Family Therapy for Schizophrenia

Schizophrenia is a group of psychotic reactions that affect various areas of individual functions, including thinking and communicating, receiving and interpreting reality, feel and show emotions and behave in a manner that is socially unacceptable (Durand and Barlow, 2007)

Family Therapy for Schizophrenia

Family psychotherapy is an important aspect in the treatment of Schizophrenia. In general, the goal of psychotherapy is to build a collaborative relationship between the patient, family, and doctor or psychologist. Through psychotherapy, the patient is helped to socialize with their environment. Family and friends are the ones that are also very instrumental in helping patients to socialize. In the case of acute schizophrenia, patients should receive special treatment from the hospital. If necessary, he should stay in the hospital for some time so that the doctors can do with regular control and ensure the safety of patients.

But in fact, the most important is the support of the patient's family, because if this support is not obtained, the patient is not likely to experience hallucinations returned. According to Dadang, a number of people with schizophrenia also often recur even after completion of therapy for six months. Therefore, in order to hallucinations did not reappear, then the patient should continue to communicate with reality. However, the family also should not exaggerate in treating patients with schizophrenia.

According to dr. LS Chandra, SpKJ, schizophrenic patients requires attention and empathy, but the family needs to avoid being Expressed Emotion (EE) or an overreaction as overly critical attitude, indulgent, and too controlling who can actually complicate healing.

All family members should play a role in the effort to support for people with schizophrenia. Efforts to form a self help group among families who have family members with schizophrenia is a positive step (Arif, 2006).

Discussant group serves as a group therapy for the treatment of schizophrenia. According to the authors, the provision of group therapy in patients with schizophrenia are less precise. The main reason is the usual group therapy used in the rehabilitation process of drug addicts (the healing process). The basic concept is group therapy mediation problems in groups, group dynamics, or outbound (with individuals who are having the same problem).

How could the schizophrenics could do things over?
Discussant group presents some of the following on group therapy:

1. Provide education about schizophrenia, including symptoms and signs of recurrence.
2. Provide information about and monitor the effects of treatment with antipsychotics.
3. Avoid blaming each other in the family.
4. Improve communication and problem solving skills in the family.
5. Encourage patients and families to develop their social contacts, especially related to the support network.
6. Raising hopes that everything is improved, and the patient may not have to go back to the hospital.

Points 3, 4, and 5 is actually part of the process of family therapy. So maybe there is still confusion in the group of discussants on the basic concept of group therapy and family therapy.

Nursing Assessment for Schizophrenia

Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social or occupational dysfunction. The onset of symptoms typically occurs in young adulthood, with a global lifetime prevalence of about 0.3–0.7%. Diagnosis is based on observed behavior and the patient's reported experiences.

Schizophrenia is associated with a wide variety of abnormal behaviors; therefore, assessment findings vary greatly, depending on both the type and phase of the illness. The individual may exhibit a decreased emotional expression, impaired concentration, and decreased social functioning, loss of function, or anhedonia. Individuals with these particular symptoms (present in one-third of the schizophrenic population) are associated with poor response to drug treatment and poor outcome.

Although behaviors and functional deficiencies can vary widely among patients and even in the same patient at different times, watch for the following characteristic signs and symptoms during the assessment interview:

1. ambivalence coexisting strong positive and negative feelings, leading to emotional conflict
2. apathy
3. clang associations words that rhyme or sound alike used in an illogical, nonsensical manner; for instance, It's the rain, train, pain.
4. concrete thinking inability to form or understand abstract thoughts
5. delusions false ideas or beliefs accepted as real by the patient. Delusions of grandeur, persecution, and reference (distorted belief regarding the relation between events and one's self; for example, a belief that television programs address the patient on a personal level) are common in schizophrenia. Also common are feelings of being controlled, somatic illness, and depersonalization.
6. echolalia meaningless repetition of words or phrases
7. echopraxia involuntary repetition of movements observed in others
8. flight of ideas rapid succession of incomplete and poorly connected ideas
9. hallucinations false sensory perceptions with no basis in reality. Usually visual or auditory, hallucinations may also be olfactory (smell), gustatory (taste), or tactile (touch).
10. illusions—false sensory perceptions with some basis in reality; for example, a car backfiring might be mistaken for a gunshot.
11. loose associations not connected or related by logic or rationality
12. magical thinking belief that thoughts or wishes can control other people or events
13. neologisms bizarre words that have meaning only for the patient
14. poor interpersonal relationships
15. regression return to an earlier developmental stage
16. thought blocking sudden interruption in the patient's train of thought
17. withdrawal disinterest in objects, people, or surroundings
18. word salad illogical word groupings; for example, She had a star, barn, plant. It's the extreme form of loose associations.