ABSTRACT
Schizophrenia the most common type of mental illness affecting approximately 1% of the
world population is often accompanied by relapse even while on treatment. This study
assessed Caregivers’ knowledge and involvement in the prevention and management of
relapse in Schizophrenic patients of Federal Neuropsychiatric Hospital Enugu. A
descriptive cross sectional design was adopted. A sample of 197 participants was used.
43-item questionnaire developed by the researcher was used for data collection.
Descriptive and inferential statistic were used to test hypotheses at a significant level of
0.05, results show high rate of Schizophrenic relapse at Federal Neuropsychiatric
Hospital Enugu (FNHE) (97.1%). Majority of the Caregivers have knowledge of
prevention and management of schizophrenic relapse respectively. Caregivers’
involvement in the prevention and management of Schizophrenic relapse are high (mean
= 3.20) and (mean = 2.42). Among the measures adopt by caregivers’ in the prevention
of Schizophrenic relapse include providing his/her basic needs (p>.05). Making sure
he/she takes his/her drugs always (p>.05). Avoiding using strong words on him/her (p>
.05). Avoiding fighting him/her (p >.05). Giving him a sense of belonging by allowing
him/her contribute in some family issues (p>.05). Making sure his /her drugs are always
available (p>.05). Always avoiding stigmatizing words on him/her (p>.05). Helping him
to take his /her drugs regularly (p>.05). In the management, caregivers adopt the
following measures: Rushing him to the hospital immediately (p>.05). Calling his /her
personal doctor (p>.05). Calling the neighbors to help calm him down (p>.05).
However, little differences were found in the prevention and management of
schizophrenic relapse by caregivers with reference to gender, occupation, locality and
level of education. The study concluded that majority of caregivers of schizophrenic
patients have knowledge of schizophrenic relapse and were also involved in the
prevention and management of the problem. The study recommended that all hands
continue to be on deck towards reducing the increasing rate of schizophrenics relapse

CHAPTER ONE
INTRODUCTION
Background of the Study
Schizophrenia the most common type of mental illness is a chronic and disabling
psychiatric illness that affects approximately 1% of the world’s population. It is often
accompanied by relapse even while on treatment. Relapse rates vary from 50% to 92%
and are similar in developed and developing countries, despite the former having wellestablished
mental health services (Davis, 2014; Hogarty & Ulrich, 2013).
Unfortunately, psychotic relapse is so common, with up to 60% of all patients having a
relapse within the year of being hospitalized (Davis, 2014; Hogarty & Ulrich, 2013).
With the total cost of hospital care for patients with schizophrenia exceeding two billion
dollars annually (Weiden & Olfson, 2014) relapse represents a significant public health
problem. The personal costs associated with relapse-including impaired role functioning,
disrupted interpersonal relationships and demoralization is also considerable. Though
new medications have improved the course of illness for many patients, relapses are still
common. (Tanveer & Rukhsaner, 2009). Although antipsychotic medication is effective
in reducing relapse rates, 30% to 40% of patients relapse within one year after hospital
discharge even if they are receiving maintenance medication (Sena, 2003, Sariah 2013).
Schizophrenic symptoms affects patient as well as caregivers in multiple and complex
ways. It is obvious that psychiatric and or physical illnesses have great impact on
caregivers. Caregivers of schizophrenic patients can be the first source of support and
stability or it can become part of the problem that leads to ineffective coping
(Kreyenbuhl, Buchanan, Dickerson & Dixon, 2009). The recognition of the importance
of the caregiver patient’s care necessitated the incorporation of the caregiver as a unit
into healthcare modules in recent time (Bormar & McNeely, 2014).
A caregiver of schizophrenic patient struggles throughout the person’s illness with the
change it brings and their own feelings about the illness. In the past, caregivers were
blamed for many of the problems that mentally ill people experienced and although this
perception of fault has changed, caregivers still experience a catastrophic event when
mental illness occurs (Finkelman, 2002). The caregiver which is a unit of mental health
care is highly involved in the prevention and management of relapse when the client with
mental ill-health especially schizophrenia lives with caregiver. A lot of the day-to-day
help and rehabilitation is carried out by the caregiver if the caregiver has knowledge of
the prevention and management. Thus, if they are to effectively help the client,
caregivers must have help in managing their stress and coping with difficult situations to
avoid relapse.
