmission abnormalities, while negative symptoms are seen as consequences of gross structural brain abnormalities, such as ventricular enlargement and larger ventricle to brain ratio ( Andreasen & Olsen; Pogue-Geile & Harrow, 1984; Sommers, 1985), and associated with a greater genetic disposition ( Dworkin & Lezenweger, 1984; Seidman & Wencel, 2003). The positive symptoms such as severe thought disorders, hallucinations, and delusions are initially more overtly noticeable and bizarre than negative symptoms. These positive symptoms are responsive to neuroleptic medications to the extent that some normal activities of life may be resumed. Negative symptoms such as lack of energy, speed, volition, and poverty of speech are initially less noticeable and are less responsive to neuroleptic medication. These negative symptoms are more intractable to treatment and may contribute to lifelong disability. Related cognitive deficits also have been identified and associated with schizophrenic symptomatology ( Cornblatt, Lenzenweger, Dworkin, & Erienmeyer-Kimling, 1985; Saykin, Shtasel, & Gur, 1994; McGurk & Meltzer, 2000).

Research findings indicate a more optimistic prognosis for medication and/or treatment adherent individuals diagnosed with schizophrenia who exhibit positive symptoms, and a more pessimistic outlook for persons with schizophrenia who exhibit negative symptoms, even if the individuals adhere to medication and/or treatment plans. Unfortunately, an enduring state of deficit, or negative symptoms, is associated with poorer outcomes, more severe positive symptoms, lower levels of social adjustment, and poorer quality of life ( Mueser, Douglas, Bellack, & Morrison, 1991).

Self-reports about having schizophrenia are almost uniformly negative. Persons diagnosed with schizophrenia often exist in a world of uncertainty and threat due to symptoms such as altered sensory perceptions and false beliefs. Altered perceptions were difficult for those afflicted to describe, but most reports include heightened perceptual acuity and distortion of some aspects of the environment ( Cutting & Dunne, 1989; Hatfield, 1989; Leete, 1987). The impact of cognitive deficits also is generally reported. Abilities to remember and concentrate decrease, and organization of thought and speech become more difficult. Multiple stimuli become overwhelming and stress increases. Time becomes distorted, events become jumbled, and planning a sequence of activities becomes impossible ( Cutting & Donne; Hatfield).

Persons diagnosed with schizophrenia have reported that their first psychiatric hospitalizations were extremely traumatic. Most reports include a continuing, powerful, negative influence of this initial hospitalization, regardless of how far in the past. The initial hospitalization's impact is especially negative if seclusion or physical restraint was required. In a composite case study, Cohen ( 1994) likens the experience to captivity-induced trauma, in which terror, loss of self-autonomy, and total helplessness are involved. Describing frequent hospitalizations, Leete ( 1987) notes, "During my late teens and early 20's, when my age demanded that I date and develop social skills, my illness required that I spend my adolescence on psychiatric wards. To this day, I mourn the loss of those years" (p.487).

One of the greatest sources of pain reported by persons with schizophrenia is the loss of personal identity as a normal person. This is a gradual process and is usually accompanied by the painful acquisition of the role of "schizophrenic" or "mental patient" ( Bouricus, 1989; Brekke, Levin, Wolkon, Sobel, & Slade, 1993; Estroff, 1989; Lally, 1989). Acquiring the role of mental patient is especially difficult during adolescence, a stage when peer acceptance is crucial. Lopez ( 1991) found three-quarters of normal adolescents considered the mentally ill to be unpredictable and erratic. She also discovered adolescents would reject any hypothetical social or personal involvement with a psychiatrically-labeled adolescent patient, even if the normal adolescent's attitude was benign toward schizophrenic persons in general. Thus, social isolation from peers and withdrawal from the environment, as well as internal responses to symptoms, may intensify the pain of an altered identity during the transition to the role of schizophrenic or "mental patient."
Family Responses from Westernized Countries
The family has been portrayed as a negative, toxic influence on the family member diagnosed with schizophrenia in much of the psychiatric and family literature. In fact, parents and parental relationships have been frequently identified as the cause of the initial psychotic episode, as well as later relapse. Much of this literature (see Table 1) focused on the emotional climate of the family and the family home environment.

