Psychotherapy for schizophrenia: treatment methods and effectiveness

Schizophrenia is a disease that every adult has heard of. Probably, most people have not only heard, but have also repeatedly met people in their lives who suffer from it - be it a relative, co-worker, housemate, or just a person you often meet on the street. Schizophrenia affects approximately 1% of the adult population (aged 18 years and older) and this value does not differ significantly in different countries and cultures - this means that in our country the number of such patients is approaching 80,000 and that in the environment of almost all of us there is a person suffering from it.

Signs of schizophrenia

Clinical signs of schizophrenia can be divided into three groups:

• negative symptoms;
• productive symptoms;
• cognitive symptoms.

Productive symptoms include delusions and hallucinations, negative ones are expressed in lack of will, abulia, apathy, and cognitive signs include deviations in thinking, perception and attention.

How to help a patient with schizophrenia?

Monitor the implementation of the doctor’s recommendations, especially taking medications, since a patient with schizophrenia is not critical of both the disease and the use of medications. He doesn't consider himself sick! According to statistics, only about 10% of patients with schizophrenia independently comply with the regimen and dosage of taking medications, although in some areas they can show themselves to be quite responsible people.

Make sure that the sick person does not start using alcohol or drugs - these substances will only worsen the course of the disease.

Learn to notice early markers and harbingers of an approaching exacerbation of the disease. Pay attention to mood swings, sleep disturbances, unexplained anxiety and fear, increased irritability, etc.

Try to develop a close relationship with your doctor so that you can consult remotely as much as possible. In this case, if you detect disturbing symptoms, you can quickly adjust the dosage of medications taken by the patient on the recommendation of a psychiatrist in order to prevent a possible exacerbation.

Create an environment that does not irritate the patient and is clearly structured, thereby protecting him from stress and giving him the necessary support.

A patient with schizophrenia may need psychological help after such manifestations of schizophrenia as delusions (impaired thinking) and hallucinations (impaired perception) have been relieved with the help of antipsychotics. Such a person, if he realizes that he has a mental disorder (after recovering from the first or next psychosis) and is critical of the painful manifestations that were observed during an exacerbation, is often upset and depressed. A psychologist or psychotherapist helps such patients cope with awareness and acceptance of mental illness, the need for long-term use of anti-relapse therapy, and teaches new rules of interaction in society.

An illness such as schizophrenia forms in sufferers a schizophrenic defect, which significantly complicates communication with people, and also leads to lack of will and lack of initiative, which are perceived as laziness, when the motivation to realize oneself and perform even ordinary everyday functions is reduced. Push them out of bed, involve them in various activities, and participate with them in finding a job. Help in communicating with former friends and acquaintances, as well as in meeting new people.

Monitor the patient's condition. Many medications prescribed as preventive therapy can lead to increased appetite and excess weight gain, which increases the risk of diabetes and cardiovascular disease. A sharp increase in body weight requires adjustment of the dose of antipsychotics when taking anti-relapse drugs or replacing them with others.

Try to maintain a certain distance between you and the mentally ill person, do not try to control him too much.

Also try not to be alone with your feelings. For most people, it is a significant benefit and relief to be able to share their own thoughts and emotions in special psychological support groups for relatives.

People with schizophrenia are easily influenced by the environment and for this reason, effective communication with them is extremely important, when you are aware of how, at what time and what to talk about. If you are angry or upset, you may want to put off discussing important issues with them, as it is difficult to think clearly, listen carefully, and make constructive decisions in such states.

Anyone feels sad, angry, and upset when others reject them, let alone people with mental illness. The behavior of others often in itself pushes patients with schizophrenia to impulsive and unexpected actions. A person who lives with a person with schizophrenia must try to respond adequately, calmly and with understanding to his actions, to provide assistance in every possible way, to show care, support, and protect him. Relatives and friends must learn tolerance. Warm and healthy relationships in the family are the basis for the onset of high-quality and long-term remission, partial or complete social adaptation, as well as recovery!

If you notice unusual behavior, strange, inappropriate statements and beliefs in one of your loved ones, be sure to do everything to show him to a psychiatrist. This is not so simple, since people with schizophrenia do not consider themselves sick. Therefore, you can find an indirect reason for visiting a doctor: poor sleep, deterioration of mutual understanding with others, increased anxiety, fear, etc.

