Things Your Patient May Want to Discuss
The following is a list of questions you might be asked by your patients or by their caregivers along with some suggested responses that may be helpful in framing your reply:
Questions about Schizophrenia
Questions about Bipolar Disorder
Questions from Family and Caregivers
Schizophrenia Questions
What is schizophrenia?
How is schizophrenia diagnosed?
Is there a cure for schizophrenia?
How is schizophrenia treated?
How do medicines work in the treatment of schizophrenia?
What can I do to keep others from knowing about my illness or seeing me take medicine for it?
Can I eat what I want while taking medicine for schizophrenia?
I want to move into my own place. How can I get help finding housing?
Will my medicine cause me to have problems with sexual performance?
What about the potential for weight gain?
Can exercise cause me to have a relapse?
Where can I find other people to talk to who will understand what I'm going through?
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What is schizophrenia?
Schizophrenia is a chronic mental illness that affects the way the brain receives and interprets information from the outside world. This affects thinking and judgment, and impairs a person's ability to reason logically, organize and communicate thoughts, and function in society. It is important to understand that schizophrenia does not mean "split personality."
Although scientists have not been able to identify a single cause of schizophrenia, a good deal is known about the possible causes for this illness. Today, much more is understood about the chemistry of the brain, and it appears that schizophrenia is associated with an imbalance in the brain's chemical systems. It is not known exactly why some people develop the disorder, but genetic factors appear to play a role.
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How is schizophrenia diagnosed?
The diagnosis of schizophrenia is based on an interview to assess the person's symptoms and a psychiatric history to evaluate the course of the illness. At times, it can be difficult to distinguish certain mental disorders from others, and it is important for other illnesses to be ruled out when making a diagnosis of schizophrenia. Therefore, a medical history, physical examination, and laboratory tests are required to rule out other disorders that might mimic the symptoms of schizophrenia. Although there is no specific laboratory test for diagnosing schizophrenia, certain x-ray scanning techniques, which take pictures of the brain, have been used as a research tool. By far, symptoms provide the most important clues in making a diagnosis, including type and severity of symptoms, duration of symptoms, and what the person's life was like before symptoms appeared. Tests may be used to rule out the presence of alcohol or street drugs, since these substances can cause symptoms that resemble schizophrenia or can make symptoms of schizophrenia worse.
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Is there a cure for schizophrenia?
Like arthritis or high blood pressure, schizophrenia is not curable. However, like these physical diseases, it is treatable. Fortunately, research is progressing on many fronts, making the outlook for people with schizophrenia much more positive. Progress has been made toward better understanding this illness and its treatment, and scientists are using many approaches, from the study of genetics to the study of populations, to learn more about what causes schizophrenia. While no single therapy can "cure" schizophrenia, many people with schizophrenia are now able to lead more independent and satisfying lives through improved treatment. The discovery and development of newer, atypical antipsychotic medications that treat symptoms effectively with fewer or milder side effects than the older, typical antipsychotics marks a new era in the management of this illness.
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How is schizophrenia treated?
Schizophrenia is generally treated with a combination of therapies that may include antipsychotic medications, supportive therapy, and psychoeducation.
Antipsychotic medications are considered the mainstay of maintenance treatment for schizophrenia. The newer antipsychotic agents, classed as "atypical," act on both negative symptoms and positive symptoms, and they appear to have a lower potential for extrapyramidal symptoms. Medications are crucial in relieving the symptoms of schizophrenia and helping people successfully manage their illness.
Supportive psychotherapy is a cornerstone of the rehabilitation process for persons with schizophrenia. Individual psychotherapy offers the individual an opportunity to talk about thoughts, feelings, experiences, problems, and relationships with a trained mental health professional (eg, psychiatrist, psychologist, psychiatric social worker) who can help the person understand more about the illness, his or her problems, and other personal issues. Other forms of supportive therapy include rehabilitation programs for social and vocational training. Although very effective, psychotherapy and other forms of therapy are not a substitute for medication therapy.
Psychoeducation involves teaching various coping strategies and problem-solving skills to persons with schizophrenia and their families/caregivers. This may be done through support and self-help groups.