Table 1. >>> Family Responses to Schizophrenia

Author(s), Publication date

Study type*

Sample size, important character-istics

Intervention
/Procedure

Results

Country

Boye et al., 2001

Descriptive

n = 50 relatives of patients with schizophrenia

- Relatives distress related to their report of problematic patient behaviors, especially anxious and depressed behaviors

Norway

Czuchta & McCay, 2001

Descriptive

n = 20 parents of individuals with schizophrenia

- Stigma and stress reported to increase the burden of care giving
- Increased parental education decreased uncertainty about schizophrenia

Canada

Magliano et al., 1998

Descriptive

n = 236 relatives of individuals with schizophrenia

- Family burden related to constraints on social activities, negative effects on family life, and feelings of loss
- Most common coping strategies were positive communica-tion with patient and involving patient in family/ social activities

Italy

Schene, van Wijngaarden, & Koeter, 1998

Descriptive

n = 480 members of a Dutch family organization for individuals with schizophrenia
/chronic psychosis

Involvement Evaluation Questionnaire (IEQ)

- Caregiving included: tension, supervision, worrying, urging strongly related to the patient's symptoms

Netherlands

Winefield & Harvey, 1994

Descriptive

n = 121 family caregivers of individuals with schizophrenia who had been diagnosed an average of 14 years

Interviews

- Burden defined as interference in family & social relationships
- 51% of caregivers' total stress was attributed to having a family member with schizophrenia
- Majority critical of mental health professionals.
- Expressed need for professional help and information.

South Australia

Many family reports of the caregiving burdens of living with someone with schizophrenia are negative ( Czuchta & McCay, 2001; Martens & Addington, 2001). The uncertain course of the disease, disturbing behavior, loneliness, lack of external support from other than family members, lack of reciprocity in relations with the patient, continual grieving for the member's lost potential, and fear of unpredictable mood changes including violent outbursts, are identified as problems by family members of chronic patients ( Boye et al., 2001; Brown & Birtwistle, 1998; Gerace, Camilleri, & Ayres, 1993; Holzinger, Kilian, Lindenbach, Petscheleit, & Angermeyer, 2003; Howard, 1998; Magliano et al., 1998; Rose, 1998; Saunders & Byrne, 2002; Winefield & Harvey, 1994).

The basis of family reaction to their relative's schizophrenia-associated symptoms often was rooted in how the family interpreted these symptoms. Families reported the most distressing symptoms exhibited by the relative with schizophrenia to be related to negative symptomatology, such as lack of energy, lack of purposeful activity, and a generalized unresponsiveness ( Bibou-Nakou, Dikaiou, & Bairactaris, 1997; Hinrichsen & Lieberman, 1999; Weisman, Nuechterlein, Goldstein, & Snyder, 1998). Families often attributed these negative symptoms to their ill relative's personality and perceived character flaws, unaware that these negative symptoms are characteristic symptoms of schizophrenia. Often families thought that the member with schizophrenia's symptomatic behaviors were purposely designed to aggravate, annoy, or provoke other family members ( Hooley & Campbell, 2002).

Additionally, parents, spouses, and siblings are often unable to deal with their own individual or family developmental needs because the focus is so often on the relative with schizophrenia and sequelae of the illness. Siblings and parents are often embarrassed by the symptoms and behaviors of the ill member and avoid bringing others to the home ( Anonymous, 1994; Brady, 2004; Espina, Ortego, Ochoa do Alda, & Gonzalez, 2003; Friedrich, Lively, & Buckwalter, 1999; Greenberg, Kim, & Greenley, 1997). Most studies have found a relationship between negative family environments and relapse ( Hooley & Campbell, 2002; Weisman, Nuechterlein, Goldstein, & Snyder, 2000; King & Dixon, 1995; Stirling et al., 1993), while only one study did not ( King, 2000). In Brady's ( 2004) recent study, mothers expressed painful memories of having been accused of causing schizophrenia in their children. The mothers worried about their sons' fates after their own deaths. Marital discord, divorce, and feeling trapped in an unhappy marriage were related to having adult offspring with schizophrenia ( Brady). Thus, normal social interactions that are instrumental in building and keeping a social network for all members are often precluded in families with a member labeled schizophrenic.

Much of the difficulty that families face with an adult child labeled mentally ill centers around conflicting functions of both caring for the child and acting as an agent of social control ( Reinhard, 1994; Milliken, 2001). In western culture, parental care is expected for the child, but not after a certain age. For families with children who are diagnosed with schizophrenia, successful "launching" of a young adult never happens. In a society that values hard work, individual initiative, and independence, the person with schizophrenia is often seen in an unsympathetic light. Negative symptoms such as lack of initiative, motivation, and inability to study or work effectively, are often seen as laziness or a desire to remain dependent on family or society. Deficits in social role performance on the part of the ill family member were the greatest factor contributing to family care burden ( Bibou-Nakou et al., 1997; Birchwood & Cochrane, 1990). However, family burden has been associated with both positive and negative symptoms ( Mueser, Webb, Pfeiffer, Gladis, & Levinson, 1996). The family must attempt to enforce social norms of hygiene and behavior on the frequently uncooperative ill member. Often the ill family member denies the diagnosis of schizophrenia, and the need for continued treatment, as well as the need to comply with socially accepted norms of hygiene.
Expressed Emotion
Concern with the emotional climate of the home and its influence on the family member with schizophrenia began in the 1950s. Therapists working with families who had an identified member with schizophrenia noted unclear, confusing, and conflicting communication patterns in family sessions ( Bateson, Jackson, Haley, & Weakland, 1981; Haley, 1981; Schaffer, Wynne, Day, Ryckoff, & Halperin, 1962). These patterns were viewed as reflecting dysfunctional family structures and relationships, and were thought to contribute to the development and persistence of schizophrenia-associated symptoms in the ill family member. In addition to unclear and ambiguous communication, these families were perceived to have a culture of shared denial of feelings and to be overly involved or "enmeshed" with each other. Early researchers also noted that families who had a member with schizophrenia had exceptionally weak generational boundaries.

