Ch. 12 Schizophrenia

Question 1

Schizophrenia

Answer 1

SCHIZOPHRENIA – A psychotic disorder in which functioning deteriorates as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities.

• Often includes Psychosis.

Psychosis – a loss of contact with reality in key ways.

Hallucinations – (false sensory perceptions)

Delusions – (false beliefs)

Schizophrenia spectrum disorders – refers to a number of schizophrenia-like disorders listed in DSM-5.

• most of the explanations and treatments offered for schizophrenia are applicable to the other disorders as well
• 1 of every 100 people in the world suffers from schizophrenia during his or her lifetime.
• 21 million people worldwide
• 3.6 million in the United States
• Equal numbers of men and women
• average age of onset for men is 23 years
• 28 years for women.
• much more likely to attempt suicide than the general population.
• 25% of people with schizophrenia attempt suicide and 5 percent die from suicide
• People with the disorder have an increased risk of physical—often fatal—illness.
• They live 10 to 20 fewer years than other people
• It is found more frequently in the lower socioeconomic groups.
• Stress of poverty is itself a cause of the disorder. However, it could be that schizophrenia causes its sufferers to fall from a higher to a lower socioeconomic level or to remain poor because they are unable to function effectively, called the DOWNWARD DRIFT THEORY.
• Symptoms of schizophrenia vary greatly from sufferer to sufferer, and so do its triggers,
• Clinicians believe that schizophrenia is actually a group of distinct disorders that happen to have some features in common.

SYMPTOMS OF SCHIZOPHRENIA

• Deterioration from a normal level of functioning to become ineffective in dealing with the world
• POSITIVE SYMPTOMS – (excesses of thought, emotion, and behavior), “pathological excesses,” or bizarre additions, to a person’s behavior. Delusions, disorganized thinking and speech, heightened perceptions and hallucinations, and inappropriate affect.
• NEGATIVE SYMPTOMS – (deficits of thought, emotion, and behavior),
• PSYCHOMOTOR SYMPTOMS – (unusual movements or gestures)
• 50% of those with schizophrenia have significant difficulties with memory and other kinds of cognitive functioning

Schizophrenia- A mental disorder that causes severe delusions, hallucinations, and an abnormal interpretation of reality. Symptoms can vary from person to person as do their triggers and responsiveness to treatment. Often people will begin to deteriorate from a normal level of functioning and lose touch with reality.

People with schizophrenia experience psychosis which is a state where a person loses contact with reality.

DSM-5- A person can be diagnosed with schizophrenia only if symptoms persit for 6 months or longer

There are multiple schizophrenia-type disorders listed in DSM-5. All these psychotic disorders are similar to schizophrenia and along with schizophrenia, they are collectiveley called schizophrenia spectrum disorders. (next card)

About 1 in every 100 people in the world suffer from schizophrenia. It’s estimated that 21 million people world wide are affected including 3.1 million in the USA. Schizophrenia appears in men and women equally. The average age of onset is 23 for men and 28 for women

People with schizophrenia are far more likely to attempt suicide than the general population. it is estimated that up to 25% of people with schizophrenia attempt siucide and 5% end up dying from suicide

People with schizophrenia have an increased risk of physical, often fatal illness. Life expectancy is about 10-20 yrs less than average

Schizophrenia appears in all socioeconomic groups but is most frequently found in lower class.

Question 2

Schizo Spectrum Disorders

Answer 2

Question 3

Positive Symptoms

Answer 3

POSITIVE SYMPTOMS

• DELUSIONS – ideas that they believe wholeheartedly but that have no basis in fact.
  
