Dr Mari Järvelaid, Nordic Estonia Health Centre, Tallinn, Estonia talks about how relapse prevention is an important aim, but few patients really understand the need to keep taking medication when they are at home.
Q: When and how do you first tell a patient that they have schizophrenia?
A: I see mostly patients with first episode psychosis, and frequently they are brought to the hospital by the emergency services. We evaluate the patient in the acute phase, but at that stage we don’t know the diagnosis ourselves. The patient’s history is very likely a long story that we have to follow.
We may have suspicions. But we don’t come to a diagnosis without seeing how the disease develops. These are people in their late teens or young adults, and they are well educated. By the time I am ready to say it is schizophrenia, the patients very often know that for themselves. Giving them written material is useful in helping them recognise what the problem is. We may help the process by asking if there is anything they see in a booklet that they think is like themselves.
Q: And how are you able to help them?
We will have patients in the hospital for 21 days, perhaps 40 if they are severely ill. Once they are stabilised, we have a team: psychiatrists, clinical psychologists, art therapists.... . And we work with families.
There is still stigma, or course, but that will disappear with time. And compared with decades ago, we have treatments that are effective -- if we can co-operate with patients and they co-operate with us.
Relapse prevention is an important aim, but few patients really understand the need to keep taking medication when they are at home. That is our biggest problem.
Results are better if patients regularly meet a specialist – not necessarily a psychiatrist but someone able to give advice and act as a resource.
The best outcome is that people with schizophrenia live a normal life. But we all have different capacities. They may need support. But everyone needs somebody.