Concepts such as Expressed Emotion (EE) ( Brown, Birley, & Wing, 1972; Vaughn & Leff, 1976); Affective Style ( Doane, West, Goldstein, Rodnick, & Jones, 1981), and Communication Deviance ( Schaffer et al., 1962) also were proposed to represent characteristics of deviant family emotional climate. Seminal studies by Brown and colleagues, and Vaughn and Leff indicated relapse rates four times higher for patients with schizophrenia who were discharged to parents who were hostile, critical, or overly involved, compared to patients whose parents who did not behave this way. The differences were found regardless of social factors and patients' symptoms. Family tolerance of expressions of feelings and problems, as well as less conflict in the home, also were found to be associated with better patient adjustment and decreased relapse ( Spiegel & Wissle, 1986).
Emotional Climate: Measurement
The majority of studies on family emotional climate have focused on expressed emotion, a measure of hostile, critical, or overly involved parental attitudes toward the patient, measured by the Camberwell Family Interview (CFI) ( Vaugh & Leff, 1976) The CFI requires extensive training to learn and takes approximately 90-minutes to administer. The Five Minute Speech Sample (FMSS) is a shorter tool and measures the same concepts ( Shimodera, et al., 1999). Both the CFI and the FMSS result in a categorical dichotomous variable thought to represent the family environment (i.e. high or low expressed emotion). Some have used the Family Environment Scale (FES) instead of the CFI, citing ease of administration, scoring, and increased validity to determine the emotional quality of the home environment ( Moos & Moos, 1994). Schnur and colleagues ( 1986) suggest the FES's conflict score may be analogous to the CFI's critical comments, and that an inverse relationship may exist between the CFI's emotional over-involvement and the FES's expressiveness scores.
Emotional Climate: Studies from 1990-2004
Few studies have focused on the effect of EE in families with a member who has a diagnosis of recent-onset schizophrenia ( Bachmann et al., 2002; Stirling et al., 1991, Stirling et al., 1993). Studies that have focused on EE are presented in Table 2. Stirling and colleagues' ( 1991) initial study did not find an association between high Family EE and relapse rates. A follow-up study eighteen months later did find a significant association between high family EE and relapse rates. In the follow-up study, 10 of 11 patients from high EE families relapsed, compared to 7 of 19 patients from low EE households. The studies are considered significant because they suggest a possible developmental course for EE within families related to the stresses of living with a family member with schizophrenia. However, Bachmann and colleagues ( 2002) failed to find differences in EE between relatives of first episode patients and those with a chronic diagnosis of schizophrenia. The assumption that negative parental attitudes create a toxic environment for the family member with schizophrenia ignores the reciprocal transaction between the family member and the parents. Family friction, disruption, social embarrassment from psychotic behavior, stigma, worry, guilt, and depression were frequently cited as examples of negative effects on parents and other family members ( Angermeyer, Schultze, & Dietrich, 2003; Schene, van Wijngaarden, & Koeter, 1998; Oldridge & Hughes, 1992).

Table 2. >>> Expressed Emotion

Author(s), Publication date

Study type*

Sample size, important character-istics

Intervention
/Procedure

Results

Country

King, 2000

Descriptive

28 patients with schizophrenia & their mothers

Brief psychiatric Rating Scale (patients)
Camberwell Family Interview (mothers)

Canada

Scazufca & Kuipers, 1998

Descriptive

n = 36 relatives of patients with schizophrenia at hospital discharge & 9-months post discharge

Camberwell Family Interview
Social and Behavior Assessment Schedule (Adverse Effects on Others' section)

England

Scazufca & Kuipers, 1996

Descriptive

n = 50 patients with schizophrenia & 50 relatives living with or in close contact with patients

Camberwell Family Interview
Social & Behaviour Assessment Schedule for burden (families)
Present State Examination
Social Role Performance Schedule
Social Behaviour Schedule (patients)

- High EE relatives reported higher burden of care, & perceived more deficits in patients' social role performance compared to low EE relatives

