Living with Schizophrenia: A Holistic Approach to Care and Support, with Tracy Hicks, D.N.P.

Tracy Hicks, D.N.P., FNP-BC, PMHNP-BC

Credit: University of North Texas Health Science Center College of Nursing

Schizophrenia is a chronic and severe mental health disorder that affects how a person thinks, feels and behaves. It’s more than just what people commonly picture — it’s not just about someone talking to themselves or having unusual beliefs. It is characterized by episodes of psychosis, which may include hallucinations (seeing or hearing things that aren’t there), delusions (false beliefs that are not based in reality), disorganized thinking and impaired cognitive function.

The way it affects a person’s daily life can vary greatly. Some individuals might struggle with maintaining employment or relationships, while others, with the proper support and treatment, can lead fulfilling lives. In my practice, I’ve seen people turn their lives around with the right approach. For instance, I had a patient in her late 60s who used to disappear frequently, causing her family great distress. But after starting treatment and addressing her overall health needs, she’s now driving around Dallas and doing all the things she loves. Her family knows where she is, and she’s engaged in her life again.

Ultimately, schizophrenia requires a holistic approach to treatment because there’s no mental health without physical health. Addressing the whole person — not just the symptoms — is crucial for long-term success.

Schizophrenia presents with a range of symptoms that impact a person’s thoughts, emotions and behaviors. It’s important to understand that the experience of schizophrenia is unique for each individual. As I often say, “There’s a lot of misunderstanding out there, and people have a specific persona in their head, but it’s not the case.” The symptoms generally fall into three main categories:

• Positive symptoms (excess or distortion of normal functions):
  • Hallucinations (auditory being the most common)
  • Delusions (paranoia, grandiosity, etc.)
  • Disorganized speech and behavior
  • Agitation or inappropriate emotional responses
• Negative symptoms (diminished function):
  • Social withdrawal and isolation
  • Lack of motivation (avolition)
  • Blunted affect (reduced emotional expression)
  • Anhedonia (inability to experience pleasure)
• Cognitive symptoms:
  • Difficulty with attention and concentration
  • Impaired executive function (planning and decision-making)
  • Memory problems

Living with schizophrenia can be challenging, as the symptoms often interfere with many aspects of a person’s day-to-day functioning. As I often share with my patients and their families, it’s not just about the diagnosis; it’s about how it impacts your life, your relationships and your ability to feel in control.

Schizophrenia affects different areas in the following ways:

• Many individuals struggle with maintaining focus, completing tasks and interacting with colleagues or peers due to cognitive and social challenges. As I’ve seen in my practice, if someone’s mental health isn’t where it needs to be, they’re going to struggle with everything else, whether it’s keeping a job or staying on top of their studies.
• Impaired social skills, isolation and paranoia can make it difficult to maintain meaningful connections with friends and family. No-judgment zones are helpful to create, as isolation only deepens the challenges schizophrenia may lead to.
• Basic daily activities such as hygiene, nutrition and attending medical appointments can become overwhelming due to lack of motivation or disorganized thinking.
• Managing finances, maintaining stable housing and making sound decisions can become difficult without support. In some cases, individuals may require assistance to avoid financial hardship or unstable living situations.
• There’s often an increased risk of comorbid conditions such as diabetes, cardiovascular diseases and substance use disorders, often due to medication side effects and lifestyle challenges.

Managing schizophrenia requires a comprehensive, long-term approach that focuses on both medical and psychosocial aspects of care. Treatment typically includes the following:

• Medications:
  • Medications such as dopamine receptor-blocking agents and muscarinic agonists help manage symptoms and improve quality of life. However, treatment isn’t just about prescribing medication; it’s about how we talk about it. Instead of asking, “Did you take your medicine?” we should be saying, “How can I help you? What is your goal?” The way we frame these conversations can make a huge difference in how individuals engage with their treatment.
• Psychosocial interventions:
  • Therapy plays a crucial role in helping individuals develop coping strategies and social skills. Evidence-based approaches such as cognitive behavioral therapy (CBT), cognitive enhancement therapy (CET), social skills training and supported employment programs can empower individuals to better navigate daily challenges. It’s about bringing people into the fold and working as a team to create a judgment-free zone.
• Community support services:
  • Case management, peer support groups and housing assistance are essential in promoting stability and independence. We need all hands on deck when it comes to care, ensuring that individuals have access to the right resources at the right time.
• Family involvement:
  • Family education and support are key to helping loved ones understand schizophrenia and provide effective support. I always remind families, you can’t do this alone, but by working together and understanding what you can and cannot control, you can create an environment that fosters healing.

While schizophrenia is a lifelong condition, early diagnosis, adherence to treatment and a strong support system can make all the difference. With the right approach, I’ve seen patients turn their lives around, regain independence and reconnect with their families. The key is compassionate care, early intervention and ongoing support tailored to each individual’s needs.

Risk Factors

Several risk factors can contribute to the development of schizophrenia, and certain populations may be more vulnerable due to genetic, environmental and social influences. While the exact cause isn’t fully understood, it’s believed to result from a combination of biological, psychological and environmental factors.

