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Chapter 14 (Exam 2) Flashcards

1
Q

how have indiv with schizophrenia been treated in the past?

A

they were considered BEYOND HELP

  • the discovery of antipsychotic drugs enabled schizophrenics to think CLEARLY and BENEFIT from PSYCHOTHERAPY
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2
Q

which theoretical model is the most effective for schizophrenia?

A

biological

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3
Q

what was institutional care like (in the past) for schizophrenics?

A

for more than half of the 20 century, schizophrenics were institutionalized
- because they failed to respond to traditional therapies, the primary goal was to RESTRAIN them and give them FOOD, SHELTER, and CLOTHING

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4
Q

what 2 approaches brough hope to chronic schizophrenic patients in the 1950s?

A
  1. Milieu therapy (humanistic principles)
  2. token economies (behavioral principles)

these helped improve personal care, self-image of patients (problem areas that were worsened by institutionalization)

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5
Q

Milieu therapy (humanistic principles)
approach for schizophrenia treatment

A

institutions CAN help patients make progress by creating a SOCIAL CLIMATE (milieu) that promotes productive activity, self-respect, and individual responsibility
- Milieu-style programs set up in the west had moderate success
- research shows that pt with schizophrenia in milieu programs often leave the hospital at higher rates than pt receiving custodial care

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6
Q

token economy (behavioral principles)
approach for schizophrenia treatment

A

based on operant conditioning principles; patients are REWARDED when they behave in a SOCIALLY ACCEPTABLE way and not rewarded when they behave unacceptably

  • immediate rewards are tokens that can be later exchanged for food, cigarettes, privileges, and other desirable objects
  • acceptable behaviors likely to be targeted include care for oneself and one’s possessions, going to a work program, speaking normally, following ward rules, and showing self-control

these helped REDUCE PSYCHOTIC BEHAVIORS

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7
Q

the first antipsychotic
schizophrenia

A

discovered in 1950s, revolutionized treatment
- antihistamines (phenothiazines) were used to calm patients about to undergo surgery
- chlorpromazine was tested on patients with psychosis and sharp symptom reduction observed; it had a calming effect
- in 1954, chlorpromazine (thorazine) was approved by FDA as an antipsychotic

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8
Q

how did first-gen antipsychotics work?

A

they bind to D2 receptors, thereby blocking dopamine; helped positive symptoms

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9
Q

first-gen antipsychotic drugs

A

drugs developed from 1960s-1980s are known as FIRST-GEN antipsychotics
- they are also known as NEUROLEPTIC DRUGS (because they often produce undesired movement effects similar to symptoms of neurological diseases)
- most of these work by reducing dopamine activity

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10
Q

how effective are anti-psychotics?

A

antipsychotic drugs reduce schizophrenia symptoms in at least 70% of pt
- drugs appear to be more most effective than any other approach used alone
in most cases, drugs produce MAXIMUM IMPROVEMENT within the FIRST 6 MONTHS of treatment (symptoms may return if pt stops taking them too soon)

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11
Q

what are unwanted effects of first-gen anti-psychotics?

A

EXTRAPYRAMIDAL EFFECTS (impacts these areas in the brain):
- parkinsonian and related symptoms
- neuroleptic malignant syndrome
- tardive dyskinesia

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12
Q

parkinsonian and related symptoms
extrapyramidal effects of first-gen antipsychotics

A

at least 50% develop symptoms including:
- tremors, rigidity, feet shuffling
- involuntary muscle contractions

result of medication-induced reductions of dopamine activity in the striatum

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13
Q

neuroleptic malignant syndrome
extrapyramidal effects of first-gen antipsychotics

A

POTENTIALLY FATAL (esp in older adults)

symptoms:
- muscle rigidity, fever, autonomic dysfunction

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14
Q

tardive dyskinesia
extrapyramidal effects of first-gen antipsychotics

A

symptoms are similar to psychotic symptoms; difficult to eliminate

takes 6 months - 1 year to develop symptoms such as:
- involuntary muscle movements (~20% developed this side effect)

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15
Q

success rate of first-gen antipsychotics

A

65%

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16
Q

success rate of second-gen antipsychotics

A

85%

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17
Q

success rate/efficacy of antipsychotics (in general)

18
Q

since learning of the unwanted side effects of first-gen antipsychotics, clinicians must _______

A

BE MORE CAREFUL IN THEIR PRESCRIPTION PRACTICES

  • they try to prescribe the LOWEST effective dose
  • gradually reduce or stop medication weeks or months after pt begins functioning normally
19
Q

second-generation antipsychotic drugs

A

different biological operation than first-gen:
- received at fewer dopamine D2 receptors; more D1 and D4 and serotonin receptors than others
- symptoms: weight gain, dizziness, significant elevations in blood sugar

  • reduce pos AND some neg symptoms
  • cause fewer extrapyramidal symptoms and less tardive dyskinesia (although 7% still develop it with second-gen)
  • MOST COMMONLY PRESCRIBED medicine for schizophrenia
20
Q

what is the most frequently prescribed antipsychotic?

A

CLORAZIL (second-gen antipsychotic)

21
Q

what is a risk of second-gen antipsychotics?