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How do medicines work in the treatment of schizophrenia?
Antipsychotic medicines are the primary pharmacologic treatment for schizophrenia. By adjusting the imbalance of chemicals in the brain of persons with schizophrenia, antipsychotic medicines can diminish the symptoms of a psychotic episode. They also allow the person to function more effectively and appropriately, think clearly, and concentrate better. Since all antipsychotic medications take time to work, it is important to realize that symptoms will improve gradually, and it may take several weeks or months before you notice a difference in the way you feel.
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What can I do to keep others from knowing about my illness or seeing me take medicine for it?
It is healthy to be taking medication for your illness, and others will respect your desire to manage your symptoms. However, it is understandable that you may not want other people to know you are taking medication for a mental illness; many people feel this way and worry that others will think taking medicine is a sign of weakness. If your medicine is doing the job of controlling your symptoms, no one has to know you are taking medication. Talk to your therapist if you want to discuss which people you can trust with this information. If you are concerned about others seeing you take your medicine in public, talk to me about taking your medicine at a time of day when you are able to have more privacy.
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Can I eat what I want while taking medicine for schizophrenia?
There are no specific food restrictions while taking antipsychotic medication. However, some antipsychotics might cause an increase in appetite for some people. It is very important to follow a healthy, balanced diet and get regular exercise while taking these medications. Some hints for controlling hunger include:
- Take a walk when you feel hungry
- Drink a glass of water or other sugar-free beverage
- Chew sugar-free gum or suck on sugar-free mints
I want to move into my own place. How can I get help finding housing?
It is natural to have the desire as an adult to live independently. First, it is important to evaluate with your treatment team if you have the skills to live independently, and then discuss what options are available to you. Your case manager is a good resource to help you assess whether you have the resources to live on your own and to help you investigate appropriate living arrangements. To live on your own, you will need to have mastery over the activities of daily living. You will also need to know how to manage your money. You may find it helpful to make a list of questions for your case manager (or other treatment team member) before having this discussion.
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Will my medicine cause me to have problems with sexual performance?
Some men might have difficulty with erection or ejaculation. It is important to know that lack of sexual desire may also be a symptom of schizophrenia itself. If you are having sexual difficulties, it is important to discuss these problems with me to find out if the problem is being caused by your medicine or your illness. If the problem is being caused by your illness, the problem may improve as you continue with your treatment. If your medicine appears to be the cause, we may decide to adjust your dosage or change your medicine altogether. Do not make any adjustments to your medication on your own.
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What about the potential for weight gain?
Weight gain is a potential side effect for many psychotropic therapies on the market today. As with any prescription medication, you should not stop taking ZYPREXA without talking to your doctor first. If you are otherwise doing well, but a gain in weight is concerning, you and you doctor can discuss whether a change in lifestyle (such as diet and exercise), medication, dose, or some combination of these should be planned.
Lilly also makes resources available, free of charge, which provide ongoing support to people taking ZYPREXA. These materials can help you manage your diet, become more active, and cope better with stress. Ask your doctor or healthcare professional for these free materials.
Here are things you can do to manage weight gain during your treatment:
- Drink plenty of water—six to eight 8-oz glasses each day
- Choose to drink water or diet soda instead of regular soda
- Exercise at least 3 times each week. (It's a good idea to talk to your doctor before starting a new exercise program)
- Make healthy food choices:
- Eat smaller portions
- Snack on crunchy fruits and vegetables
- Avoid junk food (eg, potato chips, cookies)
- Control cravings for sweets by eating fruits
- Eat less red meat and more white meat
- Avoid fast food
- Avoid sugars and starches (eg, cakes, cookies, sugary sodas, pasta) and high-fat foods (eg, potato chips, fries, ice cream)
Can exercise cause me to have a relapse?
Moderate exercise is a great idea and can improve overall health. Psychological benefits such as a greater sense of well-being, increased self-esteem and decreased anxiety and depression have all been linked to exercise. Be sure not to overdo it in your exercise routine, however. If you are thinking about starting an aerobic exercise program (such as jogging) or working out with weights, it's a good idea to check with me before you start. Regardless of the type of exercise you choose, remember that people tend to feel better after doing some type of physical exercise each day.