  • The deluded person may consider the ideas enlightening or may feel confused by them. Some people hold a single delusion that dominates their lives and behavior; others have many delusions.
  • DELUSIONS OF PERSECUTION – are the most common in schizophrenia. People with such delusions believe they are being plotted or discriminated against, spied on, slandered, threatened, attacked, or deliberately victimized.
  • DELUSIONS OF REFERENCE – they attach special and personal meaning to the actions of others or to various objects or events.
  • DELUSIONS OF GRANDEUR – believe themselves to be great inventors, religious saviors, or other specially empowered persons.
  • DELUSIONS OF CONTROL – believe their feelings, thoughts, and actions are being controlled by other people.
  • EROTOMANIC DELUSIONS – false beliefs that they are loved by and in a relationship with the object of their attention.
    
    • Ex: Some stalkers may have this.
  • LYCANTHROPY – The delusion of being an animal.

DISORGANIZED THINKING AND SPEECH.

• FORMAL THOUGHT DISORDERS – A disturbance in the production and organization of thought.
  
  • They may not be able to think logically and may speak in peculiar ways.
  • Can cause the sufferer great confusion and make communication extremely difficult.
  • Research suggests that some people may have disorganized speech or thinking long before their full pattern of schizophrenia unfolds.
  • Can include: pathological excesses such as:
    
    • LOOSE ASSOCIATIONS – People who have loose associations, (or derailment), rapidly shift from one topic to another, believing that their incoherent statements make sense.
    • NEOLOGISMS – made-up words that typically have meaning only to the person using them.
    • PERSEVERATION – in which they repeat their words and statements again and again
    • CLANG – where they speak in rhymes

HEIGHTENED PERCEPTIONS AND HALLUCINATIONS

• The perceptions and attention of some people with schizophrenia seem to intensify, overwhelming them and making everyday life impossible
  
  • These may develop years before the onset of the actual disorder
• HALLUCINATIONS – perceptions that a person has in the absence of external stimuli.
  
  • AUDITORY HALLUCINATIONS – by far the most common kind in schizophrenia, hear sounds and voices that seem to come from outside their heads.
    
    • Auditory hallucinations actually produce the nerve signals of sound in their brains, “hear” them, and then believe that external sources are responsible
  • TACTILE HALLUCINATIONS – form of touch, tingling, burning, or electric- shock sensations.
  • SOMATIC HALLUCINATIONS – something is happening inside the body, such as a snake crawling inside one’s stomach.
  • VISUAL HALLUCINATIONS – produce vague perceptions of colors or clouds or distinct visions of people or objects.
  • GUSTATORY HALLUCINATIONS – find that their food or drink tastes strange,
  • OLFACTORY HALLUCINATIONS – smell odors that no one else does, such as the smell of poison or smoke.
  • Hallucinations and delusional ideas often occur together. Whatever the cause and whichever comes first, the hallucination and delusion eventually feed into each other.

INAPPROPRIATE AFFECT – emotions that are unsuited to the situation.

• These emotions may be merely a response to other features of the disorder.
  
  • Ex: One could be responding instead to another of the many stimuli flooding her senses.

Question 4

Negative Symptoms

Answer 4

NEGATIVE SYMPTOMS – “pathological deficits,” characteristics that are lacking in a person. Symptoms of schizophrenia that seem to be deficits in normal thought, emotions, or behaviors.

• POVERTY OF SPEECH (or ALOGIA) – reduction in speech or speech content. people with this negative kind of formal thought disorder think and say very little. Others say quite a bit but still manage to convey little meaning.
  
  • • RESTRICTED AFFECT:
  • BLUNTED AFFECT – display less anger, sadness, joy, and other feelings than most people.
  • FLAT AFFECT – Indeed, a number show almost no emotions at all.
    
    • May actually reflect an inability to express emotions as others do.
    • However, research shows that they still report feeling just as much positive and negative emotion and in fact displayed more skin arousal.
    • They also grapple with high levels of anxiety and/or depression.
• LOSS OF VOLITION:
  
  • AVOLITION (or APATHY) – feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action.
  • AMBIVALENCE – conflicting feelings
• SOCIAL WITHDRAWAL – may withdraw from their social environment and attend only to their own ideas and fantasies.
  