England

King & Dixon, 1995

Descriptive

n = 69 schizophrenia outpatients & 108 relatives

Camberwell Family Interview
Family Adaptability and Cohesion Evaluation Scale (families)
Social Adjustment Scale
Brief Psychiatric Rating Scale (patients)

- Patient relapse was greater in high EE families (51%) compared to low EE families (17%)

Canada

Sayers et al., 1995

Descriptive

n = 57 patients with schizophrenia & their relatives

- Severity of symptoms & patients' social skills were not related to relatives' negativity
- Quality of communica-tion in patient-relative dyad discussions was related to each participant's level of negativity

USA

Snyder, Wallace, More, & Lieberman, 1994

Correla-tional

n = 15 residential care operators & 30 residents with schizophrenia

Camberwell Family Interview
Five Minute Speech Sample (operators)
Family Environmental Scale
Lehman Quality of Life Scale
Brief Psychiatric Rating Scale

- Home operators had lower EE than family members
- Home operators EE related to residents' QOL & symptom level

Smith, Birchwood, Cochrane, & George, 1993

Descriptive

n = 49 family members living with or in close contact with a patient with schizophrenia

Camberwell Family Interview
The Knowledge Questionnaire
Family Distress Scale
Symptom Related Behaviour
Disturbance Scale
Symptom Rating Test
Social Function Scale

UK

It is not clear what accounts for high EE among families. High EE in families has been associated with: (a) parental disengagement and less connectedness ( McCreadie, Williamson, Athawes, Connolly, & Tilak-Singh, 1994; Wuerker, Fu, Haas, & Bellack, 2002; Wuerker, Haas, & Bellack, 2001), (b) attribution of control over illness to patients ( Harrison, Dadds, & Smith, 1998; Weisman et al., 1998, 2000), (c) patient symptoms of aggression and hostility ( Hall & Docherty, 2000; King, 2000; Rosenfarb, Goldstein, Mintz, & Nuechterlein, 1995), and (d) greater care burden ( Barrowclough & Parle, 1997; Scazufca & Kuipers, 1996, 1998; Smith, Birchwood, Cochrane, & George, 1993). Only one study did not find a relationship between negativity on the part of relatives and severity of patient symptoms ( Sayers et al., 1995). Despite this one study, there is evidence that both family and patient characteristics play a part in EE.

Thus, rather than a cause of relapse, parental attitudes toward the patient may be part of a more complex and dynamic phenomenon reflected in the family emotional environment. Expressed Emotion has been identified and quantified in residential care operators, and has been reflected in the evaluations residents with schizophrenia make about their environments using the Family Environment Scale (FES) ( Moos & Moos, 1994). Results indicated that home operators were generally less critical, less hostile, and less overly involved compared to family members. However, in cases where high EE was found in the residential care homes, patient symptomatology was higher and quality of life was poorer than low EE homes ( Snyder, Wallace, Moe, & Liberman, 1994). These findings suggest that persons with schizophrenia may be sensitive to emotional climate characteristics, and that this sensitivity is not limited only to family emotional environments. In addition, relapse rates for individuals labeled "chronic schizophrenic" are, with few exceptions, consistently higher in high EE families than low EE families, independent of symptom severity, duration of illness, or medication compliance ( Miklowitz, 1994; Stricker, Schulze, Monking, & Buchkremer, 1997). Despite recent attempts toward a more interactive, reciprocal view of family relationships and family emotional climate, negative family emotional climates continue to be regarded as a potential contributing factor to the symptoms of schizophrenia.

There is little evidence about whether EE is experienced in the same manner among American minority groups as it is for Caucasians. In general, lower rates of EE have been reported among Mexican-American families compared to Caucasian families ( Kopelowicz et al., 2002; Weisman, Gomes, & Lopez, 2003). Furthermore, high EE family environments did not predict relapse for Mexican-Americans as it did for Caucasians ( Kopelowicz et al.).

For the most part, studies reviewed on emotional climates lacked a clearly articulated, comprehensive, theoretical framework. Overall, family dynamics have been studied from a perspective of dysfunction and pathology. The most commonly studied concept was EE in which the number of critical, hostile, or over-intrusive comments by the primary caregiver was counted. The time frames for collecting data on emotional climate were varied in these studies. Additionally, family climates were evaluated in some studies prior to hospitalization and in other studies post discharge.

Communication deviance also has been used as a measure to identify negative family environments. This concept is defined as unclear or incomplete messages and excessive speech rates that result in poor understanding on the part of the receiver. There is some evidence that communication deviance is greater for parents of offspring with schizophrenia ( Docherty, 1993). Communication deviance is associated with patients' symptom severity and relapse ( Velligan et al., 1996; Velligan, Funderburg, Giesecke, & Miller, 1995), and with high EE ( Docherty, 1995).