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Where can I find other people to talk to who will understand what I'm going through?
Loneliness is a big problem for many people, especially for those who have an illness such as schizophrenia. This illness can make it harder for you to communicate with others. You may have a hard time understanding what others are saying and a hard time expressing your own thoughts. Getting acquainted with a new friend can be especially hard under these conditions.
As you continue your treatment and your symptoms improve, it will probably become easier for you to meet others and make friends. One of the best ways to meet other people is to get involved in activities that you enjoy. Some ideas for meeting other people with whom you may have things in common are to:
- Join a support group to meet others who have schizophrenia
- Find out from your case manager if there is a clubhouse for persons with schizophrenia in the area where you live
- Gain access to the Internet and look into one of the online communities for people with schizophrenia so you can exchange messages and ideas with others online. Ask your therapist or case manager for specific instructions on how to log on
Bipolar Disorder Questions
View possible responses:What is the cause of bipolar disorder (manic depressive illness)?
What are the symptoms, and how do I recognize if I might have bipolar disorder?
Do all people have the same symptoms? Are there differences? Why is it so difficult to make a diagnosis?
How do I explain my diagnosis to family members and friends? How do I explain what is going on with me? How do I tell them about my illness?
What happens if I ignore my symptoms? What are the dangers of not getting treatment?
What types of side effects or symptoms should prompt me to immediately call you?
What about the potential for weight gain?
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Possible responses to questions about bipolar disorder:
What is the cause of bipolar disorder (manic depressive illness)?
The exact cause of bipolar disorder is not known. We do know that it is a brain-based medical illness that involves certain structures of the brain related to emotions, behavior and thinking. Bipolar disorder may be related to an imbalance in certain biochemicals in the brain, called neurotransmitters. Bipolar disorder runs in families, and there is a strong genetic component, although genetics do not completely predict who will develop the disorder and who will not.
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What are the symptoms, and how do I recognize if I might have bipolar disorder?
Bipolar disorder, previously known as manic-depressive illness, affects an individual's mood, behavior, and thinking. Symptoms vary as moods swing from the manic phase of the illness (characterized by feelings of elation/euphoria, extreme optimism, inflated self-esteem, difficulty sleeping, and engaging in risky activities) to the depressive phase (feelings of extreme guilt, sadness, anxiety, and, at times, suicidal thoughts).
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Do all people have the same symptoms? Are there differences? Why is it so difficult to make a diagnosis?
The symptoms of bipolar disorder may look different depending on the person experiencing them. Generally, bipolar disorder is associated with extreme swings in mood separated by periods of normal mood that may be brief or lengthy. This can make the diagnosis difficult, because I may not see the full range of symptoms you are having. It is important to know the symptoms associated with bipolar disorder and to tell me about symptoms you have had that may indicate the manic or depressive phase of the illness.
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How do I explain my diagnosis to family members and friends? How do I explain what is going on with me? How do I tell them about my illness?
Sometimes it can be helpful to get family and friends involved with me and with your treatment plan. These discussions will allow them to see that the things going on in your life are related to a diagnosable medical condition, not simply a lack of willpower or a character flaw. You might also find it helpful to share some of the materials on bipolar disorder.
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What happens if I ignore my symptoms? What are the dangers of not getting treatment?
Many people who have bipolar disorder can't fully recognize the interruptions it brings to normal living. Especially in the manic phase of the illness when energy levels, creativity, and productivity seem heightened, some individuals decide not to seek treatment. Unfortunately, untreated symptoms often lead to long-term problems as heightened energy and too little sleep give way to extreme risk-taking and errors in judgment. Also, the symptoms of bipolar disorder can be very trying on family and friends, damaging relationships and making it hard for them to support their loved one who has the disorder. Finally, it has been reported that 25% to 50% of persons with bipolar disorder attempt suicide at some point in the course of their illness. Seeking treatment, therefore, is extremely important.
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What types of side effects or symptoms should prompt me to immediately call you?