Dissimulation of their painful symptoms by patients with schizophrenia is characteristic of this mental illness. Patients often hide the presence of hallucinations and delusions so well that even experienced psychiatrists find it difficult to recognize the disease; therefore, a qualified doctor analyzes the characteristics of behavior, facial expressions and gestures, the manner of answering questions, changes in mood during a clinical conversation, etc. Dissimulation is caused by the patients' anosognostic attitude towards the disease (lack of a critical assessment of their disease). This can manifest itself in paranoia, when the patient includes others in the delusion, and therefore hides from them, because he is afraid of them and does not trust them, and sometimes voices forbid a person with schizophrenia to talk about their painful experiences.

Unfortunately, the stigmatization of mental illness is widespread in our society, which is why people often believe that going to a psychiatrist is something shameful, as they may be considered crazy. But this is certainly not the case at all! Consultation with a specialist is the first step towards cure, especially since without adequate therapy, schizophrenia progresses quite quickly, and irreversible changes can occur in the patient’s personality. Modern possibilities of drug therapy, in particular, the latest psychotropic drugs, give patients with schizophrenia a chance to overcome the disease, become fully socially adapted, and not be and not feel mentally ill.

It is necessary to know that the active course of the disease, when delusions and hallucinations persist, lead over time to the formation of a specific schizophrenic defect, which changes the personality and prevents it from adapting to society. Therefore, if you turn to a specialist for help in time, you can give your loved ones not only the opportunity to get rid of the painful manifestations of schizophrenia, which change a person, his views and behavior, but also the opportunity to become socially adapted and function at a pre-morbid level.

Initial symptoms

• speech dysfunction, slowness of speech or its complete absence;
• low concentration;
• absent-mindedness and inattention;
• inability and unwillingness to perform simple tasks, which is associated with a complete lack of understanding of the logic and meaning in these tasks;
• emotional rigidity and poverty;
• the emergence of new strange interests or their complete absence.

Most common signs

• disorganization of thought processes;
• speech disorder;
• auditory, visual and tactile hallucinations;
• social isolation;
• the emergence of delusional ideas;
• catatonic reactions: freezing in awkward positions followed by acute agitation.

The most characteristic signs of schizophrenia are auditory hallucinations and pseudohallucinations, manifested in voices sounding in the head, ordering something to the patient, threatening him, as well as delusional ideas.

Symptoms

Schizophrenia can be identified by certain symptoms:

• Personality disorders;
• Paranoia;
• Speech disorder;
• Social phobia;
• Decreased attention and mental functions;
• Hallucinations, both auditory and visual;
• Depression and apathy;
• Delirium, obsessive thoughts.

Sometimes a person can freeze, looking at one point, or, on the contrary, be overactive with a lot of unintelligible phrases.

Classification of schizophrenia

Based on clinical symptoms, the DSM-4 distinguishes five types of schizophrenia:

• Paranoid schizophrenia - there are delusions and hallucinations in the absence of emotional flattening, disorganized behavior and thinking disorders
• Disorganized schizophrenia (hebephrenic schizophrenia) - thinking disorders and emotional flattening are identified
• Catatonic schizophrenia – psychomotor disturbances predominate
• Undifferentiated schizophrenia - psychotic symptoms are detected that do not fit into the picture of catatonic, hebephrenic or paranoid schizophrenia
• Residual schizophrenia – mild positive symptoms are observed.

Along with those listed, the ICD-10 identifies two more types of schizophrenia:

• Simple schizophrenia - gradual progression of negative symptoms is detected in the absence of acute psychosis
• Post-schizophrenic depression - occurs after an exacerbation, is characterized by a persistent decrease in mood against the background of mildly expressed residual symptoms of schizophrenia.

The importance of rehabilitation for schizophrenia

This is mainly due to refusal to undergo rehabilitation for schizophrenia and take maintenance therapy. Violation of the regime during rehabilitation for schizophrenia, independent, uncontrolled reduction of doses of medications taken. The easiest way, of course, is to blame patients for lack of consciousness, placing all the blame on them for the next relapse of the disease. However, considerable blame for the current situation still lies with doctors and the healthcare system as a whole.

Often, after discharge from a psychiatric hospital, a patient undergoing rehabilitation for schizophrenia finds himself virtually left to his own devices and unable to continue to cope with his illness. He faces wary glances from his family and work colleagues or even tries to hide the fact of his hospitalization.

He is left alone with fears for his future, which often seems uncertain. In this case, there is a risk of severe mental illness, such as psychosis, the treatment and rehabilitation of which should be carried out in a specialized hospital.