  • Because their ideas are illogical and confused, the withdrawal has the effect of distancing them even further from reality.
  • The social withdrawal seems also to lead to a breakdown of social skills, including the ability to recognize other people’s needs and emotions accurately.

Question 5

Psychomotor Symptoms

Answer 5

PSYCHOMOTOR SYMPTOMS – Many move relatively slowly, and a number make awkward movements or repeated grimaces and odd gestures that seem to have a private purpose—perhaps ritualistic or magical.

CATATONIA – A pattern of extreme psychomotor symptoms, found in some forms of schizophrenia, which may include catatonic stupor, rigidity, or posturing.

• CATATONIC STUPOR – stop responding to their environment, remaining motionless and silent for long stretches of time.
• CATATONIC RIGIDITY – maintain a rigid, upright posture for hours and resist efforts to be moved.
• CATATONIC POSTURING – assuming awkward, bizarre positions for long periods of time.
• CATATONIC EXCITEMENT – move excitedly, sometimes wildly waving their arms and legs.

Question 6

The Course of Schizophrenia

Answer 6

THE COURSE OF SCHIZOPHRENIA

• It first appears between the person’s late teens and mid-thirties
• There are three phases—prodromal, active, and residual
  
  • PRODROMAL PHASE – symptoms are not yet obvious, but the person is beginning to deteriorate.
  • ACTIVE PHASE – symptoms become apparent. Sometimes this phase is triggered by stress or trauma
  • RESIDUAL PHASE – in which they return to a prodromal-like level of functioning.
    
    • They retain some negative symptoms, but have a decrease in the striking symptoms.
    • Phases may last for days or for years.
• 25% or more of patients recover completely.
• Majority continue to have at least some residual problems for the rest of their lives
• Fuller recovery from schizophrenia is more likely in people who:
  
  • Functioned quite well before the disorder.
  • Whose initial disorder is triggered by stress, comes on abruptly, or develops during middle age.
  • Who receive early treatment.
• Relapses are apparently more likely during times of life stress

TYPE 1 SCHIZOPHRENIA – (80 to 85% of cases) seem to be dominated by positive symptoms, such as delusions and hallucinations.

TYPE 2 SCHIZOPHRENIA – (15 to 20% of cases) display mostly negative symptoms, such as restricted affect and poverty of speech.

Question 7

Explaining Schizophrenia

Answer 7

EXPLAINING SCHIZOPHRENIA

BIOLOGICAL VIEWS

BIOLOGICAL explanations have received by far the most research support.

• DIATHESIS-STRESS RELATIONSHIP** – people with a **GENETIC biological predisposition (i.e., a diathesis) will develop schizophrenia only if certain kinds of events or stressors are also present (i.e. stress).
  
  • A diathesis–stress relationship often seems to be operating in the development of other kinds of psychotic disorders as well.
• The more closely related the relatives are to the person with schizophrenia, the more likely they are to develop the disorder.
• CONCORDANT – If both members of a pair of twins have a particular trait, they are said to be concordant for that trait.
  
  • if one identical twin develops schizophrenia, there is a 48% chance that the other twin will do so as well.
  • Biological relatives of adoptees with schizophrenia are more likely than their adoptive relatives to develop schizophrenia – no shit.
  • Research procedures, studies have identified possible gene defects on chromosomes
• Two kinds of biological abnormalities that could conceivably be inherited – biochemical abnormalities and dysfunctional brain circuitry.
• BIOCHEMICAL ABNORMALITIES:
  
  • DOPAMINE HYPOTHESIS – to help explain schizophrenia: certain neurons that use the neurotransmitter dopamine fire too often and transmit too many messages to receiving neurons, thus producing the symptoms of schizophrenia.
    
