FAP5_Lecture_Ch12

FAP5_Lecture_Ch12 - Chapter 12 Schizophrenia Comer,...

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Unformatted text preview: Chapter 12 Schizophrenia Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Slides & Handouts by Karen Clay Rhines, Ph.D. 1 Psychosis Psychosis is a state defined by a loss of contact with reality The ability to perceive and respond to the environment is significantly disturbed; functioning is impaired Symptoms may include hallucinations (false sensory perceptions) and/or delusions (false beliefs) Psychosis may be substanceinduced or caused by brain injury, but most psychoses appear in the form of schizophrenia 2 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Schizophrenia Schizophrenia affects approximately 1 in 100 people in the world About 2.5 million Americans currently have the disorder The financial and emotional costs are enormous One estimate is greater than $100 billion per year Sufferers have an increased risk of suicide and illness 3 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Schizophrenia Schizophrenia appears in all socioeconomic groups, but is found more frequently in the lower levels Leading theorists argue that the stress of poverty causes the disorder Other theorists argue that the disorder causes victims from higher social levels to fall to lower social levels and remain at lower levels This is called the "downward drift" theory 4 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 5 Schizophrenia Equal numbers of men and women are diagnosed In men, symptoms begin earlier and are more severe 3% of divorced or separated people 2% of single people 1% of married people Rates of diagnosis differ by marital status It is unclear whether marital problems are a cause or a result Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 6 Schizophrenia Rates of the disorder differ by ethnicity and race About 2% of African Americans are diagnosed compared with 1.4% of Caucasians The reason for these different rates is not clear Some theorists believe that the difference reflects diagnostic biases, economic factors, or both Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 7 The Clinical Picture of Schizophrenia Schizophrenia produces many "clinical pictures" The symptoms, triggers, and course of schizophrenia vary greatly Some clinicians have argued that schizophrenia is actually a group of distinct disorders that share common features Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 8 What Are the Symptoms of Schizophrenia? Symptoms can be grouped into three categories: Positive symptoms Negative symptoms Psychomotor symptoms Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 9 What Are the Symptoms of Schizophrenia? Positive symptoms These "pathological excesses" are bizarre additions to a person's behavior Positive symptoms include: Delusions faulty interpretations of reality Delusions may have a variety of bizarre content: being controlled by others; persecution; reference; grandeur; control May include loose associations, neologisms, perseverations, and clang 10 Disordered thinking and speech Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 What Are the Symptoms of Schizophrenia? Examples of positive symptoms Loose associations: "The problem is insects. My brother used to collect insects. He's now a man 5 foot 10 inches. You know, 10 is my favorite number; I also like to dance, draw, and watch TV." "This desk is a cramstile"; "He's an easterhorned head" How are you? "Well, hell, it's well to tell" How's the weather? "So hot, you know it runs on a cot" 11 Neologisms: Clang: Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 What Are the Symptoms of Schizophrenia? Examples of positive symptoms Heightened perceptions People may feel that their senses are being flooded by sights and sounds, making it impossible to attend to anything important Most common are auditory Hallucinations faulty sensory perceptions Generally involve a running commentary and/or accusations Spoken directly to or overheard by the hallucinator Hallucinations can involve any of the other senses: tactile, somatic, visual, gustatory, or olfactory Inappropriate affect 12 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 What Are the Symptoms of Schizophrenia? Negative symptoms These "pathological deficits" are characteristics that are lacking in an individual Negative symptoms include: Poverty of speech (alogia) Long lapses before responding to questions, or failure to answer Reduction of quantity of speech Slow speech Blunted and flat affect 13 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 What Are the Symptoms of Schizophrenia? Examples of negative symptoms Blunted and flat affect Avoidance of eye contact Immobile, expressionless face Lack of emotion when discussing emotional material Apathetic and uninterested Monotonous voice, low and difficult to hear Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 14 What Are the Symptoms of Schizophrenia? Examples of negative symptoms Loss of volition (motivation or directedness) Feeling drained of energy and interest in normal goals Inability to start or follow through on a course of action Withdrawal from social environment Seems to lead to a breakdown of social skills, including the ability to accurately recognize other people's needs and emotions Social withdrawal Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 15 What Are the Symptoms of Schizophrenia? Psychomotor symptoms People with schizophrenia sometimes experience psychomotor symptoms Awkward movements, repeated grimaces, odd gestures The movements seem to have a magical quality These symptoms may take extreme forms, collectively called catatonia Includes stupor, rigidity, posturing, and excitement 16 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 What Is the Course of Schizophrenia? Schizophrenia usually first appears between the late teens and mid30s Many sufferers experience three phases: Prodromal beginning of deterioration; mild symptoms Active symptoms become increasingly apparent Residual a return to prodromal levels Onequarter of patients fully recover; threequarters continue to have residual problems Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 17 What Is the Course of Schizophrenia? Each phase of the disorder may last for days or years A fuller recovery from the disorder is more likely in