Some Frequently Asked Questions
About a Individual with Schizophrenia
in Crisis

What is schizophrenia?

Schizophrenia is the most chronic and disabling of the severe mental disorders. It affects more than 2 million people in the US. It appears to be related to an abnormality in the brain. Its cause is not yet known. Research suggests that it may originate in a problem during fetal development. It usually appears during the teens or twenties. Sufferers may suddenly experience distortions of reality, behave in a confused manner, isolate themselves, or show other symptoms. It usually develops slowly over months and years.

What causes a crisis for a individual with schizophrenia?

A crisis for someone with schizophrenia or a related disorder involves a sudden and severe break with reality that may be unexpected and unpredictable. Such episodes are part of the disease and may occur episodically. A crisis may happen within a year after the first signs of unusual behavior or it may be the first sign of the problem. During a crisis the individual may have hallucinations, delusions, disordered thinking, and disturbed behavior and emotions.

What does the individual experience during such a crisis?

Initially the individual is confused, traumatized, and terrified by what is seemingly occurring. The world around them changes into a very different and threatening place. She or he experiences major distortions what is seen, heard, and felt. A TV or radio may become a source of strange messages. "Voices" may give commands to harm others. An entirely altered environment with creatures and things that seem very real and frightening may be "seen."

What should a relative or friend do in such a crisis?

You must get them emergency medical help as quickly as possible. They may be at high risk of harming themselves or others, and they may be suicidal or they may become so. If they have been under care, contact their doctor, therapist, or mental health center immediately. If you can't reach any of these sources, or if the individual is not receiving service, call the number for the local crisis hotline in your telephone directory or dial 911.

How should somebody act around a person in crisis?

Stay as calm as possible (the individual may become more upset if others are emotional). Eliminate as many sources of distractions as possible. Shut the TV, CD player, radio, etc. Minimize the number of people in the room. Try to have only one person speak at a time. Speak slowly and clearly in a normal voice. Be reassuring. Let the individual have their "space" and try not to crowd them. Listen and try to understand how they are feeling or what they need regardless of the logic of what they are saying. Pay attention to the needs expressed.

What are some things that shouldn't be done in such a situation?

Don't raise your voice or show frustration if the individual doesn't seem to hear you. They may be distracted by what they are seeing or hearing. Don't argue or criticize. Don't be confrontational or "get in their face." Don't tell them what to do or be patronizing. Don't try to reason. Don't agree or disagree. Don't try to make sense out of their statements.

What about hospitalization?

This may be necessary. This is determined by a psychiatrist or other physician based on an assessment of the individual's condition. The individual may need acute inpatient care. This can be provided by a psychiatric hospital or a local community hospital. Such care involves a short stay with an intensive program of diagnosis, evaluation, and treatment, including medications.

Can hospitalization be voluntary?

Yes. It is generally easier if the individual goes to the hospital on their own. Ask if they will go with you or a friend (or the EMTs or police). Try to make it "their" decision. Give them as much choice as is possible. Don't order them to go. Support their sense of control over what is happening. Understand that hospitalization may be the safest and most effective means of help. At the hospital the staff will help everyone to understand if an admission is needed.

What about involuntary hospitalization?

State law governs the involuntary hospitalization of individuals who are at high risk of harming themselves or others. This applies where the individual may be unwilling or unable to consent to psychiatric treatment. There are legal procedures to protect their rights. Court hearings determine the individual's discharge, outpatient care, or continued hospitalization.

What about the possibility of violent behavior?

The individual may try to act out the delusion, escape from the threatening perceptions, or comply with what the "voices" are saying. This may cause them to threaten self-harm, attack others, or destroy property. You must protect yourself and others (including the individual in crisis) from harm. This may include leaving the premises until emergency personnel arrive.

How is schizophrenia treated?

Long-term therapy involving medications, counseling, and rehabilitation is the norm. In recent years several new medications have been introduced, which are effective and have fewer side effects than older drugs. These medications can prevent relapses and reduce psychotic symptoms, including delusions and hallucinations. They may also help with the blunted or flat affect (blank expression). Following through with treatment, especially regularly taking all medications, is often a problem for those with schizophrenia. This is because they may choose to deny the disease because of the stigma associated with mental illness. An important part of their care is to get them to accept their illness and overcome the sense of stigma.

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Posted 07.31.01
© Copyright, MCES, Inc., 2001.