Sunday, April 17, 2011

When Hysterical Isn't Funny

When you love a person with a mental illness, you either make yourself learn advanced communication skills ... or you sit in a corner and talk to yourself. One of the most challenging skills is dealing with hysteria. 

Good old-fashioned hysteria seems to have slipped away from the diagnostic criteria. But you know it when you see it.

When you are in the midst of dealing with it, remember one thing: Your goal is to calm the person down, not to solve the problem that caused the meltdown. There's something about being in the company of a person who is crying uncontrollably that makes me forget that.  I just want to fix it. And I have plenty of strategies to suggest.  Amazingly this isn't useful.

I haven't been able to find much advice about what to do, particularly when the person on the telephone and not standing in front of you.  But these basic emergency communications guidelines apply:

1. Stay calm.
2. Be accepting and listen. Don't argue.
3. Recognize agitation and allow the person to escape to a safe place.
4. Be brief.
5. Make clear, specific and firm demands: "Put down the knife."
6. Take a break if you need it.  Call for help if either of you need it.
7. Do something physical if you can. Getting the person to drink water or hot tea can calm things down.

 You have my permission to do all these things imperfectly when under pressure. It's the No. 1 rule of caregiving: Do the best you can, and don't feel guilty about what you can't do.

Sunday, April 10, 2011

They Love You, Phillip Morris

People with schizophrenia smoke. A lot.  And it's really hard to quit.

Well, at least we now know why. A team of researchers out of the University of Maryland School of Medicine studied 100 smokers with schizophrenia and 100 mentally healthy smokers aged between 18 and 65 years. The two groups had no significant differences in levels of nicotine dependence, number of cigarettes smoked per day, expired breath carbon monoxide or age at smoking initiation.

What they did find was a significant different in tobacco craving that occured 10 to 15 minutes after smoking a cigarette. Breaking down the subject of craving, the people with schizophrenia had higher scores in emotionality (anticipation of relief from negative mood or withdrawal symptoms), compulsivity (lack of control over tobacco use) and purposefulness (intention and planning to smoke for positive outcomes).

The report of the study in Schizophrenia Research said the scientists hope the study will help doctors to figure out how to prevent and treat cigarette smoking among people with schizophrenia.

This is important because 80 percent of people with schizophrenia smoke, according to The Complete Family Guide to Schizophrenia by Kim Mueser and Susan Gingerich. They suggest foregoing the cold turkey approach, and having your loved one keep track of how many cigarettes they smoke a day, trying to gradually reduce it.  This is less stressful, and, of course, stress makes the symptoms worsen.

Since people with schizophrenia have lifespans that are about 25 years shorter than average people, it would seem smart to find a way to help them stop. But this also helps me, at least, decide that, in a world where you have to choose your battles everyday, this moves further down the list.

Sunday, April 3, 2011

Educating Yourself About Mental Health

Learning as much as you can about mental illness can improve your mental health.  You will discover more about what is really going on, as well as good information about what you can do about it.  The best websites to visit for basic information about mental illnesses are:

National Alliance on Mental Illness (NAMI)

Mental Health America

A Healthy Place

Psych Central

National Institute of Mental Health

NAMI also has a new website on schizophrenia, just announced on March 31.