Q: MY brother is schizophrenic and suffers from delusions, hallucinations and hearing voices. He can become quite difficult to calm down when he has them. What is the right thing to do when he has one of these episodes? - Janet, Batu Caves.

DR YEN TECK HOE: Most families reported that a crisis or psychotic episode - that is, a severe break with reality - occurred a few months to a year after they began to notice unusual behaviour. Some said, however, that the crisis occurred with little or no warning.

During a crisis episode, your relative will exhibit some or all of the following symptoms: hallucinations, delusions, thought disorder, and disturbances in behaviour and emotions. No amount of preparation can fully protect you from the shock and dread you will feel when your relative enters this stage of schizophrenia.

Understand also that your relative may be as terrified as you are by what is happening: "voices" may be giving life-threatening commands or delusions like "snakes crawling on the window".

You must get medical help for your relative as quickly as possible, and this could mean hospitalisation. If your relative has been receiving medical help, phone the doctor or psychiatrist immediately. Ask which hospital you should go to and for advice about what to do.
Try to remain calm, speak slowly and clearly in a normal voice. Too much emotion on your part can upset your relative further. Allow your relative to have personal "space". Don't stand over him or her or get too close.

Don't shout. If your relative appears not to be listening to you, it may be because other "voices" are louder. Don't criticise. Your relative cannot be reasoned with at this point. Avoid continuous eye contact. Don't block the doorway.

It is far better, if possible, to have your relative go to the hospital voluntarily. Some have found that presenting their relative with a choice seem to work. "Will you go to the hospital with me, or would you prefer that John take you?"

Such an approach may serve to reduce the person's feeling of helplessness. Offering choice, no matter how small, provides some sense of being in control of the horrible situation in which they find themselves in.

If your relative becomes violent during the psychotic episode threatening to harm him or herself, to hurt you, or to damage property, you must do whatever is necessary to protect yourself and others (including the ill person) from physical harm. Under extreme circumstances, it may be advisable to secure your relative in a room while you phone or go for help. -NST