Schizophrenia and a Daily Routine

 INSHAPE NEWS MIND MATTERS

Peter Walker – Clinical Psychologist

Schizophrenia is a broad diagnosis that covers a range of possible clinical presentations. As a result, those suffering the condition have a varied degree of function, with some individual’s experiencing relatively minor problems and others having a profound disability. For the purpose of this article, I have interviewed a client, who will be known as David (not his real name). Diagnosed with schizophrenia in his late 20s, David is now in his 40s.

Symptoms of Schizophrenia

Before we move on, I would like to define the symptoms of schizophrenia as it is worth describing these in detail to give you a sense of the complexity of the condition. Delusions and hallucinations are hallmarks of the condition and are profound in some cases.

Delusions

Viewed as fixed and false beliefs delusions are resistant to contradictory evidence. They are bizarre and an extreme preoccupation. Examples include persecutory delusions, the belief that others are conspiring to harm you in some way, and ideas of reference, such as the belief that TV or radio refer specifically to the individual.

Hallucinations

These are false sensory experiences that are most commonly experienced as voices but can also occur in all senses. Voices are often critical and disturbing.  People may experience a single or many voices; they can be both malevolent and benevolent. They can be highly distressing and distracting making concentration and organisation difficult.

Disorganised Thinking and Behaviour

Speech and thinking can become disorganised to the point of incoherence. Initially, this behaviour can manifest itself as a tendency to “go off-track” in conversation or become “tangential”.  Such disorganised behaviour creates difficulties with basic tasks of living.

For David, disorganised thinking and behaviour were one of the earliest signs of his illness.

“I used to try to form a plan in my mind, but it would get all jumbled,” said David. “I couldn’t sequence tasks,” he said. “I would jump all over the place.”

Negative Symptoms

An individual’s expression becomes less reactive and responsive emotionally; there is a lack of speech and individuals typically offer brief, superficial replies in conversation. They also experience a difficulty initiating and maintaining goal-directed activities.

Management

Given the enormous variety of presentations of schizophrenia that can occur, it’s hard to offer a “one size fits all” suggestion for treatment. Pharmacological management of schizophrenia has developed significantly since the 1950s. However, this has too often been the only treatment made available.  There are a range of psychosocial interventions that have also been demonstrated to be useful when used jointly with pharmacological management.

The Social Context of Schizophrenia and Recovery 

At present, a diagnosis of schizophrenia is poverty and social exclusion linked. In response to this, the “recovery movement” was developed to address the failure of traditional psychiatric services and the holistic needs of those struggling with mental illness. This social movement confronted oppressive aspects of the mental health system and emphasised hope, supportive relationships and empowerment, as well as social inclusion and coping skills. Importantly, it encourages individuals to develop and work toward goals that were personally meaningful and consistent with their values.  The establishment of a daily routine is a key priority for those in the process of recovery.

Schizophrenia Daily Routine

Due to problems associated with organisation and negative symptoms, the establishment of a routine can be challenging. Nonetheless, it can be invaluable and can help in reducing disability, confronting stigma and facilitating the goal-directed activity.

In the early stages of treatment, David recognised the importance of routine.

“I felt I needed a basic structure around my health,” said David. “I needed to establish regular times to wash, to eat and to clean. Otherwise, days would go past, and I would get lost,” he said. “This routine became like a discipline. It makes you feel you’re alive. You feel better about yourself and being alive.”

It is important to be both realistic and patient with the establishment of routines, as there are many challenges that those experiencing schizophrenia face. The sedating effects of medication, the flattened mood associated and changes in temporal perception can all interfere.  David believes that negative symptoms pose the greatest challenge.

“I would set myself the task of doing the vacuuming and before I knew it three days had passed,” said David. “This was disheartening, and my family and team of workers would get frustrated.”

Ideally, the routine established should be composed of behaviours consistent with the individual’s values and should act to promote the establishment of hope, the development of relationships and social inclusion. It should be established gradually, giving the individual time to set personal limits. Many public community mental health rehabilitation services run programs that encourage a graded approach to routines. They initially schedule necessary self-care behaviours, build up to psychosocial group attendance and will then establish vocational activities such as study or work. Again, the level of functioning will vary between individuals.

David was eager to stress the importance of goals being personal and not imposed by family or the treating team.

“Friends and family can offer encouragement and practical help, but being pushy can be counterproductive,” said David. “I am only able to keep up motivation if I’m involved in interests that are my own.”

 Peter Walker has over 12 years experience working as a clinical psychologist. He has worked in both public and private practice, having specialised in complex presentations. He established his private practice, Peter Walker & Associates, clinical psychologists, in 2002 as a service to provide psychological treatments for those experiencing difficulties with anxiety, depression and couples in distress. In addition, the practice was relatively unique in that it offered specialised treatments for those experiencing psychotic disorders and bipolar disorder. At the time Peter Walker & Associates was established the development of psychological treatments for these conditions was in its infancy and Peter was considered an innovator in this field. Peter provides clinical supervision for mental health practitioners, is a sought after presenter and has experience providing expert opinion in the media. In recognition of his experience treating mood disorders he has been asked to take on a role at the Black Dog Institute in 2013.

Jay Spence – Clinical Psychologist and PhD Candidate

Schizophrenia affects about 0.5 to 1 percent of the population or about 7 in 1000 people. It is often incorrectly believed to be a multiple personality disorder, but, in fact, it refers to a disorder where sufferers live with hallucinations and delusions. These, in turn, are often accompanied by problems with depression and a difficulty with routine behaviours. Daily routines such as getting-up early, self-care, meals and using transport, along with socialising and working are often disrupted.

