ch 14 Flashcards
1
Q
what drugs are used for people with schizophrenia?
A
antipsychotic drugs
2
Q
to this day, at least ____% of people with schizophrenia do not receive adequate care
A
36
3
Q
In the ____th century, many people with schizophrenia where institutionalized in _____ ______ ________
A
20, public mental hospitals
4
Q
What were the goals of 20th century hospitals with schizophrenics as patients? (4)
A
- restrain the
- give food
- give shelter
- give clothing
5
Q
who was the french physician in 1793 that declared that patients of mental hospitals deserved moral treatment?
A
Philippe Pinel
6
Q
State-run public mental institutions in the United States.
A
state hospitals
7
Q
New mental hospitals after Pinel’s ideas spread where usually located where? what were the goals of these places?
A
isolated areas
goals: protect patients from the stressed of daily life and offer healthful psychological environment to work with therapists
8
Q
In the face of overcrowding, what did public mental hospitals revert back to?
A
keeping oder, inhumane treatment and punishment instead of humanitarian care
9
Q
Patients were transferred to ______ ______, or chronic wards, if they failed to improve quickly, most of their patients struggled with which disorder?
A
back wards; schizophrenia
10
Q
In 1935, a Portuguese neurologist named ____ _____ performed a revolutionary new surgical procedure, which he called a prefrontal leucotomy, on a patient with severe mental dysfunction
A
Egas Moniz
11
Q
What happened during the procedure of lobotomy?
A
drilling 2 holes in either side of the skull and using an instrument to cut nerve fibers
12
Q
Who developed the transorbital lobotomy? what happens during it?
A
Walter Freeman
a surgeon inserts a needle in the brain through the brain socket and rotate it to destroy brain tissue
13
Q
what is the fatality rate of lobotomies?
A
1.5 - 6%
14
Q
what are some problems lobotomies can cause? (6)
A
brain seizures
huge weight gain
loss of motor coordination
partial paralysis
endocrine malfunctions
poor intellectual and emotional responsiveness
15
Q
extreme withdrawal, anger, physical aggressiveness, and loss of interest in personal appearance and functioning, a common pattern of decline after a lobotomy
A
social breakdown syndrome
16
Q
According to humanistic theorists, why do institutionalized patients deteriorate?
A
they are deprived of opportunities to exercise independence, responsibility, positive self-regard, and meaningful activities
17
Q
A humanistic approach to institutional treatment based on the premise that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity
A
milieu therapy
18
Q
What was the pioneer of the milieu therapy approach?
A
Maxwell Jones
19
Q
what does research show about patients who receive milieu therapy in hospital programs?
A
they leave the hospital at higher rates than those who received basic care
20
Q
the use of procedures like warm baths, cold showers, and wet sheets to treat mental disorders
A
wet cure hydrotherapy
21
Q
what psych concept did behavior-focused researchers discover could help change the behavior of schizophrenia patients in hospital wards
A
operant conditioning
22
Q
A behavior-focused program in which a person’s desirable behaviors are reinforced systematically by the awarding of tokens that can be exchanged for goods or privileges
A
token economy programs
23
Q
how does the reward system work for token economy programs? for example, what can patients do with the tokens?
A
patients are rewards when they behave acceptably and not rewarded when they behave unacceptably
tokens can be exchanged for food, privileges, and so forth
24
Q
what are some examples of acceptable behaviors in a token exchange economy?
A
caring for oneself and doing chose, going to a work program, speaking normally, following rules
25
What did researchers find about the effectiveness of token economies? what percent of patients with the token program are released?
token economies do help reduce psychotic and related behaviors
98%
26
What is the uncontrolled limitation of token economies?
most of the token economies employed in hospitals are uncontrolled. This means that patients improvements can only be compared to their past behaviors, so maybe increase in staff attention may be improving them, not the token economy
27
what are the ethical limitations and concerns of the token economy theory?
there are some things in life that humans should be automatically entitled to, patients should not have to act a certain way to get them as 'rewards'
28
what are some rights patients are entitled to in treatment programs?
food, storage space, furniture, freedom of movement
29
what is once concern regarding the operant conditioning principle of a token economy?