    • ANTIPSYCHOTIC DRUGS, medications that help remove the symptoms of schizophrenia. The first group of antipsychotic medications, the
      
      • were discovered in the 1950s by researchers who were looking for better antihistamine drugs to combat allergies.
    • Researchers later learned that these early antipsychotic drugs often produce troublesome muscular tremors, symptoms that are identical to the central symptom of Parkinson’s disease, a disabling neurological illness. This undesired reaction to antipsychotic drugs offered the first important clue to the biology of schizophrenia. Scientists already knew that people who suffer from Parkinson’s disease have abnormally low levels of the neurotransmitter dopamine in some areas of the brain and that lack of dopamine is the reason for their uncontrollable shaking. If antipsychotic drugs produce Parkinsonian symptoms in people with schizophrenia while removing their psychotic symptoms, perhaps the drugs reduce dopamine activity. And, scientists reasoned further, if lowering dopamine activity helps remove the symptoms of schizophrenia, perhaps schizophrenia is related to excessive dopamine activity in the first place.
    • AMPHETAMINES – stimulate the central nervous system by increasing dopamine.
      
      • People who take high doses of amphetamines may develop AMPHETAMINE PSYCHOSIS – a syndrome very similar to schizophrenia.
      • Antipsychotic drugs bind to many of these receptors, prevent dopamine from binding there, and so prevent the neurons containing those receptors from firing.
  • Second-generation antipsychotic drugs**, which are often more effective than the phenothiazines and related early drugs, now collectively called **First-generation antipsychotic drugs. newer drugs bind not only to D-2 dopamine receptors, but also to many D-1 and D-4 receptors and to receptors for other neurotransmitters such as serotonin .
    
    • Thus, it may be that schizophrenia is related to abnormal activity or interactions of both dopamine and other neurotransmitters, rather than to abnormal dopamine activity alone.
• BRAIN STRUCTURE AND CIRCUIT DYSFUNCTION
  
  • BRAIN CIRCUITS – networks of brain structures that work together, triggering each other into action and producing particular behaviors.
    
    • Studies suggest brain circuit dysfunction contributes to schizophrenia.
    • Several of the structures in this circuit are also members of brain circuits that contribute to other disorders, but in cases of schizophrenia the structures function and interconnect in problematic ways that are, collectively, unique to this disorder.
    • Dysfunction of this schizophrenia-related circuit cannot be characterized in broad terms as, for example, a generally “hyperactive” or generally “underactive” circuit.
    • This focus on brain circuitry is compatible with the dopamine hypothesis of schizophrenia as dopamine activity is very prominent throughout the schizophrenia-related brain circuit.
    • The KEY DIFFERENCE between the dopamine hypothesis** and the newer **brain circuit view is that abnormal activity by dopamine is now seen as part of a broader circuit dysfunction that can propel people toward schizophrenia.
• VIRAL PROBLEMS
  
  • Brain abnormalities may result from exposure to viruses before birth. Perhaps a viral infection triggers an immune system response in the mother, is passed on to the developing fetus, enters his or her brain, and interrupts proper brain development
    
    • An unusually large number of people with schizophrenia are born during the late winter, which could be because of an increase in fetal or infant exposure to viruses at that time of year. mothers of people with schizophrenia were more likely to have been exposed to the influenza virus (the Flu) during pregnancy than were mothers of people without schizophrenia.
  • MICROGLIA – are especially active in the brains of people with schizophrenia. Microglia are brain immune cells that provide a first line of defense against brain infections and inflammation.

PSYCHOLOGICAL VIEWS

• Biological factors merely set the stage for schizophrenia, while key psychological and sociocultural factors must be present for the disorder to appear.
• PSYCHODYNAMIC EXPLANATION:
  
  • SIGMUND FREUD – cold or unnurturing parents may set schizophrenia in motion.
  • FRIEDA FROMM-REICHMANN (1948) noted psychodynamic clinician – elaborated on Frued’s assertion noting that mothers of people who develop the disorder are cold, domineering, and uninterested in their children’s needs – labeling them SCHIZOPHRENOGENIC MOTHERS.
    