That relapse and re-hospitalization are negative results of a toxic family emotional climate also may be a flawed assumption. In cases where the family climate is negatively charged, relapse and re-hospitalization may not be perceived as negative by the individuals diagnosed with schizophrenia and their families. Patients with schizophrenia may benefit from the less emotionally-charged environment of a psychiatric hospital, while family members may view re-hospitalization as a respite from the stresses of living with a symptomatic family member.
Family Responses and Expressed Emotion Studies: Non-Westernized Countries
Unlike family studies from western countries, findings from Asian, African, and Middle Eastern countries suggest that some positive aspects are associated with living with a family member who has schizophrenia (see Table 3). Schwartz and Gidron ( 2002) found that Israeli parents reported satisfaction from their care giving roles for their ill relatives. Additionally, Yamashita ( 1996) found that Japanese couples reported feeling increased closeness and support resulting from care giving activities. However, families in other studies reported similar stresses and care burden as found in the family reports from westernized countries ( Wong & Lok, 2002; Rungreangkulkij & Chesla, 2001; Srinivasan & Thara, 2001; Karanci, 1995; Salleh, 1994; Shibre et al., 2001).

Similar to western countries, higher levels of EE among Israeli and Japanese families were associated with higher relapse rates for the family members with schizophrenia compared to those from low EE families ( Marom, Munitz, Jones, Weizman, & Hermesh, 2002; Mino et al., 1998; Tanaka, Mino, & Inoue, 1995). The popular belief is that families in under-developed rural areas have less negative attitudes toward the mentally ill, and that the less negative attitudes are protective against relapse. In contrast to this, others reported that urban Chinese family members expressed more warmth and positive remarks to their ill relatives than rural families ( Ran, Leff, Hou, Xiang, & Chan, 2003).

Table 3. >>> Studies from Asia, the Middle East, and Africa

Author(s), Publication date

Study type*

Sample size, important character-istics

Intervention
/Procedure

Results

Country

Ran, Leff, Hou, Xiang, & Chan, 2003

Descriptive

n = 71 family members of individuals with schizophrenia
49.3% from rural area
50.7% from urban area
M age = 36 yrs, M illness duration = 8 yrs

Mandarin Chinese version of the Camberwell Family Interview (CFI) for EE

- Low level of EE predominated (72% rated low EE)
- Relatives used fewer critical comments and less emotional over involvement (EOI) than respondents in similar Western studies
- Urban residents expressed more
warmth, positive remarks, and EOI than rural residents

China

Shibre et al., 2001

Descriptive

n = 178 family members of individuals with schizophrenia

Interview

- 75% reported stigma due to their ill family member
- 37% wished to conceal having a mentally ill family member
- 27% attributed mental illness to supernatural forces
- 65% reported prayer to be the preferred coping method

Rural Ethiopia

Summary
The condition labeled schizophrenia is a severe mental illness incorporating the worst of both acute and chronic illnesses. Individuals with this condition experience frightening and inexplicable symptoms that may or may not respond to anti-psychotic medication, even when the individual takes prescribed medication on a regular basis. Family members are frightened and confused by their family members' strange new beliefs or behaviors, decreased energy levels, loss of motivation, or cessation of usual activities. Marital and sibling relationships are severely tested in response to the symptoms of schizophrenia. Most often families do not know how best to respond to these changes in their family member with schizophrenia, and need guidance and direction.
Recommendations for Practice
When working with families who have members with schizophrenia:

1. Listen to family care givers and acknowledge and respect the role they play in the life of the member with illness.

2. Acknowledge the difficulties associated with living with someone with this mental condition. Offer support and understanding at each encounter.

3. Provide realistic and accurate education about schizophrenia including diagnostic criteria, current treatment strategies, and prognosis. Use correct terminology and provide thorough explanations using lay language.

4. Assure that family members understand the nature of both positive and negative symptoms. Clarify any misinterpretations of negative symptoms as personality or character flaws.

5. Remind family members to care for themselves as individuals and to maintain other significant relationships.

6. Encourage parents to discuss their ill member's symptoms and behaviors with their well children. Help parents to explain on an age appropriate level that symptoms are a result of an illness or brain disease and are not deliberate acts. If the well siblings are comfortable, role-play explanations of schizophrenia-associated symptoms to their friends. If bringing friends to the home is a problem, allow well siblings to arrange activities with friends away from the home. Advise parents to try to arrange special individual times and activities with well siblings on a regular basis.