Are operant conditioning procedures changing a patient’s psychotic thoughts and perceptions or simply improving the patient’s ability to imitate normal behavior?
30
what is a limitation of token economy regarding when patients are released from the hospital?
it is difficult for patients to make a satisfactory transition from hospital token economy programs to community living
31
Drugs that help correct grossly confused or distorted thinking
anti-psychotic drugs
32
The discovery of antipsychotic medications dates back to the 1940s, when researchers developed the first __________ drugs to combat allergies
antihistamine
33
Who discovered phenothiazines?
Henri Laborit (French)
34
which phenothiazine antihistamine was found to be calming for people withs severe psychological disorders?
chlorpromazine
35
what is the trade name for chlorpromazine in the US?
Thorazine
36
what time period are first-generation antipsychotic drugs referred to ?
1960-1980s
37
what time are second-generation antipsychotic drugs referred to?
after 1980s
38
An alternative term for first-generation antipsychotic drugs, so called because they often produce undesired effects similar to the symptoms of neurological disorders. The term is used less often in today’s clinical literature.
neuroleptic drugs
39
how do antipsychotic drugs reduce symptoms?
blocking excessive activity of neurotransmitter dopamine
40
what are the 4 best down first-generation antipsychotic drugs? (Trade Names)
Mellaril
prolixin
Stelazine
Haldol
41
Research has shown that antipsychotic drugs reduce symptoms in around ___ percent of patients diagnosed with schizophrenia
70
42
when used alone, which is the most effective for schizophrenia?
a) antipsychotic drugs
b) psychotherapy
c) milieu therapy
d) electroconvulsive therapy
a
43
how long does it take meds to bring maximum improvement?
6 months
44
what might prematurely withdrawing from antipsychotic meds for schizophrenias do to the drug takers?
they may relapse
45
antipsychotic drugs reduce ___________ symptoms more completely/quickly than __________ symptoms
positive, negative
46
people whose symptoms are largely __________ generally have better rates of recovery from schizophrenia than those with predominantly _________ symptoms
positive, negative
47
why might a schizophrenia patient refuse to take antipsychotic drugs?
because of the side effects
48
Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by antipsychotic drugs.
extrapyramidal effects
49
what are 3 examples of unwanted side effects produced by antipsychotic drugs?
parkinsonian and related disorders
neuroleptic malignant syndrome
tardive dyskinesia
50
reactions that closely resemble the features of the neurological disorder Parkinson’s disease caused by antipsychotic drugs
Parkinsonian symptoms
51
At least _____ of patients on first-generation antipsychotic drugs have muscle tremors and muscle rigidity at some point in their treatment
half
52
what are some examples of Parkinsonian symptoms?
shuffling feet
little facial expressions
temors
restlessness
limb discomfort
53
how does medication affect the brain to produce parkinsonian symptoms?
reduce dopamine activity in the striatum (the brain structure that coordinates movement and posture)
54
what are 2 ways Parkinsonian symptoms can be reduced?
1. patient takes anti-parkinsonian drug with antipsychotic drug
2. clinicans reduce the dose of the antipsychotic drug or stop it
55
what percent of patients who take first-generation antipsychotic drugs produce neuroleptic malignant syndrome? what is the most common age group
1%, elderly
56
a severe, potentially fatal reaction consisting of muscle rigidity, fever, altered consciousness, and improper functioning of the autonomic nervous system caused by antipsychotic drugs
neuroleptic malignant syndrome
57
What are 2 ways a person with neuroleptic malignant syndrome is treated?
1. immediately taken off the drug and each symptom is treated medically
2. dopamine-enhacing drugs
58
Extrapyramidal effects involving involuntary movements that some patients have after they have taken antipsychotic drugs for an extended time.
tardive dyskinesia
59
how long does a person have to take first-gen antipsychotic drugs for them to display tardive dyskinesia?