In addition to such “vivid” symptoms as delusions and hallucinations during an attack, schizophrenia can manifest itself as mood swings, causeless anxiety, and peculiar personality changes. It becomes difficult for patients to communicate with people and correctly understand the world in general.

Thus, the patient needs support and rehabilitation for a long period after the acute episode. Help in the recovery of patients with schizophrenia consists, first of all, in informing the patient and his relatives about the course of the disease and debunking “myths” about the disease.

What kind of rehabilitation is needed for schizophrenia?

A person suffering from schizophrenia often does not fully understand the depth of damage to his psyche, so his closest relatives have to monitor his health, nutrition, appearance and adaptation in society.

Often, if a person does not undergo rehabilitation for schizophrenia, the patient’s personality is destroyed to such an extent that he is not capable of independent life, work and starting a family. In this case, disability due to mental illness is issued: the patient is assigned a pension depending on the group and other social benefits are added. For 5 years, the patient must undergo a medical-labor expert commission annually, undergo rehabilitation for schizophrenia, take prescribed medications and regularly visit his doctor. If after 5 years the condition is not restored, then disability is assigned for life. In the absence of visits to a psychiatrist and refusal of recommended treatment, such behavior of the patient can be interpreted by the medical commission as recovery. In this case, the disability is not extended.

The main rehabilitation for schizophrenia is ensuring regular examinations by a psychiatrist, monitoring the intake of antipsychotic medications, maintaining physical health and undergoing socio-psychological rehabilitation. Such complex therapy can be obtained at the Preobrazhenie Clinic.

Patients need rational employment that allows them not to drop out of society and to feel needed and useful for society. Finally, psychotherapy has an important influence in the rehabilitation of patients with schizophrenia, allowing the patient to understand his illness and consult a doctor in a timely manner to prevent relapses, and adapt to the world around him.

Why do they strive to do without antipsychotics?

History will tell us how schizophrenia will progress without antipsychotics. Before their appearance in the early 50s of the 20th century, patients were tied to beds, kept in rooms with bars on the windows and treated worse than criminals, even if the unfortunate people had not done anything criminal. Treatment was often lifelong or incredibly long. Modern patients who have tried to take some alternative path, if they are actually sick, and not someone who once rejected the army through the discovery of a diagnosis, talk about several months of great suffering.

People go this route for several reasons:

• they are afraid of psychiatry as such - killer doctors, sadistic orderlies, loss of rights;
• they are afraid of the side effects of antipsychotics - squashing and sausage, mental capacity decreases;
• they fear that sooner or later antipsychotics for schizophrenia will provoke a new psychosis - there is an opinion that after 5-7 years of taking antipsychotics they begin to act differently and become the cause of more severe forms of schizophrenia.

Forecast

Patients and their loved ones are interested in whether schizophrenia can be cured with psychotherapy. In fact, schizophrenia is an incurable disease, and today there is not a single effective method that would give a chance for a full recovery. As practice shows, psychotherapy helps the patient learn to live with psychopathology, teaches him to recognize the initial symptoms of exacerbation, which allows patients to voluntarily consult a psychiatrist if alarming signs appear. The result is timely drug correction, which entails prolongation of remission. In addition, psychotherapy teaches the patient to control his emotions and significantly reduces the risk of suicide among patients with this diagnosis.

There are cases where a combination of psychotherapy and drug treatment led to stable remission for many years and helped the patient return to a normal, fulfilling life without regard to the time spent in a psychoneurological dispensary.

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Psychotherapy

Impact on the psyche through psychotherapeutic methods: conversation, suggestion, relaxation, creative self-expression, training, group lessons, individual psychotherapy. One of the tasks is to develop a critical attitude towards one’s condition, towards the disease; strengthening confidence in the doctor; improving communication with the environment; restoration of social activity (study, work, family, etc.). It is used at all stages of treatment of schizophrenia.

Hypnosis treatment

Treatment of schizophrenia with hypnosis is a variant of communication therapy. Its essence lies in the fact that during a hypnosis session, when a person is most easily suggestible, the psychotherapist gives him behavioral skills that help control and overcome the disease.

Schizophrenia is a serious mental illness, the cause of which scientists from all over the world are unsuccessfully struggling with. However, despite all the achievements of modern science, this disease remains a mystery.

Currently, methods for the treatment of schizophrenia have appeared, including a wide range of psychotropic (acting on the psyche) drugs and their combinations, allowing treatment to be carried out taking into account all the features of the symptoms and course of psychosis.

