The parents of a young man with schizophrenia express feelings of responsibility and guilt for ir son’s problems. How can nurse best educate family?

Correct Answer: B. Explain the biological nature of schizophrenia.

The parents are feeling responsible and this inappropriate self-blame can be limited by supplying them with the facts about the biological basis of schizophrenia. Schizophrenia is a psychiatric disorder, which is characterized by slow functional deterioration and episodes of relapse or acute exacerbation of psychotic symptoms. The mean age of onset in early adulthood, deterioration in patients’ activities of daily living and ability to sustain employment, and the propensity of the disorder to affect insight leave many patients requiring assistance and care for an extended period of time.

• Option A: Acknowledging the patient’s responsibility is neither accurate nor helpful to the parents and would only reinforce their feelings of guilt. Caregivers of patients with childhood-onset chronic psychiatric disorders such as autism spectrum disorders, who are usually the parents, realize at an early stage that there will be a responsibility for them to care for their child for the rest of their lives in most cases. They, therefore, tend to adapt accordingly as the child grows up and experience a comparatively slow change to their lives and expectations regarding their ill child.
• Option C: Support groups are useful; however, the nurse needs to handle the parents’ self-blame directly instead of making a referral for this problem. Patients with schizophrenia can often have a normal childhood and adolescence before suddenly, unexpectedly, and often dramatically becoming ill. Because of the age of onset, care responsibilities are suddenly thrust upon mostly parents, even before they have come to terms with the shock of the sudden, dramatic onset of the illness. It often comes at a time when they would expect their child to gain independence and when they themselves are at an age when retirement could have been considered. The lowering of expectation for the future of their child, along with the new, long-term care responsibilities, tends to weigh heavily on these parents, requiring a dramatic adjustment to their lives and subjecting them to unique symptoms and behaviors, which become increasingly difficult to manage, especially for people of their age.
• Option D: Teaching the parents various ways to change would reinforce the parental assumption of blame; although parents can learn about schizophrenia and what is helpful and not helpful, the approach suggested in this option implies the parents’ behavior is at fault. Caring for family members with schizophrenia subjects caregivers to mostly negative experiences, which in turn negatively impact the caregivers themselves. These negative aspects experienced by patients’ relatives as a consequence of their caregiving role are collectively known as ‘burden’. Attempts have been made in the literature to better define ‘burden’ as the existence of serious psychosocial and emotional problems, difficulties or negative events, stressful situations or significant life changes that influence the family member of an ill relative.