How to Help Someone with Delusional Schizophrenia

A schizophrenia support group meeting

According to recent World Health Organization data, around 23 million people have schizophrenia worldwide. This mental illness – one of the most disabling and frightening of them all – affects more men than women but is rarer than other psychiatric disorders.

Unfortunately, more than half of people with schizophrenia do not receive the proper care and are facing severe societal threats, such as human rights violations, emotional, physical, or financial abuse, and more.

Regrettably, schizophrenia does not negatively influence only the ill person, but the family and the patient’s social network as well. Delusional schizophrenia is even more problematic for the patient’s close circle, as some delusions may lead to unfortunate consequences for everybody. To be able to help a person with delusional schizophrenia genuinely, we have a few suggestions for you today.

How to Help a Person with Delusional Schizophrenia

Schizophrenia – and the delusional type in particular – is a hard-to-understand illness. For most caregivers, it becomes overwhelming and exhausting both physically and emotionally. However, we hope that this guideline will help you cope better with your suffering so you can sustain better a family member or a friend suffering from this illness.

1. Educate Yourself and Others

The drama with delusional schizophrenia is that people either know too little about it or know the wrong things, in part due to the media and cinema’s appetite for the sensational. If you want to learn how to help a family member or a friend, the first thing to do is learn as much as you can about this illness.

Start with understanding the types of delusions in schizophrenia, as they are more than one. If you can identify and differentiate between an erotomanic delusion and a persecutory one, you will be able to offer sustained support to the patient – and cope better with the subsequent problems. Understanding the delusions is mandatory so you can explain them to the other family members or friends, doctors, or support group members.

Some people fear the concept of schizophrenia itself, fed with preconceptions and tabloid stories about violent attacks and bursts of rage from the patients’ part. What you should know is that patients with delusional schizophrenia are more harmful to themselves than to others, the risk of careless behavior and suicide being significant.

Violence in delusional schizophrenia is somewhat a symptom of a bigger picture, which does not mean you should take things for granted. Jealousy and persecution delusions may lead to some extent to aggressive moods or behaviors from the patient’s part.

To make sure you know what to expect and how to cope, read as many scientific resources you can find, research the latest studies in the field, and talk to specialized professionals.

2. Assign a Person of Trust as Primary Support Giver

People suffering from persecution delusions or delusions of reference with paranoid influence show high levels of distrust in people. However, even if this is the case, you can convince the person to trust you, or another person in the family/friends circle. The assignation of a person for support means that the schizophrenic patient has someone to rely on at all times.

It is a hard and painful job for the primary support giver, but when the schizophrenic patient goes through a bad period, this person might be the only thing that can help, even if some psychoses turn the patient against everybody else.

What you have to understand at this point is that even if the patient has a primary caregiver, the rest should not go about their usual business. Observing the patient’s behavior and corroborating information helps doctors and healthcare providers manage better the patient in question.

Even if the patient is in therapy, he/she may not be open or honest with the doctors. This is the moment when the primary caregiver and the close circle interferes: offering information and providing healthcare specialists with the missing or the necessary data to further the treatment.

3. Keep a Log of the Symptoms

Psychiatrists recommend the patients to log their symptoms, actions, behaviors, and thoughts, but not all of them can do that. Delusional patients do not see anything wrong with their beliefs; therefore, they have nothing of the ordinary to report.

On the other hand, the primary caregiver and the family members play the role of objective observers and can log symptoms and signs thoroughly:

Record and make correlations between the symptoms (when and how they appeared) with the medication taken;
Keep track of all medications taken and record any side-effects, improvements, or worsening of the symptoms;
Record the warning signs of a potential relapse;
Note down what medication seems to work and what seems not to, to help doctors find a more efficient treatment;
Note down any health problems the patient experiences and make sure they are not the result of medication side effects or various treatments’ interactions; this is important, because patients with delusional schizophrenia may blame you for trying to make them sick, or may think they are terminally ill because they do not feel well.

You can also record behaviors, recurrent thoughts, and more. Such a journal is of absolute importance for the family and the psychiatrist/therapist.

4. Set Goals and Try Keeping Them

The general opinion about people with schizophrenia is that they all lost their minds and they hear voices, being irresponsible. It is far from the truth. People with delusional schizophrenia have a harder time, but they can understand reachable goals, just like everybody else.