If you experience any unwanted effects during treatment, whether these effects seem to be related to your medication or not, call me. You should contact me if you start to feel very discouraged, feel that you may lose control of your behavior, or feel that you may hurt yourself or someone else.
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What about the potential for weight gain?
Weight gain is a potential side effect for many psychotropic therapies on the market today. As with any prescription medication, you should not stop taking ZYPREXA without talking to your doctor first. If you are otherwise doing well, but a gain in weight is concerning, you and you doctor can discuss whether a change in lifestyle (such as diet and exercise), medication, dose, or some combination of these should be planned.
Lilly also makes resources available, free of charge, which provide ongoing support to people taking ZYPREXA. These materials can help you manage your diet, become more active, and cope better with stress. Ask your doctor or healthcare professional for these free materials.
Here are things you can do to manage weight gain during your treatment:
- Drink plenty of water—six to eight 8-oz glasses each day
- Choose to drink water or diet soda instead of regular soda
- Exercise at least 3 times each week. (It's a good idea to talk to your doctor before starting a new exercise program)
- Make healthy food choices:
- Eat smaller portions
- Snack on crunchy fruits and vegetables
- Avoid junk food (eg, potato chips, cookies)
- Control cravings for sweets by eating fruits
- Eat less red meat and more white meat
- Avoid fast food
- Avoid sugars and starches (eg, cakes, cookies, sugary sodas, pasta) and high-fat foods (eg, potato chips, fries, ice cream)
Family and Caregiver Questions
View possible responses:How can I find out about my family member's treatment plan and how to be a part of it?
Which member of the treatment team should I address specific questions to about my family member's care?
What are some ways to help my family member socialize more effectively with others?
How can I provide structure for my family member without taking away his/her sense of freedom?
Where can I get help for my family member on managing his/her activities of daily living?
What are the signs of relapse in a person with schizophrenia?
My family member seems to want to only eat junk food. How can I get him/her to eat more healthy foods?
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Possible responses to family and caregiver questions:
How can I find out about my family member's treatment plan and how to be a part of it?
It is critical for you as the caregiver to become involved in your family member's treatment and progress toward recovery. Not only is your involvement helpful to your loved one, but being connected with his or her treatment team provides a source of support for you. A first step for becoming a part of this process is speaking with me, your loved one's doctor, the head of the treatment team. The case manager (usually a licensed social worker) is also a key member of the treatment team with whom you will want to become acquainted.
The case manager interacts with mental health clients and their families concerning family and individual therapy, information you need to care for your family member (such as benefits and social services), referral to support groups and coordination of housing arrangements.
Other members of the treatment team who are valuable resources include the therapist/psychologist, pharmacist, nurse, and rehabilitation counselors.
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Which member of the treatment team should I address specific questions to about my family member's care?
The treatment team is made up of people who are trained in different professional areas. They have different kinds of education, knowledge, and experience, and work together to help your loved one develop and reach reasonable treatment goals. Who is on an individual treatment team depends on different factors, such as the person's housing situation, the treatment setting, and what services are needed. Here are some general descriptions of treatment team members and their roles in helping the person with schizophrenia or bipolar disorder. Team members and their duties may vary from case to case.
Doctors/Psychiatrists
- Diagnose illness
- Prescribe and monitor medication; discuss medication options
- Order appropriate tests
- Discuss other treatment approaches
- Explain what to expect for the future regarding the course of the individual's illness
- Interface with other physicians in the medical treatment of the patient
- Meet periodically with family members/caregivers
- Individual, family, and group psychotherapy (explore concerns, hopes, feelings, problems, etc)
- Help choose goals and work toward achieving them
- Provide problem-solving strategies
- Administer psychological testing
- Discuss diagnosis, symptoms, and how to avoid relapse
- Help coordinate individual's overall treatment
- Connect individual with services he/she needs
- Support and represent individual in certain situations
- Help individual get their basic needs met (food, housing, financial assistance, transportation, etc)
- Answer questions about symptoms and treatment, medications, possible side effects, and other health problems
- Give medication by injection, if needed
- Provide medication information and consultation
- Monitor dose levels and medication supply
- Assist with compliance issues, including side effects
- Monitor for possible drug interactions
- Help individual create a balanced lifestyle
- Explore individual's abilities and interests
- Help individual develop interests, hobbies, and leisure activities
- Help individual learn stress management and relaxation techniques
- Help individual identify his or her skills and strengths
- Help individual choose rehabilitation goals that are reasonable and help him or her work toward them
- Help individual learn skills necessary to be successful at a job, school, etc
What are some ways to help my family member socialize more effectively with others?