Genetics plays a significant role — individuals with a family history of schizophrenia are at higher risk. But environmental factors, such as exposure to trauma, complications during birth or significant stress during developmental years, can also increase vulnerability. Social influences matter, too. People who experience isolation, stigma or lack of access to supportive resources may be at greater risk. Understanding these risk factors is key to providing early intervention and targeted support.

Early Warning Signs

Recognizing the early warning signs of schizophrenia is crucial for timely intervention and better long-term outcomes. The onset of schizophrenia often occurs gradually, with subtle changes in behavior, emotions and thinking before more pronounced symptoms appear. These early signs, known as prodromal symptoms, can develop months or even years before a full psychotic episode.

Personally, I saw these signs with my daughter. She had a more blunted affect and did not respond to high-emotion situations or changes the way you’d expect. At first, it was thought to be just teen mood or hormonal changes. Her changes required a deeper dive and more understanding.

Some key early warning signs to look out for include the following:

• Changes in behavior: Withdrawal from social interactions, neglect of personal hygiene, or an unusual drop in performance at school or work.
• Emotional shifts: Blunted affect, increased irritability or responses that don’t match the situation.
• Cognitive difficulties: Trouble concentrating, indecisiveness or a sense of confusion in conversations.
• Unusual perceptions: Hearing, seeing or feeling things that aren’t there, even in subtle ways.
• Paranoia or suspicion: Becoming overly distrustful or fearful without clear reason.

Additionally, understanding family history and other risk factors is essential when assessing these changes. What might initially seem like typical stress or moodiness could be an indication of something more serious, particularly if the behaviors persist or intensify over time. In my experience, having open, empathetic conversations is key. Approaching loved ones with care and curiosity — rather than judgment — can help create a safe space for them to share their feelings and experiences, making it easier to identify when professional support may be needed.

How to Support a Loved One in Need

Encouraging a loved one to seek help starts with creating a supportive, nonjudgmental environment. It’s important to lead with empathy and meet people where they are. This means listening to their concerns, validating their experiences and aligning with their goals rather than imposing your own.

Building a therapeutic alliance is key, and this involves including family members in the process. Working together with caregivers and loved ones helps create a psychologically safe space where the individual feels supported and understood. When initiating these conversations, use language that shows care and collaboration rather than judgment or pressure.

Questions such as “How can I help you?”; “What can we do together to make things easier?”; “What is your goal?”; and “What would you like to achieve?” open the door to dialogue and help reduce defensiveness or resistance.

Ultimately, the goal is to let your loved one know that they’re not alone and that seeking professional support isn’t a sign of weakness but an opportunity to feel better and regain control. With patience, understanding and teamwork, you can help guide them toward the care they need.

Navigating Stigma

One of the most powerful ways to combat stigma is by being open to discussing personal and family experiences. When I tell my family’s story, people feel more comfortable — they realize they’re not alone, and it often prompts conversations they didn’t know they needed to have. More often than not, someone has a story to tell, and they’re grateful for an outlet and a shared experience. These shared moments can help break down barriers and encourage individuals to see seeking care as a sign of strength, not weakness.

Families can also lead by example, normalizing conversations about mental health within the household and fostering a safe space. Letting your loved one know they’re supported, understood and not alone in their journey can go a long way toward helping them feel comfortable seeking care.

Quality of Life with Schizophrenia

Recovery is a journey, and improvement may vary from person to person. As I like to remind families, it’s important to understand what you can change and what you cannot, and to offer consistent encouragement and support along the way. There may be periods of stability and setbacks, but with a solid treatment plan, the overall trajectory can improve significantly.

Encouragement, patience and continued professional support play a vital role in long-term success. While every journey is different, the goal is to empower individuals to live fulfilling lives — whether that means maintaining independence, contributing to their communities or simply finding joy in daily moments.

With the right combination of medication, therapy and social support, many individuals with schizophrenia can achieve meaningful improvements in their quality of life, enabling them to live independently and contribute to their communities. With consistent care and the right resources, better days are absolutely possible.

Advice for Living Well with Schizophrenia

Do not be afraid to ask for help. Just because you’re dealing with schizophrenia doesn’t mean you have to go through it alone. Find support systems that align with your needs, goals and values. This could include family, friends, peer groups or healthcare professionals who genuinely understand and support your journey.

It’s also important to take ownership of your goals. Start by identifying what matters most to you, whether it’s building stronger relationships, maintaining a job or simply feeling more in control of your day-to-day life. Work with your care team to create realistic, step-by-step expectations and celebrate the small victories along the way. Remember, you are not defined by your diagnosis. Your goals are valid, and there are people and tools to help you achieve them.

The Importance of Open Conversations

Open-ended questions are crucial in supporting individuals with schizophrenia. It’s like living by a train that goes by daily at the same time — you get used to it, and it stops disrupting our lives, but is that really a good thing? Patients shouldn’t feel like they have to just live with it.

As healthcare providers, it’s our responsibility to partner with patients to figure out how to live with schizophrenia in a way that enhances their quality of life. This starts by understanding what “improved quality of life” truly means to them.

Empathy, vulnerability, transparency and honesty are integral to building a strong therapeutic alliance. By fostering open, honest conversations, we can help patients envision and work toward a better, more fulfilling life with schizophrenia.