7. Refer families to the National Alliance for the Mentally Ill (NAMI). This nonprofit organization provides support, education, and advocacy for consumers and families of the mentally ill on local, state, and national levels. Suggest families consider joining a local Alliance for the Mentally Ill (AMI)-sponsored family support group. Information about NAMI including referral to local chapters and support groups may be found on the NAMI website: www.nami.org or by calling 1.800.950.6264. The mailing address is NAMI; Colonial Place Three; 2107 Wilson Blvd., Suite 300; Arlington, VA 22201-3042.

Noreen Brady PhD, RN, CNS, LPCC
E-mail: Noreen.Brady@Case.edu

Noreen Brady PhD, RN, CNS, LPCC received a bachelor's degree in nursing and a PhD from Case Western Reserve University, and a master's degree in psychiatric nursing from Kent State University in Ohio. This manuscript is related to her recently completed doctoral dissertation about the lives of families who have members with schizophrenia. She is currently an Assistant Professor and Director, Hirsh Institute for Evidence Based Practice at the Frances Payne Bolton School of Nursing, Case Western Reserve University. In addition, Dr. Brady maintains an active practice as an advanced practice nurse with seriously mentally ill clients and their families at Murtis H. Taylor Multi-Service Center, Cleveland, Ohio.
Gail C. McCain PhD, RN, FAAN
Gail C. McCain PhD, RN, FAAN received a master's degree in child health nursing from the State University of New York, Buffalo, a master's degree in sociology from Kent State University, and a PhD from Case Western Reserve University. She holds the Sarah Cole Hirsh Professorship in Nursing and is Associate Dean for Community Affairs at Frances Payne Bolton School of Nursing, Case Western Reserve University.

The Sarah Cole Hirsh Institute for Best Nursing Practices of the Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
http://fpb.cwru.edu/HirshInstitute

The Hirsh Institute's mission is to build a repository of best nursing practices based on research findings. Institute activities include: disseminating the most current scientific evidence on best nursing practices to clinicians, educators, administrators, and policy makers; guiding nursing research by identifying areas where scientific evidence is lacking; and conducting certificate programs for nursing staff to identify and implement evidence based practice.

Acknowledgement: We thank our Hirsh Institute students, Arax Balian and Bette Idemoto, for their help with database searches and creation of the tables.

© 2004 OJIN: The Online Journal of Issues in Nursing
Article published November 29, 2004

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November 29, 2004

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key words: schizophrenia

# data[].attributes.attachment_link.title
Living with Schizophrenia: A Family Perspective

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The lifetime emotional, social, and financial consequences experienced by individuals with schizophrenia have significant effects on their families. Family responses to having a family member with schizophrenia include: care burden, fear and embarrassment about illness signs and symptoms, uncertainty about course of the disease, lack of social support, and stigma.

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This article expresses the extent to which loved ones must look after themselves as a result of the diagnosis of a mental illness in a loved one.

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Family and friends of someone living with a condition often share similar experiences. People living with mental health condition can be helped in many ways by family and friends. It is not uncommon for family and friends to focus a large portion of their attention and energy on their loved one. However, it is important to look after yourself too.

Getting mental health help early

It's important to look out for early warning signs of mental health conditions in a family member or friend. Some early warning signs include:

Changes in mood

Erratic or risky behaviour

Loss of motivation

Unusual thinking patterns or beliefs

Withdrawal from usual activities

The sooner the person receives support and treatment, the better the outcome is likely to be. It can help to:

Encourage the person to speak with a doctor about their concerns.

Speak with your own doctor about your concerns and what options might be available if the person is reluctant to see their doctor.

Common reactions to mental health problems

Mental health conditions often has a 'ripple effect' on families, creating tension, uncertainty, stress and sometimes significant changes in how people live their lives. Different family members are likely to be affected in different ways.

It's normal to feel a whole range of emotions, such as guilt, fear, anger and sadness. Acknowledging these feelings can be the first step towards working through them.

No one is to blame when a person is affected by mental health conditions.

Taking care of yourself

Sometimes caring for someone living with a mental health condition can increase your own risk of mental and physical ill health. It is important to look after yourself and know your limits.

It can be helpful to:

Learn as much as you can about the relevant mental health condition, treatment and what are available in your area. This also helps in understanding what's going on for your loved one and knowing how you can help.

Find out if there are education and training courses for carers that you can attend.

Understand that symptoms may come and go, and vary in severity. Different levels of support may be required for yourself and your loved one at different times.

Develop a sense of balance between your own needs and the needs of the person you care for.

Consider contacting a support group for carers or relatives and friends of people with mental health conditions.

It might be helpful to decide what level of support and care you are realistically able to provide to the person. Engage in a supportive conversation with your family member or friend (as well as mental health professionals) about the type of support you can provide. This can help ensure that any types of support you are unable to provide can be arranged in another way.

Talk to the person's doctor, case manager, or mental health professional about what types of professional support are available to help you. This might include options such as psychological therapies or counselling, peer support, respite, rehabilitation programs, or NDIS eligibility.