people: With high premorbid functioning Whose disorder was triggered by stress With rapid onset With later onset 18 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Diagnosing Schizophrenia The DSMIVTR calls for a diagnosis only after signs of the disorder continue for six months or more People must also show a deterioration in their work, social relations, and ability to care for themselves Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 19 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 20 Diagnosing Schizophrenia The DSMIVTR distinguishes five subtypes: Disorganized characterized by confusion, incoherence, and flat or inappropriate affect Catatonic characterized by psychomotor disturbance of some sort Paranoid characterized by an organized system of delusions and auditory hallucinations Undifferentiated characterized by symptoms which fit no subtype; vague category Residual characterized by symptoms which have lessened in strength and number; person may continue to display blunted or inappropriate emotions Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 21 How Do Theorists Explain Schizophrenia? While there is no known cause, research has focused on: Biological factors (most promising) Psychological factors Sociocultural factors Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 22 Biological Views Genetic and biological studies of schizophrenia have dominated clinical research in the last several decades These studies have revealed the key roles of inheritance and brain activity and have opened the door for changes in treatment Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 23 Biological Views Genetic factors Following the principles of a diathesisstress approach, genetic researchers believe that some people inherit a biological predisposition to schizophrenia This disposition (and disorder) is triggered by later exposure to stress This theory has been supported by studies of relatives, twins, and adoptees, and by genetic linkage studies Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 24 Biological Views Genetic factors Family pedigree studies have repeatedly shown that schizophrenia is more common among relatives of people with the disorder The more closely related they are to the person with schizophrenia, the greater their likelihood for developing the disorder Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 25 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 26 Biological Views Genetic factors Twins have received particular research study Studies of identical twins have found that if one twin develops the disorder, there is a 48% chance that the other twin will do so as well If the twins are fraternal, the second twin has a 17% chance of developing the disorder Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 27 Biological Views Genetic factors Adoption studies have compared adults with schizophrenia who were adopted as infants with both their biological and adoptive relatives Because they were reared apart from their biological relatives, similar symptoms in those relatives would indicate genetic influences; similarities to their adoptive relatives would suggest environmental influences Researchers have repeatedly found that the biological relatives of adoptees with schizophrenia are more likely to display schizophrenic symptoms than are their adoptive relatives 28 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Biological Views Genetic factors Genetic linkage and molecular biology studies indicate that possible gene defects on numerous chromosomes may predispose individuals to develop schizophrenia These varied findings may indicate: A case of "mistaken identity" that is, some of these gene sites do not contribute to the disorder; Various types of schizophrenia are linked to different genes; or Schizophrenia, like many disorders, is a polygenic disorder, caused by a combination of gene defects Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 29 Biological Views Genetic factors Genetic factors may lead to the development of schizophrenia through two kinds of (potentially inherited) biological abnormalities: Biochemical abnormalities Abnormal brain structure Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 30 Biological Views Biochemical abnormalities One promising theory is the dopamine hypothesis: Neurons using dopamine fire too often, producing symptoms of schizophrenia This theory is based on the effectiveness of antipsychotic medications (dopamine antagonists) Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 31 Biological Views Biochemical abnormalities Originally developed for treatment of allergies, antipsychotic drugs were found to cause a Parkinson's diseaselike tremor response in patients Scientists knew that Parkinson's patients had abnormally low levels of dopamine which caused their shaking This relationship between symptoms suggested that symptoms of schizophrenia were related to excess dopamine Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 32 Biological Views Biochemical abnormalities Research since the 1960s has supported and clarified this hypothesis Example: patients with Parkinson's develop schizophrenic symptoms if they take too much Ldopa, a medication that raises dopamine levels Example: people who take high doses of amphetamines, which increase dopamine activity in the brain, may develop amphetamine psychosis a syndrome similar to schizophrenia 33 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Biological Views Biochemical abnormalities Investigators have also located the dopamine receptors to which antipsychotic drugs bind The drugs are apparently dopamine antagonists which bind to the receptors, preventing further dopamine binding and neuron firing These findings suggest that, in schizophrenia, messages traveling from dopaminesending neurons to dopamine receptors (particularly D2) may be transmitted too easily or too often This is an appealing theory because certain dopamine receptors are known to play a role in guiding attention 34 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Biological Views Biochemical abnormalities Though enlightening, the dopamine hypothesis has limitations It has been challenged by the discovery of a new type of antipsychotic drug ("atypical" antipsychotics) that are more effective than traditional antipsychotics and also bind to serotonin receptors Thus, it may