The image of isolated people with serious mental illness, especially schizophrenia, who
return to communities, other than their caregiver, has been widely publicized. However,
most people with mental illness are involved with their families and have frequent
contact with family members who are always the caregivers while they are within the
larger community. The mental illness impact on the entire family is so heavy that it is
often called family burden (Doornbos, 1997). Mental illness can have a negative impact
on the caregiver as well. Problems identified by caregivers/family include the following
(Doornbos, 1997):
Increased stress and conflict.
Blaming each other for the illness.
Difficulty understanding or accepting the illness.
Tension during family gatherings.
Disproportionate amount of family time, energy, or money given to the ill member.
Family members may feel guilty about their relative’s illness. It is also common for
those who are close to a person with any serious illness to wonder whether they could
have done something to prevent regression of the illness (Miller, 2002).
Caregivers who provide care for schizophrenics often feel isolated and alone in dealing
with the challenges of care-giving. Sometimes they may be embarrassed about the
illness or fear that the person with psychological disorder will behave inappropriately in
the presence of others. The caregiver in no doubt has a lot of challenges to face in the
prevention and management of relapse of family member that is mentally recuperating or
adjusting to the societal dynamics. The services of a mental health nurse may be quite
necessary as a support person. The mental health nurse can play an important role in
offering caregiver opportunities to discuss their concerns and taking action to meet their
needs whenever possible.
Statement of the problem
Schizophrenia is a disabling group of brain disorders characterized by symptoms such as
hallucinations, delusions, disorganized communication, poor planning, reduced
motivation, and blunted affect (McGrath, Saha, Welham, Saadi, MacCauley & Chant,
2014). In the Global Burden of Disease 2010 study, psychiatric disorders accounted for
3.4% of the total Disease Adjusted Life Years (DALYs) in the African region; of these,
schizophrenia accounted for 0.5% of total DALYs (WHO, 2011).
Schizophrenia is often accompanied by relapse even while on treatment (Gelder, Lopez-
Ibor & Andreasen, 2014). Relapse has been defined as a worsening of
psychopathological symptoms or rehospitalization in the year after hospital discharge
(Schennach, Obermeier, Meyer, Jäger, Schmauss & Laux, 2012). Schizophrenia follows
a variable course, with complete symptomatic and social recovery in about 1/3 of cases.
Schizophrenia can however follow a chronic or recurrent course, with residual symptoms
and incomplete social recovery. Individuals with chronic schizophrenia constituted a
large proportion of all residents of mental institutions in the past and still do where these
institutions continue to exist (WHO report, 2011).
An international survey was done to shed light on experiences and insights of caregivers
of individuals with schizophrenic disorder. Relapse was seen to have been a major
concern for care givers because of its devastating consequences for family members of
people living with the mental illness. A few studies regarding relapse and schizophrenia
have been done in Africa. Studies done in South Africa have found that presence of a comorbid
depressed mood, poor adherence due to a lack of patient insight, and medication
side-effects appear to be the factors most likely to increase the risk of a relapse (Kazadi,
Moosa & Jeenah, 2013). Other factors that have been identified include: lack of social
support, grief following the loss of a close family member, and lack of employment. The
discussions above revealed that most of the researches on schizophrenic relapse centered
more on the causes. In addition effort to control the menace centered more on drug
management with little or no attention on the role of caregivers. Since studies have
identified the importance of non drug therapy in prevention and management of
schizophrenic relapse, roles of care giver cannot be over looked
A visit to the Outpatient Clinic and the Medical records of Psychiatric Hospital Enugu
shows some reported cases of relapse most of which were schizophrenic patients who
had earlier been mentally stable and discharged home. Hence this study as investigated
the knowledge of care givers in prevention and management schizophrenic relapse
Aim of the study
The main purpose of this study was to examine caregivers’ knowledge and involvement
in the prevention and management of relapse in schizophrenic patients at Federal
Neuropsychiatric Hospital Enugu.