Structure can be an important part of developing and maintaining good self-care strategies as well as supporting the recovery for people living with a mental health condition. Plans may include:

develop predictable routines - for example, regular times to get up and eat. Introduce gradual changes to prevent boredom

break tasks into small steps - for example, discuss with the person what steps would help with daily self-care

try to overcome any challenges with motivation - for example, encourage and include the person in activities

encourage the person to make decisions - sometimes this can be difficult for a person who is unwell, or they may keep changing their mind. Try to resist the temptation to make the decision for them.

Supporting someone who may have suicidal thoughts

If you think a friend or relative is at risk of , discuss your concerns with them openly and non-judgmentally. Rather than putting the idea of suicide into someone's head, a supportive conversation gives them the opportunity to acknowledge and talk about their distress. Encourage, or help, the person to access professional help, such as their mental health professional. To stay safe, suggest they contact a helpline such as:

If the person is at serious risk of suicide, stay with them if possible and contact the psychiatric emergency team at your local hospital. Or, call 000 and explain that the person is suicidal, has made a plan, and you have concerns for their safety. Keep these numbers readily available in case you need urgent help.

Managing aggressive or violent behaviour

Aggression and violence are not necessarily common features or symptoms of mental health conditions. But they can be associated with some mental health conditions, because of the higher likelihood of experiencing emotional states that can lead to episodes of aggression or violence (such as periods of confusion, distress or high emotional arousal).

If someone is persistently aggressive, report any actual or threatened violence to their treating health professionals immediately (and the police, if necessary). If you live with someone who is persistently aggressive, you may need to seriously consider ways you can stay safe, including possibly living apart or working with a family violence service.

Where to get help

Your

are full of people who want to talk to you and offer support.

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You can do a lot to help your friend or relative with a mental illness, but you need to look after yourself too.

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This article emphasizes the effects that mental illnesses have on relationships with loved ones after a diagnosis.

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A survey showed that more than 80% of patients agreed that their mental health conditions had had a detrimental effect on their family.

Mental health issues can be an extremely painful and traumatic time for all of the family and have huge impact on a family's financial and emotional components. When it comes to mental illness, the emotional and behavioural consequences for family members go largely ignored. It is clear that individuals' mental health problems have consequences for others within their social networks, most notably, their family.

Looking after a family member with a mental illness can be an extremely stressful time and coping with stress may rouse various reactions such as somatic problems (migraines, loss of appetite, fatigue, and insomnia), cognitive and emotional problems (anxiety, depression, guilt, fear, anger, confusion) and behavioural troubles (changes in attitude, and social withdrawal).

According to a Swedish study, one half of family members claimed they had developed psychological or social problems (such as sleeping problems and depression) of their own, to such an extent that they also needed help and support.

However, whilst the influence of poor mental health on families is largely misunderstood, the consequences are extremely apparent to those actually suffering from mental illness. Those surveyed by Priory reported that their emotions and behaviour put "extra stress" on their family, with one patient reporting that: "my addiction affected everyone close to me." Another mentioned that they "isolated" their family and some even reported being physically violent towards members of their own family. Nearly all mentioned that their loved ones became upset and worried about them.

Another area highlighted by the survey was the effect that mental health had on patients' children. Children are often too young to fully grasp the consequences of mental illness and find it difficult to understand why their parent isn't well or is acting unusually. Therefore, many tend to blame themselves and grow up feeling different, lonely, and isolated. Ultimately this may lead to the child developing mental health concerns as well as other psychological, behavioural, and social problems.

Family life can become unsettled and unpredictable as the needs of the ill become paramount. Studies show that a large number of family members have had to, on one or more occasions, leave their job, whilst others said they have had to give up their recreational pursuits. Social lives are usually the first to go as they may feel nervous about inviting people into their home and find it difficult to open up to people about their relative's problems.

Dr Niall Campbell (MBBS, MRCPsych), Consultant Psychiatrist at Priory Hospital Roehampton (London): "It is easy for family members to feel guilt or blame themselves for their relative's decline in mental health. For a long time, parents and other family members were the focus of blame for the occurrence of psychological problems.

"This was largely due to Freud's early psychoanalytic theory which states that problems in adulthood are due to early childhood experiences. Other psychological theories have developed since then and we now know that the family actually plays a huge role in their relative's recovery.

"It has always been clear to us how much illness and addiction can affect a patient's family. This survey was excellent in outlining the main areas and relationships that are influenced. At Priory, we always try to treat holistically so that the family are always involved and understand what is happening."

Dr Niall Campbell (MBBS MRC Psych), has been a consultant adult general psychiatrist since 1996, initially completing 6 years in the NHS at Tolworth Hospital.