    • Has received little research support and the majority of people with schizophrenia do not appear to have mothers who fit the schizophrenogenic description.
    • No one today thinks this.
• COGNITIVE-BEHAVIORAL EXPLANATION –Two explanations of how and why people develop schizophrenia.
• OPERANT CONDITIONING – process by which people learn to perform behaviors for which they have been rewarded frequently.
• Operant explanation of schizophrenia – on the Behavioral side – holds that some people are not reinforced during childhood for proper attention to social cues – that is, attention to other people’s smiles, frowns, and comments. As a result, they stop attending to such cues and focus instead on irrelevant cues – the brightness of light in a room, a bird flying above, or the sound of a word rather than its meaning. As they attend to irrelevant cues more and more, their responses become increasingly bizarre.
• MISINTERPRETING UNUSUAL SENSATIONS – on the Cognitive side – begins by accepting the biological position that the brains of people with schizophrenia are actually producing strange and unreal sensations – sensations triggered by biological factors – when they have hallucinations and related experiences. when the individuals attempt to understand their unusual experiences, more features of their disorder emerge.
  
  • When first confronted by voices or other troubling sensations, these people turn to friendsand relatives. Naturally, the friends and relatives deny the reality of the sensations, and eventually the sufferers conclude that the others are trying to hide the truth. They begin to reject all feedback, and some develop beliefs (delusions) that they are being persecuted. People take a “rational path to madness”

SOCIOCULTURAL VIEWS

• Sociocultural Views – Believe that multicultural factors, social labeling, and family dysfunction all contribute to schizophrenia.
• Multicultural Factors – schizophrenia appear to differ between racial and ethnic groups.
  
  • 2.1% of African Americans
  • Hispanic American fall between these two
  • 1.4% of white Americans.
  • On average, African Americans are more likely to be poor; when economic differences are controlled for, the prevalence rates of schizophrenia become closer for the two racial groups.
  • Schizophrenia differs from country to country.
  • Schizophrenic patients who live in developing countries have better recovery rates than schizophrenic patients in Western and other developed countries.
  • Some clinical theorists believe that these differences partly reflect genetic differences from population to population.
    
    • However, others argue that the psychosocial environments (families and friends) in developing countries tend to be more supportive and therapeutic than those in developed countries, leading to more favorable outcomes for people with schizophrenia
• SOCIAL LABELING** – Once the label of “schizophrenia” is assigned, it becomes a negative **SELF-FULFILLING PROPHECY that promotes the development of many schizophrenic symptoms.
• FAMILY DYSFUNCTION – schizophrenia, like a number of other mental disorders, is often linked to family stress.
  
  • Parents of schizophrenics often:
    
    • display more conflict
    • have more difficulty communicating with one another
    • more critical of and over-involved with their children.
    • EXPRESSED EMOTION – when family members frequently express criticism, disapproval, and hostility toward each other and intrude on one another’s privacy.
      
      • Recovering Schizophrenics are 4 times more likely to relapse while living in such a situation.
      • People with schizophrenia greatly disrupt family life, themselves producing some of the family problems.
    • DEVELOPMENTAL PSYCHOPATHOLOGY VIEW
    • Developmental Psychopathology View – the road to schizophrenia:
      
      • begins with a genetically inherited predisposition
      • This can lead to schizophrenia if one experiences significant life stressors.
      • All kindness of theorists agree with the diathesis–stress relationship, the idea that people with a biological predisposition to this disorder will develop it if they further experience significant life stress or other negative events.
    • • Two clarifications on the diathesis–stress processes at work in schizophrenia:
        
        • Schizophrenia typically begins to unfold long before the actual onset of the disorder in young adulthood.
          
          • People with this disorder often display cognitive, perception, and attention problems earlier in their lives.
          • People also tend to be more socially withdrawn, disagreeable, and disobedient, and to have more motor difficulties, throughout their early development.
          • Some early problems result from inherited predisposition, but they may also be due to repeated experiences of childhood stress.
        • A dysfunctional brain circuit may adversely affect functioning through the circuit’s impact on the operation of the hypothalamic-pituitary-adrenal (HPA) stress pathway.
          