Objectives of the study were to:
1. Determine caregivers’ knowledge of relapse among schizophrenic patients.
2. Determine caregivers’ knowledge of prevention of relapse among schizophrenic
patients.
3. Assess caregivers’ knowledge of management of relapse among schizophrenic
patients.
4. Ascertain caregivers’ involvement in prevention of relapse among schizophrenic
patients.
5. Determine caregivers’ involvement in the management of relapse among
schizophrenic patients.
Research Questions
1. What is the caregivers’ knowledge of relapse among schizophrenic patients?
2. What is the caregivers’ knowledge of prevention of relapse among schizophrenic
patients?
3. What is the caregivers’ knowledge of management of relapse among
schizophrenic patients?
4. What is the caregivers’ involvement in prevention of relapse among
schizophrenic patients?
5. What is the caregivers’ involvement in the management of relapse among
schizophrenic patients?
Hypotheses
1. There will be no significant difference in the knowledge of relapse prevention
among male & female caregivers’ of schizophrenic patients.
2. There will be no significant difference in the knowledge of relapse management
between male and female caregivers’ of schizophrenic patients.
3. There will be no significant association between knowledge of relapse prevention
and preventive measures adopted by caregivers of schizophrenic patients.
4. There will be no significant association between knowledge of relapse
management and management measures adopted by caregivers of schizophrenic
patients.
5. There will be no significant association between some demographic variables of
the caregivers and the prevention/ management of relapse in schizophrenic
patients.
Significance of the study
It is generally acknowledged that mental illness especially schizophrenia creates burdens
for the family care givers. Since the 1950s, medical literature has identified the type and
extent of those burdens, especially for families of patients with schizophrenia. It is
therefore an imperative to provide empirically evidence-based research to proactively
engage family members in the prevention and management of relapse among
schizophrenic patients.
This study will provide mental health policy makers with information on the outcomes of
existing psycho-educational initiatives for families of schizophrenic patients, their level
of effectiveness and plausible improvements to be adopted where necessary.
For the clinical healthcare personnel, findings from this study will provide insight into
the need to expand existing approaches in order to proactively engage families of
schizophrenic patients in their management. The study will also bring to the fore the
challenges inhibiting the incorporation of requisite family support-based approaches in
management of schizophrenic patients in psychiatric hospitals with a view to providing
ameliorative measures.
The generality of the public, especially families which have schizophrenic patients as
members, will benefit from the findings of this research as it will adequately highlight
the existing challenges as well as the integral role which the immediate family as well as
the larger community needs to play to prevent the relapse of schizophrenic patients. The
fear and powerlessness often reported by affected families will be adequately addressed
by intervention approaches which will be sequel to the findings of this study.
Moreover the outcome of this study will in no doubt proffer solutions to the various
challenges being experienced by families caring and living with the schizophrenic family
member, and the outcome of this study will finally add to the existing body of
knowledge.
Operational definitions
Schizophrenia patients: These are patients that have been diagnosed as
schizophrenics, characterized by breakdown of thought processes and poor emotional
responsiveness, which have been discharged from the Psychiatric Hospital.
Caregiver: A person who must have spent a minimum of one year caring for a
schizophrenic patient. This does not include health workers.
Knowledge of schizophrenic relapse: This means an understanding of signs and
symptoms of schizophrenic relapse by the caregiver.
Caregiver management of relapse in schizophrenic patients: This means the roles
caregiver plays in the management of schizophrenic relapse.
Knowledge of Relapse: This means understanding of signs and symptoms associated
with relapse by the caregiver who may be a blood relation or paid caregiver. This
excludes health workers.
Caregiver Prevention of schizophrenic relapse: This means the roles caregiver play in
the prevention of relapse among a schizophrenic patient.
Caregiver knowledge of Schizophrenic relapse: This means the understanding of
Schizophrenic relapse among those who take care of them.
Caregiver Involvement: This means the participation of caregivers in the management
and prevention of Schizophrenic relapse.