If the goal is to follow treatment or see a therapist, break down these goals in smaller steps and achievements that the person can accomplish. Be there and offer support for each small win of this kind. Just like anybody else, the person with schizophrenia needs encouragement and positive interactions.

Refrain from criticizing the patient or forcing him/her do things your way. It may feed some paranoid delusions, and you may lose all the trust you have built so far. Pressure and criticism do not work well. What works well is a strategy and a plan you can both commit to with ease.

For instance, a person with schizophrenia may show reluctance and suspicion about taking medication or seeing the doctor for the first time (or participating in another therapy session); however, making some small lifestyle changes and setting treatment goals that do not cause discomfort may lead to a greater openness towards pills, for instance.

5. Join Support Groups Together

The Schizophrenia and Related Disorders Alliance of America and the National Alliance on Mental Illness both offer support groups to patients with schizophrenia. The meeting of people who share similar problems is helpful, especially in remission periods, as they manage to make patients feel understood and less lonely or exposed.

To some extent, people with delusional schizophrenia may also manifest significant levels of social anxiety. If it is the case, you or the primary caregiver can take part in the support group meetings organized by your current psychiatrist or psychotherapist. If the person has somebody to trust by his/her side, then they might build the strength and confidence to participate in the group’s discussions.

It is of utmost importance that the primary caregiver and the members of the close circle to join support groups for families of patients with schizophrenia. As we said, the thing can be overwhelming, exhausting, and bleak very often. You need support as well, together with coping mechanisms, coping with stress, and emotional relief. Otherwise, you will not be able to offer the proper support to your family member or friend.
Sometimes, yoga, tai chi, or meditation can help you manage the stress better; light physical activity may also improve the patient’s focus on something else; specialists recommend you introduce such undertakings in your life plan and strategy, as they may help you during a crisis.

6. Learn how to Respond to the Delusions

We reached what seems to be the most challenging part of everything. Assisting a delusional schizophrenic and responding correctly to the delusions is a task that needs patience and training.

Ask the therapist/psychiatrist to teach you a few communication methods with the patient to respond to the delusions and even keep them at bay;
Do not challenge the patient’s beliefs, trying to prove they are not real, because you will arrive nowhere and you risk making things worse;
Approach the delusional beliefs in a kind, respectful, and polite manner. Not all people have the same opinions about the same things – this is your view on the matter in question. It takes years, if not decades, for a professional therapist or psychiatrist to challenge delusional beliefs in patients, so do not try at home tricks you have seen in movies;
Do not scream, argue, criticize, pressure, force, threaten, blackmail, or become physically aggressive with the patient, no matter how whacky the delusions are and no matter how exhausted you are. Cope with the stress as much as you can and if you cannot handle it anymore, call the doctor and the other members of the family so you can take a necessary break.

7. Learn How to Respond to Crisis Situations

Unfortunately, even if the patient does not show any sign of aggression or violent burst, you still need to be alert, as the risk of suicide is significant, especially during a time of severe relapse. Some delusional schizophrenics may want to take their own life to put an end to their misery or make a sacrifice for some greater good. It does not matter, because you need to learn the signs of suicide risk anyway.

In your diary or log, make sure you read every day the notes you took 1-2 days before; it will help you notice any changes in mood or behavior as time goes by;
Pay attention to any talks about death and call the doctor for advice;
Pay attention to any materials related to death: books read, poems written, random pieces of text, anything created by the patient that might suggest he/she shows increased interest in dying;
Pay attention to changes in mood from depressed to cheerful – it may mean he/she made a suicide plan and intended to go through with it.

In an emergency, you should know the following:

In case the delusion goes over a manageable level, call the other family members or friends; if the patient is acting out erratically, call 911, tell them they have to deal with a person with schizophrenia and keep your cool. Under any circumstance, do not grab, hit, stand over, block the door, stare, shout or aggressively touch the patient until the paramedics arrive.
In case you see the signs of suicide intent, call 911 and ask for the Police, then call the patient’s doctor. Call your city or state Psychiatric Crisis Center, National Suicide Prevention Lifeline, or any other resources available. They all have professionals knowing what to do in this situation.

When you have to care and help a patient with schizophrenia, you will not be able to be on call 24/7. For this reason, you need a secure network of people who can help the patient and you as well. It is essential to maintain good health and get the medical and psychological support you need whenever you feel exhausted, depressed, angry, alone or afraid.