Chapter 15 - Treating Schizophrenia Flashcards
Philippe Pinel
“unchained the insane” Asylum
- began the practice of moral treatment and treated patients as human beings who should be cared for the first time in centuries
State Hospitals
Public mental hospitals in the united states run by the individual states
What happened to state hospitals between 1845 and 1955
- overcrowded
- states could not keep up with the expansion
- started with 2,000 in 1845, ended with 600,000 by 1955
- responsibility fell on nurses and attending’s with limited knowledge and experience
- in 110 years shifted from humanitarian care to keeping order
Social breakdown Syndrome
Extreme withdrawal, anger, physical aggressiveness and loss of interest in personal appearance and functioning
– often patients couldn’t return to society
Milieu Therapy
Institutions cannot be of help to patients unless they can somehow create a social climate, or milieu, that promotes productive activity, self-respect and individual responsibility (patients viewed as residents)
- Maxwell Jones
Token economy program
A behavior-focused program in which a person’s desirable behaviors are reinforced systematically by awarding tokens that can be exchanged for goods or privileges
Antipsychotic drugs
- discovered in the 1950’s
- drugs that help correct grossly confused or distorted thinking
- reduce symptoms in 70% of patients
Chlorpromazine
- most impressive phenothiazines (first generation)
- it provokes not any loss of consciousness, not any change in the patients mentality but a slight tendency to sleep and above all disinterest for all that goes on around the patient
Neuroleptic Drugs
Another name for first generation drugs because they often produce undesired movement effects similar to the symptoms of the neurological diseases
Ex: - Mellaril
- Prolixin
- Stelazine
- HaldolExtrapyramidal Effects
Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body and extreme restlessness, sometimes produced by antipsychotic drugs
Tardive Dyskinesia
Extrapyramidal effect involving involuntary movements that some patients have after they have taken antipsychotic drugs for a long period of time
What is the most common Extrapyramidal effect?
Parkinsonian symptoms
Neuroleptic malignant syndrome
A severe, potentially fatal reaction consisting of muscle rigidity, fever, altered consciousness, and improper functioning of the ANS
Second Generation antispsychotic drugs
- “atypical antipsychotic drugs”
- as effective or more effective than first generation drugs
- reduce positive symptoms and also a small amount of negative symptoms
- Cause fewer Extrapyramidal Effects
- Most common are:
- Clozapine
- Risperidone
- Olanzapine
- Quetiapine
- Ziprasidone
- Aripiprazole
Agranulocytosis
a life threatening drop in WBCs
- caused by clozapine
Psychotherapy
- most famous is Fromm-Reichmann
- Believed you would be successful if you gained the patients trust and build a close relationship with them
What are the most helpful forms of psychotherapy?
- Cognitive-behavioral therapy
- Family therapy
- Social therapy
- various approaches are combined
Cognitive Remediation
A treatment that focuses on the cognitive impairments that often characterize people with schizophrenia - particularly their difficulties in attention, planning and memory
Hallucination Reinterpretation and acceptance
Therapists try to provide patients with information about their disorder and evidence that they are having a hallucination. To which the patients will then learn about their hallucinations as they come and go and the therapist then challenges their inaccurate ideas about the power of their hallucinations. They then try to accurately interpret their hallucinations and are taught coping mechanisms
Acceptance and Commitment Therapy
Can be used to further dilute the unpleasantry’s of hallucinations in patients
- become aware of their hallucinations and accept that they are simply harmless events of the mind
Family Therapy
When combined with drug therapy it helps reduce tensions within the family an relapse and readmission to hospitals decrease.
- Helps family have realistic expectations and become more tolerant, less guilt-ridden and more willing to try new patterns of communication
Social Therapy
Helps people stay out of hospitals by practical, active and broad approach
- offer practical advice, work with problem solving, memory enhancement, decision making, and social skills
deinstitutionalization
The discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs
- Caused State institutions to drop from 600,00 to 42,000 today
Community Mental Health Center
A treatment facility that provides medication, psychotherapy and emergency care for psychological problems and coordinates treatment in the community