be that schizophrenia is related to abnormal activity or interactions of both dopamine and serotonin and perhaps other neurotransmitters as well, rather than to abnormal dopamine activity alone 35 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Biological Views Abnormal brain structure During the past decade, researchers have also linked schizophrenia (particularly cases dominated by negative symptoms) to abnormalities in brain structure For example, brain scans have found that many people with schizophrenia have enlarged ventricles This enlargement may be a sign of poor development in related brain regions People with schizophrenia have also been found to have smaller temporal and frontal lobes, and abnormal blood flow to certain brain areas 36 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Biological Views Viral problems A growing number of researchers suggest that the brain abnormalities seen in schizophrenia result from exposure to viruses before birth Circumstantial evidence for this theory comes from the unusually large number of people with schizophrenia born in winter months More direct evidence comes from studies showing that mothers of children with schizophrenia were more often exposed to the influenza virus during pregnancy than mothers of children without schizophrenia Other studies have found a link between schizophrenia and a particular group of viruses found in animals 37 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Biological Views While the biochemical, brain structure, and viral findings are beginning to shed much light on the mysteries of schizophrenia, they offer only a partial explanation Some people who have these biological problems never develop schizophrenia May be because biology sets the stage for the disorder, but psychological and sociocultural factors must be present for it to appear 38 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Psychological Views When schizophrenia investigators began to identify genetic and biological factors of schizophrenia, clinicians largely abandoned psychological and sociocultural theories In the past decade, however, these factors are again being considered important Leading psychological explanations come from the psychodynamic and cognitive perspectives 39 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Psychological Views The psychodynamic explanation Freud believed that schizophrenia developed from two processes: Regression to a preego stage Efforts to reestablish ego control He proposed that when their world is extremely harsh, people who develop schizophrenia regress to the earliest points in their development (primary narcissism), in which they recognize and meet only their own needs This regression leads to selfcentered symptoms such as neologisms, loose associations, and delusions of grandeur 40 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Psychological Views The psychodynamic explanation Freud's theory posits that attempts to reestablish ego control from such a state fail and lead to further schizophrenic symptoms Years later, another psychodynamic theorist elaborated on Freud's idea of harsh parents The theory of schizophrenogenic mothers proposed that mothers of people with schizophrenia were cold, domineering, and uninterested in their children's needs Both of these theories have received little research support and have been rejected by most psychodynamic theorists 41 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Psychological Views The cognitive view Leading cognitive theorists agree that biological factors produce symptoms They theorize that further features of the disorder develop due to a faulty interpretation and misunderstanding of symptoms Example: a man experiences auditory hallucinations and approaches his friends for help; they deny the reality of his sensations; he concludes that they are trying to hide the truth from him; he begins to reject all feedback and starts feeling persecuted There is little direct research support for this view 42 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Sociocultural Views Sociocultural theorists believe that people with mental disorders are victims of two main social forces: Social labeling Family dysfunction Although social and family forces are considered important in the development of schizophrenia, research has not yet clarified what their precise relationships might be 43 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Sociocultural Views Social labeling Many sociocultural theorists believe that the features of schizophrenia are influenced by the diagnosis itself Society labels people who fail to conform to certain norms of behavior Once assigned, the label becomes a selffulfilling prophecy The dangers of social labeling have been well demonstrated Example: Rosenhan "pseudopatient" study Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 44 Sociocultural Views Family dysfunctioning A number of studies suggest that schizophrenia is often linked to family stress: Parents of people with the disorder often: Display more conflict Have greater difficulty communicating Are more critical of and overinvolved with their children than other parents Family theorists have long recognized that some families are high in "expressed emotion" family members frequently express criticism and hostility and intrude on each other's privacy Individuals who are trying to recover from schizophrenia are almost four times more likely to relapse if they live with such a family Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 45 How Are Schizophrenia and Other Severe Mental Disorders Treated? For much of human history, people with schizophrenia were considered beyond help and without hope Though schizophrenia is still hard to treat, the discovery of antipsychotic drugs has enabled people with the disorder to think clearly and profit from psychotherapies An historical perspective of treatment allows the best understanding of the nature, problems, and promise of modern approaches 46 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Institutional Care in the Past For more than half of the 20th century, people with schizophrenia were considered insane and were institutionalized in public mental hospitals Because patients failed to respond to traditional therapies, the primary goals of the hospitals were to restrain them and give them