Lecture 18: psychoSocial outcomes in SZ – Part II Flashcards
Name the Psycho-Social problems in SZ
- Disengagement with treatment
- Substance use and abuse
- Suicide
- Unemployment
- Homelessness
- Poor health
- Stress
- Violence and victimization
What are the three CONTRIBUTION OF STRESS TO SZ we covered in class?
- Chronic stressors (i.e poverty, homelessness)
- Repeated stressors (i.e relapses and hospitalizations, change of clinicians)
- Life events: job loss, divorce – but also job hassles, relationship difficulties
What are life events which poses a risk factor in SZ?
- Early loss or separation from a parent more common in those with SZ
- Immigration
- and social upheaval
What is the relationship between negative life events to onset or relapse in SZ?
- Some evidence linking negative life events to onset or relapse in SZ
(The connection to relapse is the strongest)
What are the hypotheses which may explain the relationship between life events and onset/relapse?
- Stress is one contributor among many
- People with SZ have a specific vulnerability to stress
In the response to daily stressors (Myin-germeys, 2007) study, they used a “experience sampling”, which meant that people would carry a cellphone that rings at unpredictable times during the day. They were asked to rate their levels of stress, situation, symptoms. They looked at people in remission and who had a reduction in their symptoms. They also asked family members and then they had controls. What were the results?
- SZ had higher negative affect than families as well as controls (SZ>relatives>controls)
- SZ also reported increases in their positive symptoms under stress.
- Susceptibility to stress and SZ share familial risk
- Risk not just due to symptoms (they were in remission)
What did the Violence and victimization (Sariaslan, 2020) study findings reveal?
- People with ___________ have a higher incidence of violence and victimization
- ___ have an overall higher incidence of violence and victimization
- _____ with a psychiatric disorder are more likely to commit violence;
- ______ are more likely to be victims
- People with any psychiatric disorder have a higher incidence of violence and victimization
- Men have an overall higher incidence of violence and victimization
- Men with a psychiatric disorder are more likely to commit violence; women are more likely to be victims
What is the take-away message from the Violence and victimization (Sariaslan, 2020) study?
1) Addressing substance use is key to reducing both ________and _________
- In the population
- For people with psychiatric disturbances
2) Risk of __________ is elevated in SZ:
3) Touches on recent problems seen _____________
1) Addressing substance use is key to reducing both violence and victimization:
- In the population
- For people with psychiatric disturbances
2) Risk of violence is elevated in SZ:
- Needs to be monitored in treatment
- Appropriate resources and treatment plans put in place
3) Touches on recent problems seen when police are called to intervene with people with mental health problems:
- Police are called when people see no other choice
- But waiting for the crisis is not a good idea
- Police do not have the training to intervene
What is the definition of a comprehensive treatment?
- Systems for coordinating and delivering comprehensive care (Including medication and health care, therapy, rehabilitation, social services)
What are the three types of comprehensive care treatments we covered in class?
- Assertive community treatment
- Critical time intervention
- Coordinated specialty care for people at high-risk and those in 1st episode
What are the components of Assertive community treatment?
1) Long-term: intervention only ends with client needs
2) Aims to reduce relapse, homelessness, increase independence
3) Multi-disciplinary team (Psychiatrist, psychologist, social worker)
4) Team actively reaches out to clients:
- Scheduling appointments, providing service
- Catch problems before they become critical
- Reduce the need for people to navigate the system
5) Cases shared across the team
Patients do not “fall between the cracks”
What are the results of the Assertive community treatment?
- Reduced number of hospitalizations, length of stay
- More days in housing, better medication adherence
What are the components of Critical time intervention?
1) Short-term (6-9mths): focused on transitions in treatment
2) Usually when leaving hospital or shelter
3) Aims to reduce relapse, homelessness
4) Help to navigate services, but no services delivered
5) Individual case worker coordinates access:
- Coordinates treatment plan
- Actively reaches out, accompanies client, facilitates contacts
- Help decreases over time
What are the Critical time intervention results?
- Reduced number of hospitalizations, risk of homelessness, lower substance abuse
What are the components of Coodinated Specialty Care?
1) Medium-term: following 1st episode diagnosis
2) Focused on recovery, reducing untreated illness (associated with poor outcome), improving long-term outcomes
3) Team approach: medication, psychological intervention, employment and educational support, skills training:
- Find the lowest effective dose of medication
- Support for career and education,
- Treatment for substance use, suicide prevention
- Family support
