Ch. 15 - Treatments for Schizo Flashcards
Today’s treatments ____ _____ for patients, families, and communities
varies dramatically
Severe mental disorders are very difficult to treat, only ______ of people with schizo receive ________ _____
40%; adequate care
What happened in 1955 regarding mental institutions?
states throughout the US were required by law to establish public mental institutions (state hospitals) for those who couldn’t afford care.
Social breakdown syndrome
~ extreme withdrawal, anger
~ loss of interest in appearance and functioning
Milieu Therapy
~ based on humanistic principals
~created social climate that promoted productive activity, self-respect, and responsibility in hopes to help patients
~ moderate success
Token Economy
~ based on operant conditioning principles
~ used in institutions to change behavior of patients w schizo
~ patients rewarded (tokens) when behaved in socially acceptable ways and aren’t rewarded when they behave unacceptably
Beginnings of antipsychotic drugs
~ discovered in 1950s
~ chlorpromazine (thorazine) approved in 1954
Types of antipsychotic drugs
~ Conventional or 1st gen (60s-80s: produced undesired movement effects)
~atypical or 2nd gen (developed in recent years)
Effectiveness of antipsychotic drugs
~ symptoms reduce in about 70% of patients
~ more effective than any other approach used alone
~ (+) symptoms are reduced more completely/quickly than (-) symptoms
1st gen: Extrapyramidal effects
~ medication induced movement disorders
~disturbing movement problems from antipsychotic drugs (can be reduced w anti-parkinsonian drug)
1st gen: Medication-induced movement disorders
- neuroleptic malignant syndrome (elderly)
2. Tardive dyskinesia
1st gen: Tardive Dyskinesia
~ tic-like involuntary movements usually of the mouth, lips, tongue, legs, or body
~ affects more than 10% taking drugs
~ difficult sometimes impossible to eliminate
2ng gen: antipsychotic drugs
~ as or more effective than 1st gen
1st gen vs 2nd gen drugs
2nd gen causes:
~ fewer extrapyramidal side effects
~ less likely to cause tardive dysk
~ agranulocytosis (risk of life-threatening drop in white blood cells)
Psychotherapy
~ more successful than schizo treatment
~ cog-beh & socio-cultural therapies
Psychotherapy: Cog-beh
~ change how individs view and react to their hallucinatory experiences
- cognitive remediation
- avatar therapy
cognitive remediation
~ psychotherapy that focuses on difficulties in attention, planning and memory
Avatar therapy
~ clients interact with computer-generated on-screen virtual human figures who sound and look mean
~ decreased hallucinations, depressions, suicidal thoughts
New Wave cognitive-behavioral therapies…
help clients to accept their stream of problematic thoughts
Family therapy
~ addresses family-related issues & psychoeducation
~ over 50% of ppl recovering from schizo live with family members
~ those who live with members of high levels of expressed emotion are more likely to relapse than living w supportive members
Social therapy (personal)
~ addressed social and personal difficulties in clients lives: practical advice, problem solving, decision making, social skill training, med management, counseling, housing etc
~ reduces hospitalization
Community approach to therapy
~ CMHA (1963) patients should b able to recieve care in their own communities rather than being transported far from home
~ massive deinstitutionalization of patients w schizo
~ assertive community treatment
Other key features of community approach
~ coordinated services
~ short-term hospitalization
Features of effective community care
~ partial hospitalization (daily supervised activities and programs to improve social skills
~ supervised residences (Halfway houses, etc)
~ occupational training and support
Community treatment failure
~ 40 - 60% of all people w schizo receive no treatment at all
~ poor coordination services & shortage of services
Poor coordination of services
challenges:
~ failure of communication between and within community agencies
~ poor communication between state hospitals and community health centers
Solution
~ case managers
Shortage of services
~ primarily for economic reasons
how many homeless ppl in America suffer from sever metal disorders?
one-third
Bottom line for community approach to treatment:
proper community care has shown great potential for assisting in recovering from schizo & well-coordinated community treatment is crucial solution to severe mental dysfunction
Experts say that prisons and jails…
have become the country’s largest mental health institutions
~ 16 -20% of prisoners are mentally ill