Types of psychotherapy

Treatment with psychotherapy for schizophrenia requires quite a lot of time - this must be taken into account by patients and their families. Before going to the first session, you should be absolutely sure that the patient’s general mental state allows him to accept such therapy, otherwise the doctor simply will not be able to reach the patient.

There are two main types of psychotherapy – individual and group. Each has a number of features.

Individual psychotherapy

Individual sessions are the beginning of psychotherapeutic treatment. The fact is that at first it is difficult for the patient to get in touch with the doctor, not to mention attending group sessions.

Individual psychotherapy helps you understand your illness, learn to cope with negative symptoms and critically evaluate your own actions. This is the key to the success of the patient’s upcoming integration into society.

The exact type of work with the patient in individual sessions is chosen by the doctor after studying the medical history and an initial conversation with the patient.

Group sessions

Group psychotherapy requires preparation. The patient is admitted to it only after a detailed study of existing problems in individual sessions. In general, group psychotherapy is the last preparatory stage before the patient returns to society, and therefore is very important.

In these sessions, patients interact with other people with the same diagnosis and, together with the doctor, discuss various topics that directly affect the life of a person with schizophrenia. Often, group therapy is aimed at jointly overcoming the stigma of schizophrenia. As a rule, such classes should be attended for a long time, sometimes for years.

Diagnosis of schizophrenia

Diagnosis of schizophrenia is carried out in those patients who have corresponding symptoms. The specialist conducts a clinical examination. There are currently no special tests for diagnosing schizophrenia. Consequently, the doctor uses a variety of research techniques, for example, radiography. Laboratory blood tests are also carried out in order to completely exclude the presence of a physical illness in a person that provokes such symptoms. If there are no physical causes that provoke such symptoms, the patient is referred for further examination by a psychiatrist or psychologist. To assess the patient’s condition, specialized specialists use various assessment programs, psychological tests, and also conduct interviews specially designed for such diagnostics.

To make a diagnosis of schizophrenia, the doctor also evaluates the duration of symptoms. So, if a person has the symptoms described above for at least six months, he is diagnosed with schizophrenia. It is very important that the diagnosis is carried out by an experienced specialist and that this process is approached in a multi-faceted way, as there is a possibility of an incorrect diagnosis.

Course of the disease

Schizophrenia can be continuous, with a progressive course. Paroxysmal, occurs in attacks. And fur-like schizophrenia or paroxysmal. Such schizophrenia occurs in attacks, but each attack worsens the patient’s condition.

Types of forecast

Due to the wide variety of forms and types of the disorder, its heterogeneous course, interrupted by remissions, in some cases stable in psychiatry, treatment of schizophrenia provides for 4 types of prognosis:

• The general prognosis depends on the onset of the third stage of psychosis and its characteristics.
• Social and labor forecast.
• Predicting the risk of homicide and suicide.
• Prediction of treatment effectiveness.

The prognosis of the course of psychosis is influenced by a number of factors, including:

• Floor. Being male is considered an unfavorable factor.
• The presence of organic pathologies.
• Heredity.
• Schizoid accentuation of character, manifested before the onset of psychosis.
• A smeared start is a negative factor.
• The presence of hallucinations is a negative factor.
• Sensitivity to applied treatment methods.
• Frequent attacks are a bad sign.

How to live with a schizophrenic?

Living with such a patient is not an easy task. No matter how much you love such a person, no matter how much you protect him, you will never know what is in his head. But if fate has decreed that you have to live next to a person with schizophrenia, then you need to do everything to make living together as comfortable as possible for everyone.

Yes, you will often have to make compromises and try not to pay attention to some statements. Many problems can arise: both in everyday mail and against the background of all kinds of disagreements. But you shouldn’t put emphasis on them. You should always look for a peaceful solution to a problem.

During schizophrenia, it is necessary to distinguish periods of exacerbations and interictal periods.

Sociotherapy

A person with schizophrenia often finds himself in social isolation. On the one hand, his behavior can cause fear and rejection in the people around him, on the other hand, the patient himself often refuses communication, focusing on his own feelings, plunging into depression, etc.

That is why treatment of schizophrenia should also be based on sociotherapy, which can restore lost social skills to the patient. Sociotherapy is usually aimed at teaching a person to lead a normal life and establish communication with friends and loved ones.

At the same time, psychotherapeutic help is often required by the relatives of a person with schizophrenia. Family behavioral psychotherapy becomes part of sociotherapy; it helps family members accept the patient’s diagnosis, understand how to live further, adapt, and mend broken family relationships and connections.

