Lecture 17: psychoSocial factors in SZ – Part I Flashcards
What are the psycho-social factors in SZ?
- Disengagement with treatment
- Substance use and abuse
- Suicide
- Unemployment
- Homelessness
- Poor health
- Stress
- Violence and victimization
Are medical and psychological treatments for SZ effective?
Only partially effective
Because of it’s partial effectiveness of treatment for SZ, _____ of people with SZ do not engage in treatment in a continuous way
About half
What are the reasons a person with SZ might not engage in treatment?
- Related to the disorder (symptoms prevent engagement)
- challenges of medication (people may not comply with their medication regime because of their symptoms, may not want to).
Other life factors which poses challenges for people with SZ to access treatment include:
- Disengagement from family and social support
- Substance use and abuse
- Homelessness
- Unemployment
- Legal issues (rel. to substance abuse, rel. to paying bills)
People with SZ have a higher rate of current use depending on the location. What is the % at any given time?
What is the % of life-time use?
Which location is associated with higher rate of drug use and abuse?
- 10-50% (at any given time)
- Larger cities, more economically depressed areas = more likely to use
- life-time used is 45-50% (most people will have use and abuse drugs at some point in their lives).
Most commonly used and abused are:
Alcohol and cannabis
What are Negative consequences for SZ patients who use & abuse subtances?
- Reduced engagement with treatment
- Related to increased symptoms and hospitalization
- Homelessness, violence, victimization, suicide
What is the association between cannabis and age of onset of SZ?
- Earlier age of onset (Helle, 2016)
- For those who reported cannabis use, age of 1st episode 3 years earlier than those who did not
Is there an overlapping genetic risk with SZ and drug abuse?
- Overlapping genetic risk with SZ is debated
- Related to the same increased risk for all people in the same SES, education, employment categories
- Being poor, uneducated and unemployed makes you more likely to use and abuse (more likely in SZ)
- It may cause SZ:
Some evidence for cannabis as a contributor to onset - It is a result SZ:
Those who develop SZ also more likely to abuse
The Hambrecht & hafner, (1996) study, 232 people at first episode with SZ or psychotic disorder were recruited. What was the results of the study?
- Alcohol abuse seen in ___________
- Drug abuse seen in _______________
- __________ most common drug; -combined Alcohol and drugs are _______
- Both Alcohol and drug abuse more common in ____
- Alcohol abuse seen in 24% (2x rate of controls)
- Drug abuse seen in 14% (2x rate of controls)
- Cannabis most common drug; -combined Alcohol and drugs common
- Both Alcohol and drug abuse more common in men
The Hambrecht & hafner, (1996) study where they recruited 232 people at first episode with SZ or psychotic disorder, also showed that:
- People with drug abuse had _________
- People with alcohol abuse had ________
- Combined drug and alcohol abuse _________
- People with drug abuse had earlier symptom onset and 1st admission
- People with alcohol abuse had first sign and negative symptom earlier
- Combined drug and alcohol abuse does not change the pattern (there’s no additve effect, they had had first sign and negative symptom earlier)
What is the most common self-reported reason for abuse?
“alleviation of dysphoria” – Drinking, using drugs to cope with negative feelings
Why are other reasons why drug abuse occur?
- Alienation (may not be in employment, loss of contact with others)
- Social drift (like the gen. pop having a lower SES, being unemployed, homeless).
- “Supersensitivity”:
[Possibly related to genetics of the DA system
[To drugs of abuse that affect DA system
[To stressors that then promote further abuse
The risk of suicide in SZ is ____times the rate of the general population.
4x
Suicide is more common in _____ with SZ
More common in men (60/40) which is similar to the rest of the population
Suicide is more common in young adults age between ____________
16 and 30 years old, unlike the rest of the population where the highest rates are in men between 45-60
At what point during the course of the disorder is suicide common in SZ?
- following first diagnosis,
- in those with depression, active psychotic symptoms,
- substance use is a risk factor
- Multiple comorbid disorders that each contribute to raising suicide risk
Employment rates for people with SZ in the competitive job market are low: _________
- 10-20% in most developed countries; higher in developing countries
__________ symptoms most strongly related to unemployment
Negative
________ symptoms also related to poor educational attainment
Negative
Lower education related to ______employment opportunities
reduced
What are other challenges to employment in people with SZ?
- Sheltered employment opportunities limited
- Working while receiving benefits is complex
(People may be unwilling to risk loosing benefits)
Homelessness or very unstable housing has a: ______________ for people with SZ
wide range of negative consequences
Rate of homelessness in SZ is approximately_____
10-20%
What are the risk factors for homelessness in SZ
Risk factors:
- Symptom severity,
- substance misuse,
- cognitive impairment,
- financial problems,
- legal problems
What are the outcomes for homelessness in SZ?
Outcomes:
- Lower rates of treatment
- Higher rates of suicide and early death
What were the Results after two years, people in “Choices” program?
Context:
What were the result of the Fighting homelessness (Shern, et al., 2000) study
Methodology:
- 168 people with SZ
77 in standard treatment; 91 in “Choices” program to promote stable housing
- “Choices” program:
[Outreach to people on the street
[Treatment Centre open 7am-7pm
[Offered food, health services, group activities
[ Respite housing (shelters)
[ Specific services to help find and maintain housing
- Biggest differences from standard treatment:
Active outreach; emphasis on assistance obtaining housing
- More likely to attend day treatment
- Had less difficulty maintaining basic needs
- Spent less time on the streets
- Spent more time in housing
- Improved life satisfaction
What are the implications of the “Choices” program from the Fighting homelessness (Shern, et al., 2000) study?
It requires _______and ________
- intensive outreach (particularly for those who have been homeless longer)
- Long-term intervention
What were the results from the Health outcomes (Hjorthoj, 2017) study in terms of life expectancy?
What was the life expectancy of people with SZ?
Methods:
Meta-analysis of 11 studies
North America (3); Europe (7); Asia; Africa; Australia
250,000 people
- 14.5 years less than the population (M=16 yrs; W=14 yrs)
- Overall 65 years (M=60; W=68)
- In Canada 82 years (M=80; W=84)
- No changes over time
What were the results from the Health outcomes (Hjorthoj, 2017) study in terms of Causes of death?
What was the number 1 cause of death following 1st diagnosis?
What was the cardiac complication caused by 2nd gen. Antipsychotics?
What were the other factors involved?
Context:
Methods:
Meta-analysis of 11 studies
North America (3); Europe (7); Asia; Africa; Australia
250,000 people
- Suicide – especially in the year following 1st diagnosis
- Coronary heart disease – can be related to metabolic syndrome cause by 2nd generation antipsychotics, poor diet and smoking
- Substance abuse
- Poor overall lifestyle (diet, exercise, preventive health)
