Chapter 14 - Treatments for Schizophrenia Flashcards
When was the move from asylums toward large mental hospitals?
1793, Philippe Pinel
What happened in 1955 in the US?
overcrowding & understaffing created dramatic changes in mental institutions
what were back wards?
chronic wards where patients were sent if they didn’t improve quickly
what was social breakdown syndrome?
extreme withdrawal, anger, physical aggressiveness, and loss of interest in personal appearance and functioning (as a result of institutionalization)
what were the early treatments of schizophrenia?
electroconvulsive therapies, prefrontal lobotomy
what were the 2 institutional approaches developed in the 1950s?
Milieu therapy and the token economy program
what is milieu therapy?
- 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
what are token economies?
- 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
what are the limitations of token economies?
- 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
what are the institutional alternatives for schizophrenia?
- 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
when were antipsychotic medications discovered?
1950s when studying antihistamines
what are the side effects of first-generation antipsychotics?
- 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
what are the first-generation antipsychotics?
chlorpromazine, fluphenazine, etc
what are the second-generation antipsychotics?
clozapine, risperidone, etc.
what are second-generation antipsychotics?
- 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)
what are the cognitive-behavioral therapies for schizophrenia?
- Focuses on difficulties in attention, planning, and memory
- Provides for moderate improvement
- cognitive remediation
- hallucination reinterpretation and acceptance
what is cognitive remediation?
an approach that focuses on the cognitive impairments, particularly their difficulties in attention, planning, and memory
what is hallucination reinterpretation and acceptance?
Therapists help change how clients view and react to their hallucinations
what are the sociocultural interventions to schizophrenia?
family therapy and social therapy
what is family therapy for schizophrenia?
- 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
what is social therapy for schizophrenia?
- Addresses social and personal difficulties in clients’ lives
- Reduces rehospitalization
what is the community approach to schizophrenia?
- In 1963, Congress passed the Community Mental Health Act
- Inadequate quality of community care creates a “revolving door” pattern for many patients
what are the features of effective community care?
coordinated services, short-term hospitalization, partial hospitalization, supervised residences
What are the consequences of inadequate community treatment?
- 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
What is the promise of community treatment?
Despite these very serious problems, proper community care has shown great potential for assisting in recovery from schizophrenia