Principles of treatment of schizophrenia

Psychotherapeutic procedures are recommended in combination with drug treatment for mental disorders

Schizophrenia is a complex and incurable disease. Modern medicine cannot offer a truly effective treatment for schizophrenia, so drug therapy plays a leading role. However, the drugs do not solve the problem once and for all, but only relieve acute symptoms, giving the patient some semblance of mental clarity.

Modern drugs for schizophrenia are effective in the early stages of the disease. In this case, there really is a chance of achieving sustainable remission for many years, or even for life. There are cases where a patient has had only one attack in his entire life, which was successfully stopped with drugs.

However, in the vast majority of cases, the prognosis is much more pessimistic. Even after the productive symptoms of the disease have been relieved, the patient is unable to live a full life and is forced to choose social isolation. The issue of social maladjustment is especially acute among male patients. This is due to the relatively low effectiveness of medications compared to treatment for women, and the longer recovery of the nervous system. In addition, an obstacle to returning to society may be the inability to accept your diagnosis and the disease with which you have to learn to live. Psychotherapy for schizophrenia helps solve this problem.

It should be noted right away that psychotherapy is not the main method of treatment. With an exacerbation of the disease and the development of productive symptoms (delusions, hallucinations, acute psychosis), the patient is admitted to an inpatient psychiatric clinic for drug treatment. After the symptoms have subsided, the patient remains under the supervision of medical personnel for some time - this is necessary in order to promptly recognize the onset of a new exacerbation, which can occur if the medications are insufficiently effective. Then the question of further therapy is decided. If the patient demonstrates full sanity and is ready to return to society, he is simply discharged and prescribed long-term prophylactic doses of medications. In cases where the patient has problems returning to society or negative symptoms of schizophrenia remain (depression, flattened affect, etc.), psychotherapy is prescribed.

Psychotherapy may be indicated for prevention in patients with long-term remission who are constantly taking medications.

Psychotherapy is widely used in the treatment of childhood schizophrenia, since only psychotherapists can truly effectively interact with the child, helping him cope with his illness.

Treatment of drug-resistant psychosis

If medications are ineffective in stopping an attack of schizophrenia, when a person has resistance to them (like bacteria to antibiotics), they resort to the following methods:

• Electroconvulsive therapy;
• Insulin comatose therapy;
• Craniocerebral hypothermia;
• Lateral therapy;
• Detoxification.

Insulin comatose therapy

Treatment with insulin, or rather insulin coma, or glypoglycemic coma, is one of the methods of treating schizophrenia by administering large doses of insulin, causing an artificial hypoglycemic coma.

The main indications for such therapy are hebephrenic and catatonic forms of schizophrenia, with a pronounced hallucinatory-delusional syndrome. ICT has a significant antidepressant effect, reduces emotional and volitional impoverishment, and reduces the phenomena of autism. Its use is especially indicated in cases where the patient cannot, for some reason, take antipsychotics and antidepressants.

However, in medical practice there have been cases where the use of this therapy for simple schizophrenia led to a significant worsening of the disease instead of the expected improvement.

Is it possible to cure schizophrenia completely?

So is schizophrenia still treatable or not? At the moment, this disease is considered chronic and cannot be completely cured. The main goal of therapy is to achieve stable and long-term remission. However, even if it lasts for years, there is no talk of a complete cure, and the patient will have to take pills and visit a specialist to avoid relapse.

In world medical practice, there are cases of lifelong remission, when the patient returned to normal life, and the disease no longer bothered him. However, this becomes possible not only due to competent and timely treatment, but also due to the exclusion of factors that could negatively affect the patient’s condition, causing another attack.

There have also been several cases of complete recovery from the disease around the world. However, they are rather exceptions to the rule. Their cause was the patient’s strong emotional shocks, which allowed him to get rid of negative mental manifestations.

New treatments

One method is the administration of cytolysins. These substances belong to the group of glycoproteins that control processes occurring in the body at the intercellular level. They modulate inflammatory and autoimmune processes, provide communication between the cells of the central nervous and immune systems, improve the regeneration of tissues and brain cells, which implies their restoration.

There are contraindications, you need to consult a specialist!