A

AGRANULOCYTOSIS- a life-threatening drop in white blood cells

1-1.5% of people develop this, therefore…
- for the first few months, pt needs their blood drawn once/week

22
Q

first-gen vs second-gen antipsychotic side effects (graph)

A

CONVENTIONAL- first gen
ATYPICAL- second gen

23
Q

psychotherapy
schizophrenia

A

before antipsychotics, psychotherapy was not an option (pt were far too removed from reality)

today, it is helpful in COMBINATION with drug therapy (most helpful: CBT, family therapy, and social therapy)

24
Q

cog behavioral therapy
COGNITIVE REMEDIATION
schizophrenia

A

COGNITIVE REMEDIATION- focuses on difficulties in attention, planning, and memory
- provides increasingly more complex computer tasks until planning and social awareness tasks are reached

provides MODERATE IMPROVEMENT:
- improvements in memory, attention, planning, and problem-solving surpass other interventions
- extend to everyday client life and social relationships

25
cog behavioral therapy HALLUCINATION REINTERPRETATION AND ACCEPTANCE schizophrenia
HALLUCINATION REINTERPRETATION AND ACCEPTANCE- therapists help change how pt views and reacts to their hallucinations; reframes their meaning (combination of behavioral and cognitive techniques) - education and evidence about biological causes of hallucinations - identification of events and triggers of hallucinations - challenge of inaccurate ideas of hallucination power - reattribution and more accurate interpretation of hallucinations - education for unpleasant sensation coping
26
cog behavioral therapy NEW-WAVE COG BEHAVIORAL THERAPIES schizophrenia
NEW-WAVE COG BEHAVIORAL THERAPIES- posit that hallucinations should be accepted rather than misinterpreted or overreacted to (mindfulness-based) - help clients accept their streams of problematic behavior - help pt gain a greater sense of control, become more functional, and move forward in life often produces HELPFUL results
27
family therapy schizophrenia
many schizophrenics live with family members which creates SIGNIFICANT family STRESS (those living with relatives who display EXPRESSED EMOTION are at greater risk for relapse) - family therapy attempts to address these issues, create more realistic expectations, and provide psychoeducation about the disorder - RELAPSE RATES AND REHOSPITALIZATION RATES DECREASE WITH FAMILY THERAPY - families may also turn to family support groups/ family psychoeducation programs (although research has not supported this yet, it is popular)
28
coordinated special care therapy schizophrenia
many clinicians believe that the treatment of people with schizophrenia should include techniques that address SOCIAL and PERSONAL difficulties in the pt's life, which includes: - practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing THIS APPROACH REDUCES REHOSPITALIZATION
29
what does social therapy offer when treating schizophrenia?
it helps schizophrenics navigate day-to-day tasks
30
community approach
a BROAD treatment for schizophrenia and other severe mental disorders; in 1963, Congress passed the community mental health act (stated that pt should be able to receive care within their own communities, rather than being transported to institutions far from home) - led to massive deinstitutionalization of pt - unfortunately, the communities were unequipped (financially and socially) to provide adequate care - resulted in "revolving door syndrome"
31
revolving door syndrome
a cyclical pattern of short-term readmissions to inpatient facilities
32
what are features of EFFECTIVE community care?
- coordinated services - short-term hospitalization - partial hospitalization - supervised residence - occupational training and support
33
coordinated services effective community care
- community mental health centers provide medications, psychotherapy, and inpatient emergency care - assertive community treatment (multidisciplinary team that provides multiple services, esp after hospitalization) - coordination of services is ESPECIALLY important for mentally ill chemical abusers (comorbidity of substance use disorder and psychological disorder)
34
short-term hospitalization effective community care
- if outpatient treatment is unsuccessful, pt may be transferred to short-term hospital programs - after a few weeks of hospitalization, pt are released to aftercare programs for follow-up in the community
35
partial hospitalization effective community care
- if pt needs to fall between full hospitalization and outpatient care, day center programs might be effective - programs provide daily supervised activities and programs to improve social skills - another popular institution: semihospital/residential crisis center (houses or other structures within community that provide 24-hour nursing care for those with severe disorders)
36
supervised residences effective community care
- halfway houses/group homes provide shelter and supervision for those pt who can not live alone or with their families but do not require hospitalization - staff are usually paraprofessionals - houses are run with a milieu therapy philosophy - help schizophrenics adjust to community life and avoid rehospitalization
37
occupational training and support effective community care
- paid employment provides income, independence, self-respect, and the stimulation of working with others - many recovering from schizophrenia receive occupational training in a sheltered workshop- a supervised workplace for employees who are not ready for competitive/complicated jobs (an alternative work opportunity for indiv with severe disorders is supported employment)
38
how has community treatment failed?
effective community programs can help, BUT fewer than half of all people who need them receive appropriate community mental health services - in any given year, 40% of people with schizophrenia receive NO TREATMENT at all two factors are primarily responsible: 1. POOR COORDINATION OF SERVICES (lack of communication, etc.) 2. SHORTAGE OF SERVICES (often due to finances)
39
what are consequences of inadequate community treatment?
- some pt have family support and live with their families - around 8% of pt enter an alternative care facility (e.g. nursing home), where they receive custodial care and medication - as many as 18% are placed in privately run residences where supervision is provided by untrained indiv - another 34% of pt are placed in single-room occupancy hotels, often in run down environments
40
where do people with schizophrenia live?
41
consequences of inadequate community care JAIL/HOUSING STATS
- 5% of people with schizophrenia are homeless - 1/4 of homeless people have a severe disorder (commonly schizophrenia) - US jails/prisons have become the country's largest mental health institutions (due to their illness, many (unintentionally) break the law - 1/3 of incarcerated indiv suffer from a severe mental disorder

Psychopathology (6 decks)

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