Chapter 14 - Treatments for Schizophrenia

Question 1

When was the move from asylums toward large mental hospitals?

Answer 1

1793, Philippe Pinel

Question 2

What happened in 1955 in the US?

Answer 2

overcrowding & understaffing created dramatic changes in mental institutions

Question 3

what were back wards?

Answer 3

chronic wards where patients were sent if they didn’t improve quickly

Question 4

what was social breakdown syndrome?

Answer 4

extreme withdrawal, anger, physical aggressiveness, and loss of interest in personal appearance and functioning (as a result of institutionalization)

Question 5

what were the early treatments of schizophrenia?

Answer 5

electroconvulsive therapies, prefrontal lobotomy

Question 6

what were the 2 institutional approaches developed in the 1950s?

Answer 6

Milieu therapy and the token economy program

Question 7

what is milieu therapy?

Answer 7

• Institutions can help patients make clinical progress by creating a social climate (“milieu”) that promotes productive activity, self-respect, and individual responsibility
• humanistic approach
• set up in institutions throughout the Western world with moderate success

Question 8

what are token economies?

Answer 8

• used in institutions to change the behavior of patients with schizophrenia
• operant conditioning techniques
• Patients are rewarded when they behave in socially acceptable ways and are not rewarded when they behave unacceptably
• reduce psychotic and related behaviors

Question 9

what are the limitations of token economies?

Answer 9

• Uncontrolled studies
• Some ethical and legal concerns about controlling rewards related to basic needs
• Some question whether change involves thoughts or perceptions or just imitations of normal behavior
• Transfer to real-world rewards may be difficult

Question 10

what are the institutional alternatives for schizophrenia?

Answer 10

• Many people who would have been placed in psychiatric institutions in the past now reside in other settings, such as nursing homes and prisons
• Mental health care is typically minimal in these settings

Question 11

when were antipsychotic medications discovered?

Answer 11

1950s when studying antihistamines

Question 12

what are the side effects of first-generation antipsychotics?

Answer 12

• tardive dyskinesia (sudden, uncontrollable, and repetitive movements of the face or body),
• Parkinson’s (progressive disorder that affects the nervous system and the parts of the body controlled by the nerves)
• neuroleptic malignant syndrome

Question 13

what are the first-generation antipsychotics?

Answer 13

chlorpromazine, fluphenazine, etc

Question 14

what are the second-generation antipsychotics?

Answer 14

clozapine, risperidone, etc.

Question 15

what are second-generation antipsychotics?

Answer 15

• Biological operation differs from first-generation agents
• Received at fewer dopamine D-2 receptors; more D-1, D-4, and serotonin receptors than others
• At least as effective as first-generation agents, possibly more effective
• Reduce positive and some negative symptoms
• Cause fewer extrapyramidal symptoms and less tardive dyskinesia (D-2 receptors)

Question 16

what are the cognitive-behavioral therapies for schizophrenia?

Answer 16

• Focuses on difficulties in attention, planning, and memory
• Provides for moderate improvement
• cognitive remediation
• hallucination reinterpretation and acceptance

Question 17

what is cognitive remediation?

Answer 17

an approach that focuses on the cognitive impairments, particularly their difficulties in attention, planning, and memory

Question 18

what is hallucination reinterpretation and acceptance?

Answer 18

Therapists help change how clients view and react to their hallucinations

Question 19

what are the sociocultural interventions to schizophrenia?

Answer 19

family therapy and social therapy

Question 20

what is family therapy for schizophrenia?

Answer 20

• Those who live with relatives who display high levels of expressed emotion are at greater risk for relapse than those who live with more positive or supportive families
• providing family members with guidance, training, practical advice, emotional support, and psychoeducation

Question 21

what is social therapy for schizophrenia?

Answer 21

• Addresses social and personal difficulties in clients’ lives
• Reduces rehospitalization

Question 22

what is the community approach to schizophrenia?

Answer 22

• In 1963, Congress passed the Community Mental Health Act
• Inadequate quality of community care creates a “revolving door” pattern for many patients

Question 23

what are the features of effective community care?

Answer 23

coordinated services, short-term hospitalization, partial hospitalization, supervised residences

Question 24

What are the consequences of inadequate community treatment?

Answer 24

• many people with schizophrenia or other severe mental disorders receive no or inadequate treatment
• Premature discharge; inadequate follow-up treatment
• Housing settings vary
• Many people with schizophrenia become homeless

Question 25

What is the promise of community treatment?

Answer 25

Despite these very serious problems, proper community care has shown great potential for assisting in recovery from schizophrenia