          • whenever we are stressed, the brain’s hypothalamus activates this brain–body pathway, leading, in turn, to the secretion of stress hormones and to a broad experience of arousal.
          • Dysfunction by the schizophrenia-related brain circuit leads to repeated overreactions by the HPA pathway in the face of stress. Such chronic overreactions leave individuals highly sensitive to and unsettled by stressors throughout their development. become all the more inclined to later develop schizophrenia in the face of stress.
        • An overreactive HPA stress pathway and chronic stress reactions lead to the development of a dysfunctional immune system, characterized by heightened inflammation throughout the brain.
          
          • Studies have found significant immune system problems and chronic inflammation throughout the brains of people with schizophrenia.
    • Just as children’s overreactive HPA stress pathways can make them particularly vulnerable to stress, so too can their acquisition of resilience and coping skills improve the operation of their HPA pathways.

Question 8

Treating Schizophrenia

Answer 8

TREATING SCHIZOPHRENIA

• Most treatments begin after the onset of the disorder rather than prevention.
• In the past, many people with psychotic symptoms were nearly always diagnosed with schizophrenia, but now it is understood that a severe form of bipolar disorder or major depressive disorder may have been inaccurately diagnosed with schizophrenia.
  
  • Because patients with schizophrenia did not respond to traditional therapies, most were merely institutionalized and restrained.
  • Philippe Pinel** introduced “**MORAL TREATMENT”. For the first time in centuries, patients with severe disturbances were viewed as human beings who should be cared for with sympathy and kindness.
  • STATE HOSPITALS,Public mental hospitals in the United States, run by the individual states, were introduced to care for the mentally ill with “moral treatment”, and it began that way, but over the next 110 years the number of patients in these hospitals rose from2,000 in 1845 to nearly 600,000 in 1955. State funding was unable to keep up and the emphasis shifted from giving humanitarian care to keeping order. In a throwback to the asylum period, difficult patients were restrained, isolated, and punished; individual attention disappeared
  • LOBOTOMY – From the early 1940s through the mid-1950s, the lobotomy was viewed as a miracle cure by most doctors and became a mainstream part of psychiatry.
• In the 1950s, clinicians developed two institutional approaches that brought hope:
  
  • MILIEU THERAPY – A humanistic approach based on the premise that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity.In such settings, patients are given the right to run their own lives and make their own decisions.
    
    • Patients often improve and leave the hospital at higher rates than patients in programs offering primarily custodial care.
  • TOKEN ECONOMY – A program in which a person’s desirable behaviors are reinforced systematically by the awarding of tokens that can be exchanged for goods or privileges.
    
    • Patients are rewarded when they behave acceptably and are not rewarded when they behave unacceptably.
    • Researchers have found that token economies do help reduce psychotic and related behaviors.
    • Problem is that operant conditioning, instead of changing a patient’s psychotic thoughts and perceptions, might simply be improving the patient’s ability to imitate normal behavior.
    • Token economy programs are no longer as popular as they once were, but they are still used in many mental hospitals
• ANTIPSYCHOTIC DRUGS (1950) – imperfect, troubling, and even dangerous though they may be – have been a breakthrough in the notoriously difficult task of treating schizophrenics. These medications help schizophrenics to think clearly and profit from psychotherapies that previously would have had little effect for them. Antipsychotic Drugs
  
  • One group of antihistamines, phenothiazines, was found helpful in calming patients about to undergo surgery. One of the phenothiazines, _chlorpromazine (_Thorazine brand name), was eventually tested on six patients with psychotic symptoms and was found to reduce their symptoms sharply.
  • FIRST-GENERATION DRUGS – also known as neuroleptic drugs because they often produce undesired movement effects similar to the symptoms of neurological diseases. blocking excessive activity of the neurotransmitter dopamine.
    