food, shelter, and clothing 47 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Institutional Care in the Past The move toward institutionalization began in 1793 with the practice of "moral treatment" For the first time in centuries, patients with severe disturbances were viewed as human beings who should be cared for with sympathy and kindness Hospitals were created in isolated areas to protect patients from the stresses of daily life and to offer them a healthful psychological environment 48 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Institutional Care in the Past States throughout the U.S. were required by law to establish public mental institutions (state hospitals) for patients who could not afford private care Unfortunately, problems with overcrowding, understaffing, and poor patient outcomes led to loss of individual care and the creation of "back wards" human warehouses filled with hopelessness 49 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Institutional Care Takes a Turn for the Better In the 1950s, clinicians developed two institutional approaches that brought some hope to chronic patients: Milieu therapy Based on humanistic principles Based on behavioral principles Token economies These approaches particularly helped improve the personal care and selfimage of patients, problem areas that were worsened by institutionalization 50 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Institutional Care Takes a Turn for the Better Milieu therapy The guiding principle is that institutions can help patients make clinical progress by creating a social climate ("milieu") that promotes productive activity, selfrespect, and individual responsibility Milieu programs have been set up in institutions throughout the Western world with moderate success Research has shown that patients with schizophrenia in milieu programs often leave the hospital at higher rates than patients receiving custodial care Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 51 Institutional Care Takes a Turn for the Better The token economy Based on operant conditioning principles, token economies are used in institutions to change the behavior of patients with schizophrenia Patients are rewarded when they behave in socially acceptable ways and are not rewarded when they behave unacceptably Immediate rewards are tokens that can later be exchanged for food, cigarettes, privileges, and other desirable objects Acceptable behaviors likely to be targeted include care for oneself and one's possessions, going to a work program, and showing self control 52 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Institutional Care Takes a Turn for the Better The token economy Researchers have found that token economies help change psychotic and related behavior However, questions have been raised about such programs: Many research studies have been uncontrolled; instead of patients being randomly assigned to groups, a whole ward will participate in the program Are such programs ethical and legal? Aren't all humans entitled to basic rights, some of which are compromised in a strict token economy system? Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 53 Institutional Care Takes a Turn for the Better The token economy Questions have been raised about such programs: Are such programs truly effective? For example, patients may change overt behaviors but not underlying psychotic beliefs Transitioning from a token economy system to community living may be difficult for patients Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 54 Antipsychotic Drugs While milieu therapy and token economies helped improve treatment outcomes, it was the discovery of antipsychotic drugs in the 1950s that revolutionized treatment for those with schizophrenia Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 55 Antipsychotic Drugs The discovery of antipsychotic medications dates back to the 1940s, when researchers developed antihistamine drugs for allergies It was discovered that one group of antihistamines, phenothiazines, could be used to calm patients about to undergo surgery Psychiatrists tested one of the drugs, chlorpromazine, on six patients with psychosis and observed a sharp reduction in their symptoms In 1954, chlorpromazine (under the trade name Thorazine) was approved for sale in the U.S. as an antipsychotic drug 56 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Antipsychotic Drugs Since the discovery of the phenothiazines, other kinds of psychotic drugs have been developed Those developed throughout the 1960s, 1970s, and 1980s are now referred to as "conventional" antipsychotic drugs These drugs are also known as neuroleptic drugs because they often produce undesired movement effects similar to symptoms of neurological diseases Drugs developed in recent years are known as "atypical" or "secondgeneration" antipsychotics Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 57 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 58 How Effective Are Antipsychotic Drugs? Research has repeatedly shown that antipsychotic drugs reduce schizophrenia symptoms in the majority of patients In direct comparisons, drugs appear to be more effective than any other approach used alone In most cases, the drugs produce the maximum level of improvement within the first six months of treatment Symptoms may return if patients stop taking the drugs too soon 59 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 How Effective Are Antipsychotic Drugs? Antipsychotic drugs, particularly the conventional ones, reduce the positive symptoms of schizophrenia more completely, or at least more quickly, than the negative symptoms Although the use of such drugs is now widely accepted, patients often dislike the powerful effects of the drugs, and some refuse to take them 60 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 The Unwanted Effects of Conventional Antipsychotic Drugs In addition to reducing psychotic symptoms, conventional antipsychotic drugs sometimes produce disturbing movement problems These are called "extrapyramidal effects" because they appear to be caused by the impact of the drugs on the extrapyramidal areas of the brain Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 61 The Unwanted Effects of Conventional Antipsychotic Drugs The most common of these effects produce Parkinsonian symptoms, reactions that closely