In 2002, Dr Campbell joined Priory Roehampton as a full time adult general psychiatrist. In 2013, he additionally became lead consultant for addictions. Dr Campbell has considerable experience treating patients with affective disorders including depression and bipolar disorder; psychotic disorders such as schizophrenia; and anxiety states including panic disorder and post-traumatic stress disorder (PTSD).

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# data[].attributes.attachment_link.title
Does mental health affect and impinge on family relationships?

# data[].attributes.attachment_link.description
A survey showed that more than 80% of patients agreed that their mental health conditions had had a detrimental effect on their family. Mental health issues can be an extremely painful and traumatic time for all of the family and have huge impact on a family's financial and emotional components.

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This video overviews schizophrenia and its symptoms, causes, and treatment options.

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How to Support Someone with Schizophrenia

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How to Support Someone with Schizophrenia

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This video gives tips for loved ones on how to aid and help anyone with schizophrenia.

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How to Support Someone with Schizophrenia/Schizoaffective Disorder

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This article gives an overview of the steps needed to take for those with financial issues relating to a mental illness.

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Government Programs and Financial Assistance for Mental Health

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Learn more about financial programs designed to support people with short and long-term mental health difficulties to stay out of debt and live a better life.

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This article outlines the steps needed to qualify for a grant from the PAN Foundation for those diagnosed with schizophrenia.

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The PAN Foundation opens new schizophrenia patient assistance fund  - PAN Foundation

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PAN partners with the Schizophrenia & Psychosis Action Alliance and launches a program to help people with schizophrenia pay for medications.

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This article goes over the steps and various resources to improve the lives of those with mental illness.

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SAMHSA Grant-Related Contact Information

Grant Announcement Questions?
Contact the person(s) listed under "Agency Contact" in the Notice of Funding Opportunity (NOFO)
Sign Up for Email Updates about Grant Funding Announcements

Problems Submitting Your Application on Grants.gov?
Contact the Grants.gov Helpdesk:
support@grants.gov (link sends e-mail)

General Grants Questions?
Call SAMHSA's Division of Grants Management at 240-276-1400

More Contact Information

eRA Commons Technical Questions?
Contact the eRA Service Desk
Web Support
Submit a Web Ticket (preferred method of contact)
Toll-Free: 1-866-504-9552
Phone: 301-402-7469 (Press 6 for SAMHSA Grantees)
Hours: Mon-Fri, 7 a.m. to 8 p.m. EST (closed on federal holidays)

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Note: A significant change has been made to the registration process for the System for Award Management (SAM). Please refer to the FAQs on the SAM website.

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This article gives the resources available for those with schizophrenia to apply for financial aid.

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HealthWell Foundation Launches Fund to Assist Patients Living with Schizophrenia

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Copayment and Premium Assistance Available to Eligible Patients with Government Insurance GERMANTOWN, Md. — October 28, 2024 — The HealthWell Foundation®, an independent non-profit charitable organization that provides financial assistance for underinsured Americans, announced today that it has launched a new fund to assist governmentally-insured people living with schizophrenia. Through…more.

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This foundation provides grants for those with mental illness and gives the steps to apply.

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We provide reintegration grants to assist those suffering from mental illness specifically schizophrenia to provide them valuable support.

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How to Find Schizophrenic Support Groups

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How to Find Schizophrenic Support Groups

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This article advises on how to find various support groups and acts as a guide to support groups.

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Schizophrenia support groups: For family, online, and more

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Support groups can help people with schizophrenia manage their symptoms and function well. Learn more about schizophrenia support groups here.

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This article helps those connected to schizophrenia find support groups and provides various sources to receive help.

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Living With Schizophrenia? A Support Group Might Help.

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Online schizophrenia support groups are a great resource for anyone living with the condition. Here are our best picks.

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This article is a foundation that provides various support groups and explains how to find the right one depending on one's situation.

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NAMI support groups are peer-led and offer participants an opportunity to share their experiences and gain support from other attendees. Los Grupos de Apoyo están disponibles en Español. Por favor comuníquese con su organización NAMI estatal para obtener más información.

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This article links to an organization that offers peer support groups for those connected to schizophrenia.

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Schizophrenia & Psychosis Action Alliance - The Schizophrenia and Psychosis Action Alliance stands for hope and recovery through the promotion of education, support programs, & better public policy

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Peer Support Groups - Schizophrenia & Psychosis Action Alliance

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Our support groups are helping restore dignity and a sense of purpose for people experiencing Schizophrenia and their families

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This article gives an overview for families to use for help after a diagnosis of mental illness.

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When your mental health is off, you want to get help to make it better. Fortunately, there are a wide range of treatments and supports. Unfortunately, they can be hard to find or pay for. We’re here to help.