6 months
60
what are some examples of tardive dyskinesia?
ticlike movement of tongue, mouth, face, body
involuntary chewing, sucking, lip smacking
jerky body movements
61
the longer the antipsychotic drugs are taken, the higher chance of what symptoms?
tardive dyskinesia
62
It is believed that more than ____ percent of the people who take first-generation antipsychotic drugs, especially the most powerful ones, for an extended time develop tardive dyskinesia
15
63
patients over 50 are ___ to ____ times more at risk of developing tardive dyskinesia than younger patients
3, 5
64
if tardive dyskinesia is discovered early, than it disappears in ____% of cases
90
65
why might clinicians overlook the symptoms of tardive dyskinesia?
the symptoms are similar to psychotic symptoms
66
If detection is late, the symptoms of tardive dyskinesia disappear in fewer than _____ percent of cases
40
67
what are 3 ways a clinician might approach a patient who is not improving with their prescribed drugs?
1. added another drug to get a synergistic effect (polypharmacy)
2. stop the drug and try alternative
3. stop all medications
68
how do today's clinicians try to prescribe doses?
they try to prescribe the lowest effective doses fro each patient and gradually reduce the medication for weeks/months after patient begins to function normally
69
second-generation antipsychotic drugs are received at fewer _______ d-2 receptors and more d-1 and d-4 and _________ receptors than the first-generation drugs
dopamine, serotonin
70
How effective are second-generation drugs in comparison to first-generation drugs?
they are equally if not more effective
71
what are 2 benefits of second-generation antipsychotic drugs over first-gen ones?
1. reduce both positive and negative symptoms to some extent
2. cause fewer symptoms and are less likely to produce tardive dyskinesia
72
which 2nd gen antipsychotic drug is least likely to cause tardive dyskinesia?
clozapine
73
around how many patients with schizophrenia take second gen antipsychotic drugs?
half
74
A life-threatening drop in white blood cells. This condition is sometimes produced by the second-generation antipsychotic drug clozapine
agranulocytosis
75
what is the percent risk of people using second-gen drugs developing agranulocytosis?
1 to 1.5% risk
76
What is one way to detect agranulocytosis?
to have frequent blood tests
77
what are some negative effects of second-gen antipsychosis drugs on women?
weight gain
diziness
metabolic problems
sexual dysfuntions
78
According to researchm how effective are second-generation antipsychotic drugs?
Moderate effectiveness for those who have chronic schizophrenia
79
what is the average length of time between the first appearance of psychotic symptoms and the initiation of treatment?
2 yrs
80
what are the 3 most helpful forms of psychotherapy for schizophrenia?
CBT and family therapy and social therapy
81
what do clinicians use avators for?
visual therapy for schizophrenia
82
what are the 2 types of CBT used for schizophrenia?
cognitive remediation
hallucination reinterpretation and acceptance
83
A treatment that focuses on the cognitive impairments that often characterize people with schizophrenia — particularly their difficulties in attention, planning, and memory.
cognitive remediation
84
how are cognitive remediation sessions structured?
clients are askeed to complete information processing tasks on a computer that get progressively harder
starts simple with a task designed to improve their attention and later they reach tasks that require planning and social awareness
85
what is the effectiveness of cognitive remediation? what is one of its key benefits?
it's moderately effective, it brings moderate improvements in attention, planning, memory, and problem solving
these improvements extend to client's everyday life and social relationships
86
consistent with the cognitive-behavioral explanation for how schizophrenia is developed, how are cognitive-behavioral therapists trying to help ppl with schizophrenia?
get clients to interpret experiences in a more accurate way, and they will not suffer fear and confusion produced by their delusional misinterpretations
87
What is a drawback of helping clients with schizophrenia recognize their hallucinations?
it does not completely eliminate the hallucinations
88
what do new-wave CB therapists believe is the most useful goal of treatment?
to get clients to accept their problematic thoughts rather than judge them or change them
89
what do new wave CT therapists help clients with schizophrenia do when they experience hallucinations?
become comfortable and detached observers, just merely mindful of them, while moving foward with the tasks and events of their lives
90
According to studies, how effective are these CBT techniques to people with schizophrenia?
very helpful
91
Rehospitalizations decrease by ____ percent among clients treated with cognitive-behavioral therapy
50
92
how might a patient's recovery be influenced by their family?
stressors
93
generally speaking, if a patient feels positive towards their family, how will they respond to treatment?
do better in treatment
94
How might family therapy help both the family and the individual with schizophrenia?