The method of psychotherapy is also used. This method is based on the therapeutic value of communication. It is implied that the patient must undergo a course of psychoanalysis. The method will be effective provided that the psychiatrist is highly qualified. In any case, relatives should understand that schizophrenia is a very serious chronic disease that should in no way be ignored or tried to cope with it without the involvement of psychiatrists. On the contrary, the sooner the patient receives qualified assistance based on an individual approach, the sooner he will be able to return to an adequate state.

How to help a person during an exacerbation of the disease

During exacerbations, various hallucinations (auditory, visual), delusional ideas (of special significance, invention, reform), and fears may appear. Patients may run away from home, wander, become aggressive, and even harm themselves or others.

During such periods, it is necessary to notice changes in mental state as early as possible and promptly seek medical help. If a person refuses to be treated, but it is clear from his behavior that he cannot take care of himself and may, under the influence of painful hallucinations, cause harm to himself or others, then it is necessary to insist on compulsory hospitalization in a psychiatric hospital.

As a rule, patients themselves are not able to be critical of their hallucinations and delusional ideas, so only relatives and close people can notice the changes that have occurred.

Where is schizophrenia treated?

Treatment of schizophrenia must have a comprehensive approach. In a state of acute psychosis, it is best for the patient to be under the full supervision of specialists in a psychiatric hospital. Doctors know how to get rid of hallucinatory and delusional symptoms, febrile schizophrenia syndrome and protect the patient from harm that he can cause to himself and others. But this does not mean that treatment of schizophrenia should always take place in a hospital setting. A large number of people registered at a psychoneurological dispensary with a diagnosis of F20 may well be treated at home or on an outpatient basis.

The main condition for successful therapy is periodic examination by a psychiatrist. He should be able to adjust the dosage of medications, replace one drug with another, or prescribe psychotherapy.

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Rules for interacting with a patient with schizophrenia

Schizophrenia is a serious psychiatric diagnosis. This mental pathology still scares people, despite the fact that many myths about this disease have already been debunked. In the modern world, no reasonable person (I hope!) considers schizophrenia to be the work of the devil or demons. The results of serious research make it possible to explain the processes occurring in the patient’s brain, and in the arsenal of psychiatrists there are the necessary medications (antipsychotic drugs), which allow not only to stop the manifestations of the disease - acute and chronic hallucinatory-paranoid symptoms, but also often achieve a complete and long-term remission and resocialization of a patient with schizophrenia. Despite this, not all people understand the rules of interaction with a person with schizophrenia. And following these recommendations is very important: they promote recovery, reduce the likelihood of recurrent psychoses, improve the climate in the family and the quality of life of both people with schizophrenia and their relatives.

• There is no need to treat your loved one yourself - this disease does not tolerate amateurs and a person with schizophrenia definitely needs professional medical (drug) help! Psychics, psychologist, church, unfortunately, will not help.
• Do not plunge deeply into the disease, do not neglect your needs and do not forget about yourself completely - in this way you will not help the sick person in any way, but you can worsen your condition.
• Do not try to constantly look for the cause of schizophrenia (no one can determine it for sure). Try to accept and come to terms with your loved one’s illness, but at the same time, do not sit idly by, but as soberly as possible, help in treatment and monitoring medication intake (a patient with schizophrenia often has no criticism of inadequate perception and the need for treatment).

The inheritance of schizophrenia is polygenic and heterogeneous - that is, this mental disorder occurs when several pathological genes are combined. Different patients with schizophrenia may have different combinations of these genes. It makes no sense to look for relatives in the patient’s pedigree who also suffered from schizophrenia - this will not change the situation in any way. It is much more rational to focus on helping the sick person, which includes not only basic care and concern, but also monitoring the implementation of the doctor’s recommendations.

• Separate for yourself the person and his illness. Try to distinguish between symptoms of illness, side effects of medications, and personality traits of a person. Even if the painful actions and statements of a person with schizophrenia hurt you, do not truly accept it. After all, these are all manifestations of the disease. It's not easy, but love your loved one even if you hate their disorder.
• Be prepared for the fact that you will most likely encounter misunderstanding and prejudice from many people around you, but despite this, remember that there is absolutely nothing to be ashamed of! No one is safe! This is your loved one, and he, unfortunately, has a mental illness.

• Expand your knowledge of mental disorders to better understand the symptoms of a disease such as schizophrenia and the illness behavior of the patient.
• Try to be close to the sick person so that he does not harm himself or someone else in a sick condition. Do not criticize his unhealthy beliefs and actions, because they will no longer trust you and may also include you in delusional experiences.
• Try to create rules and boundaries that everyone needs to know and adhere to in order to somehow keep the situation under control.