    • 70% of patients diagnosed with schizophrenia benefit from antipsychotics – more effective treatment than any of the other approaches used alone.
    • Medications have resulted in shorter hospitalizations that now last weeks rather than years.
    • Reduce the positive symptoms of schizophrenia (such as hallucinations and delusions) more completely, or at least more quickly, than the negative symptoms(such as restricted affect, poverty of speech, and loss of volition)
    • EXTRAPYRAMIDAL EFFECTS – Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by antipsychotic drugs.
      
      • These effects are Parkinsonian symptoms, reactions that closely resemble the features of the neurological disorder Parkinson’s disease – which relates back to Dopamine Hypothesis.
      • TARDIVE DYSKINESIA – Extrapyramidal effects involving involuntary movements that some patients have after they have taken antipsychotic drugs for an extended time – usually more than six months.
• SECOND-GENERATION ANTIPSYCHOTIC DRUGS – appear to be at least as effective, and often more effective, than the first-generation drugs.
  
  • is often the most effective such drug.
    
    • 1-1.5% risk of developing AGRANULOCYTOSIS a life-threatening drop in white blood cells (other second-generation drugs do not produce this undesired effect).
  • Unlike the first-generation drugs, the second-generation ones reduce not only the positive symptoms of schizophrenia, but—to a small degree—the negative ones as well.
  • Cause fewer extrapyramidal symptoms and seem less likely to produce tardive dyskinesia.
  • Also helps many patients with bipolar or other severe mental disorders.
  • use one of these drugs, clozapine, have around a
• PSYCHOTHERAPY – Before the discovery of antipsychotic drugs, psychotherapy was not really an option for people with schizophrenia. Most were too far removed from reality to profit from it.
  
  • Antipsychotic drugs allow people with schizophrenia to see themselves more clearly, learn about their disorder, participate actively in therapy.
  • AVATAR THERAPY – In this form of virtual reality therapy, clinicians have the clients interact with computer-generated on-screen virtual human figures.
    
    • Studies suggest that confronting one’s hallucinations in a virtual world can indeed help at least some people with schizophrenia.
• COGNITIVE BEHAVIORAL THERAPIES – offers two helpful therapies:
  
  • COGNITIVE REMEDIATION – is an approach that focuses on the cognitive impairments that often characterize people with schizophrenia— particularly their difficulties in attention, planning, and memory.
    
    • Improvements surpass those produced by other treatment interventions.
• HALLUCINATION REINTERPRETATION AND ACCEPTANCE – Designed to help change how people view and react to their hallucinations.
  
  • The journey into schizophrenia takes shape when people try to make sense of these strange sensations (generated biologically) and conclude incorrectly that the voices are coming from external sources, that they are being persecuted, or another such notion. These misinterpretations are essentially delusions.
    
    • If patients interpret such experiences in a more accurate way, they will not suffer the fear and confusion produced by their delusional misinterpretations.
      
      • Patients learn the biological origin of the sensations, sounds, etc.
      • Patients are challenged to reject the idea that the voices are all-powerful and uncontrollable and must be obeyed.
      • Patients are taught to reattribute and more accurately interpret their hallucinations – “It’s not a real voice, it’s my illness.
      • Teach clients techniques for coping with their unpleasant sensations (hallucinations).
      • Learn ways to reduce the physical arousal that accompanies hallucinations
    • These can help people with schizophrenia feel more control over their hallucinations and reduce their delusional ideas. But they do not eliminate the hallucinations.
  • MINDFULNESS-BASED APPROACH – new-wave cognitive-behavioral therapists believe that the most useful goal of treatment is often to help clients accept their streams of problematic thoughts rather than to judge them, act on them, or try fruitlessly to change them.
    
    • Become simply mindful of the worries that engulf their thinking and to accept such negative thoughts as harmless events of the mind.
    • Clients become detached and comfortable observers of their hallucinations—merely mindful of the unusual sensations and accepting of them—while otherwise moving forward with the tasks and events of their lives.
    • Often very helpful to clients with schizophrenia
• Family Therapy – people with schizophrenia who feel positive toward their relatives do better in treatment.
  
