Chapter 15 - Treatments for Schizophrenia and other Severe Mental disorders Flashcards
How was schizophrenia treated in the past?
Institutionalized in a public mental hospital, the primary goals were to restrain them, and give them food, shelter and clothing
What is social breakdown syndrome?
Extreme withdrawal, anger, physical aggressiveness, and loss of interest in personal appearance and functioning. As a result of institutionalization
What is milieu therapy (social climate)?Developed by Maxwell Jones
Creating a climate that promotes self-respect, individual responsible behaviour, and meaningful productive activity (otherwise they deteriorate)
What is the token economy program?
A behaviour-focused program in which persons desirable behaviours are systematically reinforced by the awarding of tokens that can be exchanged for goods or privileges (operant conditioning techniques)
What is custodial care?
Non-medical care that helps individuals with their daily basic care, such as eating and bathing
What are antipsychotic drugs
Drugs that help correct grossly confused or distorted thinking
What are first-generation drugs? (conventional antipsychotic drugs)
Neuroleptic drugs, producer undesired movement effects. Reduce more of the positive symptoms of schizophrenia
How effective are antipsychotic drugs?
Reduce symptoms in around 70 percent of patients, maximum improvement within six months
What are extrapyramidal effects?
Affect areas of the brain that help control motor activity. Result in unwanted movements
What is Parkinsonian symptoms?
Reactions that closely resemble the features of Parkinson’s disease. Result of the medication-induced reductions of dopamine activity
What is neuroleptic malignant syndrome?
A severe, potentially fatal reaction consisting of muscle rigidity, fever, altered consciousness and improper functioning of the autonomic nervous system. Largely affects elderly people. Stop treatment of antipsychotic drugs when this occurs
What is tar dive dyskinesia (late-appearing movement disorder)?
Extrapyramidal effects involving involuntary movements that some patients have after they have taken antipsychotic drugs for an extended time (at least 6 months)
What is the theory behind the tar dive dyskinesia?
Occurs as a result of the drug’s effect on dopamine receptors in the straitum. If discovered early, can be cured. Often times it is discovered late and is permanent
What do clinicians do today when a drug does not improve the patient?
Used to increase the dose, now the clinician will add an additional drug to achieve a synergistic effect (polypharmacy), or stop the drug and try an alternative or stop all medications.
Which generation of drug is found to be more effective?
Second-generation drugs
Benefits of second-generation antipsychotic drugs? most commonly used
Not only reduces positive symptoms but negative ones as well, cause fewer extrapyramidal symptoms and less likely to produce tar dive dyskinesia
What is agranulocytosis?
A life-threatening drop in white blood cells
What are the side effects of second-generation drugs?
Weight gain, dizziness, metabolic problems, sexual dysfunctions, cardiovascular changes, significant elevations in blood sugar
Overall effect of antipsychotics drugs?
Produce only modest changes in overall life satisfaction among those who have chronic schizophrenia
What would Frieda Fromm-Reichmann say to patients?
They could continue to exclude her from their private world and hold onto their disorder as long as they wished
How has psychotherapy developed?
Help relieve thought and perceptual disturbances. make changes in their behaviour, and cope with stressors
What is cognitive behavioural therapy?
Two kinds of therapy: Cognitive remediation and hallucination reinterpretation and acceptance
What is cognitive remediation therapy?
A treatment that focuses on the cognitive impairments including difficulties in attention, planning, memory and problem solving
What is hallucination reinterpretation and acceptance therapy?
Help change how people view and react to their hallucinations, control over their hallucinations and reduce delusional thinking
What is the 1st step in hallucination reinterpretation and acceptance therapy?
Provide education and evidence about the biological causes of hallucinations
What is the 2nd step in hallucination reinterpretation and acceptance therapy?
Help to learn more about the “comings and goings” of their hallucinations and delusions
What is the 3rd step in hallucination reinterpretation and acceptance therapy?
challenge the patients inaccurate ideas about the power of their hallucinations
What is the 4th step in hallucination reinterpretation and acceptance therapy?
Teach to reattribute and more accurately interpret their hallucinations
What is the 5th step in hallucination reinterpretation and acceptance therapy?
Teach techniques for coping with their hallucinations
What is new-wave cognitive behavioural therapy for schizophrenia?
Acceptance and commitment therapy, help patients accept their streams of problematic thought, rather than judge, act on or try to change them. Be mindful
What is family therapy?
overall helping the person with schizophrenia cope with the pressures of family life
What is social therapy (personal therapy)?
Provide techniques that address social and personal difficulties in the clients life. Offer practical advice, work on problem solving, memory enhancement, decision making and social skills.
What is a community mental health centre? (coordinated services)
A treatment facility that provides medication, psychotherapy, and emergency care for psychological problems
What is a day centre (day hospital)?
A program that offers hospital-like treatment during the day only
What is short-term hospitalization?
If first approach fails, will place the patient in a mental hospital for a few weeks. After improvement, patients are released to aftercare
What are semihospitals/ residential crisis centres?
provide 24-hour nursing care for people with severe mental disorders
What is a sheltered workshop?
Occupational training, that is a supervise workplace for people who are not yet ready for completive jobs. Replicates a typical work environment, paid according to perform
What is supported employment?
Vocational agencies and counsellors help clients find competitive jobs in the community and provide psychologist support while the clients are employed
How has community treatment failed?
poor coordination of services and shortage of services