Schizophrenia Studies

There have been a number of studies done to look at what contributes to a ‘good quality of life’ for people with schizophrenia. Interestingly, symptoms of schizophrenia don’t tend to influence the quality of life very much. However, you would think the opposite, where the worse your schizophrenia is, the less you would enjoy life. Studies have found instead that symptoms of depression and anxiety are highly related to whether or not people with schizophrenia can enjoy their lives. What this research shows is that if people with schizophrenia can manage their depression and anxiety, then they are more likely to have fulfilling lives.

Daily Routines and Schizophrenia

Daily routine can have a huge impact on depression and anxiety. In a study comparing employed and unemployed people with schizophrenia, those people with a job or some major daily routine, such as homemaking, were far better off. This outcome is true for all adults since there is a very strong link between being unemployed and symptoms of depression and anxiety. A daily occupation, whether paid or unpaid, is associated with reducing symptoms by providing structure and meaning, increasing social activities and providing income.

A Japanese study showed that people with schizophrenia were more likely to spend time sleeping, more time doing passive activities, such as watching TV, and less time carrying out major actions, such as paid work, than people without the disorder. However, a study investigating issues that lead to happier lives for people with schizophrenia found that meaningful relationships, meaningful work or life roles and good living conditions, as well as good quality sleep, not more sleep, lead to better lives. So the take home message here is that daily routines that incorporate work are more likely to enhance the lives of those with schizophrenia.

Unfortunately, there are many other issues that make work and other daily routines difficult for schizophrenia sufferers, these include biological factors that influence motivation as well as stigma and employment options. However, the research shows that these factors can be managed effectively by working within the recommendations of the sufferer’s mental health team, which typically includes their general practitioner (GP), psychiatrist and case worker.

Jay Spence is a Clinical Psychologist and PhD candidate who specialises in adult and adolescent mental health. He was joint recipient of the Gold Prize at the Australian and New Zealand Mental Health Service Achievement Awards (2010) and of the St Vincent’s Health Australia National Invention and Innovation Award (2010) and was the recipient of the 2011 New South Wales Institute of Psychiatry Fellowship. He has published numerous papers on the treatment of post-traumatic stress, social phobia, and panic, as well as generalized anxiety and transdiagnostic anxiety processes. He held a conjoint lecturer position at the University of New South Wales from 2009 to 2011, lecturing on the treatment of anxiety and depression. He is currently completing a PhD on internet-based interventions for post-traumatic stress disorder (PTSD). He is developing these treatments as part of the Centre for Emotional Health at Macquarie University because PTSD is the most prevalent anxiety disorder in Australia. However, many people do not have access to effective treatments. He sees patients in private practice in Darlinghurst, Sydney.

Phil Owens – Leading Australian Hypnotherapist and NLP Practitioner

Schizophrenia is a relatively rare disorder with only around 1 percent of the population being diagnosed with the condition during their lifetime. Simply put, schizophrenia is a disorder that at one end of a spectrum is very complex and consists of psychotic syndromes.

The Impact of Schizophrenia

Schizophrenia has a number of outcomes which have a real impact on the performance of the sufferer in society. These can include hallucinations and delusions, motivational impairment issues and depression, as well as mania and cognitive impairment. Such outcomes can impact significantly on a sufferer’s lifestyle and health, including employment and physical health outcomes. For example, people with schizophrenia have a high prevalence of diabetes, obesity, metabolic syndrome, and sexual dysfunction. These can all significantly affect their life expectancy, quality of life and medication adherence.

Schizophrenia Treatment

Adherence to medication is critical in reducing the risk of symptom relapse and rehospitalisation. Most communities show low social acceptance for ‘psychotic’ behaviours, so symptom relapse can also have massive social consequences.

Creating a Daily Routine

Creating and maintaining routines is therefore of high importance in patients with schizophrenia. Routines which help a patient to adhere to medication, get refills for prescriptions and ensure correct medical treatment are paramount. Further, routines around physical health monitoring, eating and exercise are important to help reduce many of the potential associated conditions, such as obesity and diabetes.

High-functioning schizophrenics can be encouraged to set their routines. However, it is important that they have appropriate support from their doctor and a carer to ensure that these routines are followed. Lower-functioning schizophrenics, particularly those with motivational and cognitive impairments, may need far more direct structure and support in maintaining their routines. They may struggle to implement or follow simple routines and systems, and these may need to be imposed or controlled by appropriate carers.

Establishing routines that ensure compliance to medication and medical appointments are critical for schizophrenics. With the added physical, emotional and social health risks, establishing and following routines designed to enhance life performance and health and fitness may be equally as important in the long-term to the success of assisting patients with schizophrenia to function normally in society.

Philip Owens is owner and director of Reflective Resolutions and is a leading Australian hypnotherapist and NLP practitioner based in Melbourne, Australia. Using scientifically validated and pragmatic approaches, Philip is a passionate about creating lasting change in and for his clients.

Working in his clinic with individuals and also with corporate clients, Philip’s international experience, state of the art training and processes have led to successful and happy clients all over the world.  Focusing on the issues of modern life, Philip routinely works with clients presenting with anxiety, fears and phobias, addictions, traumas, weight loss, insomnia and smoking cessation’.

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Disclaimer: The information published in this column is the author’s professional and personal knowledge and opinion. This information and opinion are not intended to be a substitute for professional medical advice, diagnosis or treatment of any manner. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding any medical condition and consult a qualified medical professional before beginning any nutritional or exercise program. Never disregard professional medical advice or delay in seeking it because of something you have read on InShape News.

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