Social withdrawal is often a symptom of schizophrenia, and the person may isolate himself or herself because he or she chooses to, or because he or she feels shunned by others. It is important to be tolerant and patient as you try to help the person begin to socialize with others. It is also important for the person to learn to socialize both within and outside of the family. The process should be a gradual one — at first, it is preferable to provide social opportunities with only a few people with whom your relative is comfortable. Certain social situations may be too stressful or too stimulating for your family member, so it is important to try to find a comfortable balance between extreme isolation and overstimulation. Participation in group activities (such as treatment groups and recreational activities) is a positive way for the person to move toward more social interaction. Include the person in recovery in various family activities and events as well. This will allow opportunities for the person to see models of appropriate behavior and reactions in social settings.
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How can I provide structure for my family member without taking away his/her sense of freedom?
Structure is important both for the individual and for his family members. Providing structure to the individual helps him or her feel connected to the environment and to caregivers. Structure also provides safety and stability to the individual who may find other aspects of his life very unpredictable. Structure and routines include:
- Setting up rules (eg, respecting others, listening to what is being said, adhering to a curfew)
- Setting goals (eg, choosing healthy foods for snacks, exercising regularly, going to bed at the same time each night)
- Including the individual in the decision-making process of establishing rules and goals may help him or her feel a sense of ownership and less like his or her freedom is being taken away
Where can I get help for my family member on managing his/her activities of daily living?
Recovery is a long-term effort. "A thousand mile journey starts with a single step." Make each day count! It is very important for you to provide motivation and assistance in helping your loved one fill his or her days with meaningful activities towards recovery.
Your family member's case manager is an appropriate person to contact for help on managing the activities of daily living. The case manager can provide an assessment of the person's needs and either obtain help for your family member or refer you to individuals or groups who can provide assistance and support.
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What are the signs of relapse in a person with schizophrenia?
The term "relapse" may mean different things to different people, but for most people with schizophrenia, relapse means they're getting sick again. Symptoms that have improved but haven't disappeared completely (known as residual symptoms) suddenly get worse — these are known as early-warning symptoms. Such symptoms, which warn that a relapse is beginning, are:
- Changes the individual experiences when he or she first starts getting sick again
- Returning symptoms that have previously been under control
- Strange things the individual experiences when he or she starts getting sick again
- Changes in the individual's behavior that other people notice when he or she starts to relapse
My family member seems to want to only eat junk food. How can I get him/her to eat more healthy foods?
Some people with schizophrenia adopt a monotonous diet, eating the same foods daily and gaining very little pleasure from taste. Even worse, they may not get enough to eat — this may occur when they are actively psychotic, fearing their food is poisoned. Certain medications, including some antipsychotics, might cause an increase in appetite, leading to weight gain. This is one of the reasons it is important to encourage the individual to eat a healthy diet and exercise regularly. Although it can be very difficult for most anyone to change his or her eating habits — especially those habits that may be long-standing — it is worthwhile for the short-term and long-term health of the individual.
Some strategies to help the individual improve his or her eating habits are:
- Clean out cupboards and try not to have unhealthy foods in the kitchen
- Help the individual avoid eating between meals — this adds extra calories and slows down the digestive process
- For snacking, offer low-calorie/high-fiber foods, such as rice cakes, carrots, celery, and popcorn
- Help your family member avoid fast foods. When your family must eat at a fast food restaurant, suggest a salad instead of a hamburger, forego "super-sized" entrees and extra toppings, such as cheese and bacon, and avoid french fries
- Provide positive reinforcement for sticking to a healthy diet