provide family members with guidance, training, advice and education for the disorder, so they are more supportive of the patient
the patient can learn how to cope with family stress
95
what are other programs families of people with schizophrenia and other mental disorders may turn to?
family support groups and family psychoeducational programs
96
A treatment approach for people with severe mental disorders in which clinicians — often a team of health care specialists — provide interventions ranging from psychotherapy and practical advice to medication monitoring, housing guidance, and vocational counseling
coordinated specialty care (CSC)
97
an act passed by congress in which 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
Community Mental Health Act
98
The practice, begun in the 1960s, of releasing hundreds of thousands of patients from public mental hospitals
deinstitutionalization
99
what is the most key feature of community care for people with schizophrenia?
they do best when treated by a multidisciplinary team of health professionals and have access to multiple services
100
A community approach for people with severe mental disorders in which a multidisciplinary team provides interventions ranging from medications, psychotherapy, and social skills building to residential and vocational guidance.
assertive community treatment
101
when assertive community treatment is in place, residents with schizophrenia are less likely to be _______ and avoid ________
hospitalized and homeless
102
what are 5 other key features of community programs?
1. coordination of patient services
2. short term hospitalization
3. partial hospitalization
4. supervised residencies
5. occupational training
103
A treatment facility that provides medication, psychotherapy, and emergency care for psychological problems and coordinates treatment in the community
community mental health centers
104
when people develop sever psychotic symptoms, what combo do clinicians try to treat them with?
antipsychotic medication and psychotherapy
105
in a mental hospital or a general hospital’s psychiatric unit — that lasts a few weeks
an approach that is used for people with severe psychotic symptoms if antipsychotic meds and psychotherapy fails
short term hospitalization
106
A program of posthospitalization care and treatment in the community
aftercare
107
A program that offers hospital-like treatment during the day only. Also known as a day hospital
day centers
108
where did day centers originate from?
Moscow
109
what do day centers provide patients today?
supervised activities, therapy, programs to improve social skills
110
another kind of institution that is popular among those with schizophrenia
These are houses or other structures in the community that provide 24-hour nursing care for people with severe mental disorders.
semihospital, residential crisis center
111
A residence for people with schizophrenia or other severe problems, often staffed by paraprofessionals. Also known as a group home or crisis house.
often used for people who don't need hospitalization by are unable to live alone
halfway houses
112
what are the live-in staff at halfway houses called?
paraprofessionals
113
how are halfway houses usually run?
using a milieu therapy approach
1. mutual support
2. resident responsibility
3. self-government
114
A supervised workplace for people who are not yet ready for competitive jobs.
sheltered workshop
115
An alternative work opportunity for people with severe psychological disorders in which vocational agencies and counselors help clients find competitive jobs in the community and provide psychological support while the clients are employed
supported employment
116
Fewer than _____ percent of individuals with severe psychological disorders have jobs in the competitive job market
20
117
in a given year, what percent of people with schizophrenia and other severe mental disorders receive no treatment at all?
36%
118
what are 2 factors that bar people with schizophrenia and other sever disorders from receiving treatment?
poor coordination of services
shortage of services
119
what are some examples of poor coordination of services?
mental health agencies fail to communicate with each other
poor communication between state hospitals and community mental health centers
120
A community therapist who offers and coordinates a full range of services for people with severe mental disorders, including psychotherapy, advice, medication supervision, coordination of community services, guidance through the community system, and protection of patients’ rights
case manager
121
what is one way of reducing problems in communication and coordination?
hiring a case manager
122
what is a big reason there is a public shortage of goods for mental health?
little funding goes towards the services. most of it goes to prescription drugs, monthly income payments for social security disability insurance, community services for the less disturbed
123
which race group is least likely to recieve care?
African Americans
124
of the 565,0000 homeless people in the US, how many of them are schizophrenic?
140,000
125
Around _____ percent of all persons imprisoned in the United States suffer from schizophrenia or another severe mental disorder.
20
126
a national interest group in the US that is a source of information, support, and guidance for members, powerful lobbying force in state and national legislatures
made up of families of people affected by sever mental disorders
National Alliance on Mental Illness