  • People whose fathers were over 50 years of age when they were born are more likely to develop schizophrenia than people born to fathers under 50 years old. As with bipolar disorder, this may be explained by the tendency of aging men to produce more genetic mutations during the manufacture of sperm cells
• Social Therapy – Treatment of people with schizophrenia should include techniques that address social and personal difficulties in the clients’ lives.
  
  • Make sure that the clients are taking their medications properly.

Question 9

Community Approach to Treatment

Answer 9

• The Community Approach:
  
  • Community Mental Health Act – stipulated that patients with psychological disorders were to receive a range of mental health services – outpatient therapy, inpatient treatment, emergency care, preventive care, and aftercare – in their communities rather than being transported to institutions far from home.
    
    • Deinstitutionalization – The discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs.an exodus of hundreds of thousands of patients with schizophrenia and other long-term mental disorders from state institutions into the community.
      
      • Actual quality of community care for these people has often been inadequate throughout the United States. The result is a “revolving door” pattern for many patients.
  • Features of Effective Community Care – need medication, psychotherapy, help in handling daily pressures and responsibilities, guidance in making decisions, social skills training, residential supervision, and vocational counseling—a combination of services called assertive community treatment.
  • Key features of effective community care programs are:
    
    • (1) coordination of patient services
      
      • community mental health centers – A treatment facility that provides medication, psychotherapy, and emergency care for psychological problems and coordinates treatment in the community.people with severe disturbances
    • (2) short-term hospitalization
      
      • Today’s clinicians first try to treat them on an outpatient basis, usually with a combination of antipsychotic medication and psychotherapy.
      • short-term hospitalization A program of post-hospitalization care and treatment in the community. – in a mental hospital or a general hospital’s psychiatric unit – that lasts a few weeks
      • Makes use of AFTERCARE, a general term for follow-up care and treatment in the community.
    • (3) partial hospitalization
      
      • DAY CENTERS**, or **day hospitals, all-day programs in which patients return to their homes for the night.
      • SEMIHOSPITAL**, or **residential crisis center. These are houses or other structures in the community that provide 24-hour nursing care for people with severe mental disorders.
    • (4) supervised residencies
      
      • HALFWAY HOUSES, crisis houses**or**group homes – A residence for people with schizophrenia or other severe problems. Such residences may shelter between one and two dozen people. The live-in staff usually are paraprofessionals—lay people who receive training and ongoing supervision from outside mental health professionals.
    • (5) occupational training
      
      • Receive occupational training in a sheltered workshop—a supervised workplace for employees who are not ready for competitive or complicated jobs.
      • Provides income, independence, self-respect, and the stimulation of working with others. It also brings companionship and order to one’s daily life.
      • Fewer than half of all the people who need them receive appropriate community mental health services
      • 40-60% of all people with schizophrenia and other severe mental disorders receive no treatment at all
      • poor coordination of services and a shortage of services.

WHY COMMUNITY TREATMENT FAILS

• POOR COORDINATION OF SERVICES
  
  • CASE MANAGERS – A community therapist who offers and coordinates a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patients’ rights.
    
    • Many professionals now believe that effective case management is the key to success for a community program.
• SHORTAGE OF SERVICES – lack of funding.
• Consequences of Inadequate Community Treatment? – Many return to their families and receive medication and perhaps emotional and financial support, but little else in the way of treatment.
  
  • 8% enter an alternative institution such as a nursing home or rest home, where they receive only custodial care and medication.
  • 18% are placed in privately run residences where supervision often is provided by untrained staff.
  • of people with schizophrenia and other severe disorders live in totally unsupervised settings.
  • 140,000 homeless people – have a severe mental disorder, commonly schizophrenia.
  • or more people with severe mental disorders are in prisons and jails.
  • 26% of all persons imprisoned in the United States suffer from schizophrenia or another severe mental disorder