resemble the features of the neurological disorder Parkinson's disease, including: Muscle tremor and rigidity Dystonia (bizarre movements of the face, neck, tongue, and back) Akathisia (great restlessness, agitation, and discomfort in the limbs) 62 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 The Unwanted Effects of Conventional Antipsychotic Drugs The Parkinsonian and related symptoms seem to be the result of medicationinduced reductions of dopamine activity in the substantia nigra, a part of the brain that coordinates movement and posture In most cases, the symptoms can be reversed if an antiParkinsonian drug is taken along with the antipsychotic Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Sometimes medication use must be halted altogether 63 Unwanted Effects of Conventional Antipsychotic Drugs A more difficult side effect of conventional antipsychotic drugs appears up to one year after starting the medication This reaction, called tardive dyskinesia, involves involuntary movements, usually of the mouth, lips, tongue, legs, or body It affects more than 10% of those taking the drugs It can be IRREVERSIBLE! 64 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Unwanted Effects of Conventional Antipsychotic Drugs Since learning of the unwanted side effects of conventional antipsychotic drugs, clinicians have become more careful in their prescription practices: They try to prescribe the lowest effective dose They gradually reduce or stop medication weeks or months after the patient begins functioning normally 65 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 New Antipsychotic Drugs In recent years, new antipsychotic drugs have been developed Examples: Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, and Abilify Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 66 New Antipsychotic Drugs These new drugs are called "atypical" because their biological operation differs from that of conventional antipsychotics They appear more effective than conventional drugs, especially for negative symptoms They cause few extrapyramidal side effects Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 67 Psychotherapy Before the discovery of antipsychotic drugs, psychotherapy was not an option for people with schizophrenia Most were simply too far removed from reality to profit from psychotherapy Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 68 Psychotherapy Today, psychotherapy can be very helpful when used in combination with medication The most helpful forms of psychotherapy include insight therapy and two broader sociocultural therapies: family therapy and social therapy These approaches are often combined Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 69 Psychotherapy Insight therapy A variety of insight therapies have been used to treat schizophrenia Studies suggest that the orientation of the therapist is less important than their experience with schizophrenia In addition, the most successful therapists are those who take an active role, set limits, express opinions, and challenge the patients' statements 70 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Psychotherapy Family therapy About 25% of persons recovering from schizophrenia live with family members This creates significant family stress 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 Family therapy attempts to address such issues, create more realistic expectations, and provide psychoeducation about the disorder Families may also turn to family support groups and family psychoeducation programs 71 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Psychotherapy Social Therapy Many clinicians believe that the treatment of people with schizophrenia should include techniques that address social and personal difficulties in the clients' lives These include: practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing Research finds that this approach reduces rehospitalization 72 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 The Community Approach The community approach is the broadest approach for the treatment of schizophrenia In 1963, Congress passed the Community Mental Health Act, which said that patients should be able to receive care within their own communities, rather than being transported to institutions far from home This led to massive deinstitutionalization of patients with schizophrenia Unfortunately, community care was (and is) inadequate for their care The result is a "revolving door" syndrome 73 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 What Are the Features of Effective Community Care? People recovering from schizophrenia and other severe disorders need medication, psychotherapy, help in handling daily pressures and responsibilities, guidance in making decisions, training in social skills, residential supervision, and vocational counseling This combination of services sometimes is called assertive community treatment 74 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 Other key features are... What Are the Features of Effective Community Care? Coordinated services Community mental health centers provide medications, psychotherapy, and inpatient emergency care Coordination of services is especially important for mentally ill chemical abusers (MICAs) If treatment on an outpatient basis is unsuccessful, patients may be transferred to shortterm hospital programs After being hospitalized for up to a few weeks, patients are released to aftercare programs for followup in the community 75 Shortterm hospitalization Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 What Are the Features of Effective Community Care? Partial hospitalization If patients' needs fall between full hospitalization and outpatient care, day center programs may be effective These programs provide daily supervised activities and programs to improve social skills Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 76 What Are the Features of Effective Community Care? Supervised residences Halfway houses provide shelter and supervision for those patients who are unable to live alone or with their families but who do not require hospitalization Staff are usually paraprofessionals Houses are run with a milieu therapy philosophy These programs help those with schizophrenia adjust to community life and avoid rehospitalization Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 77 What Are the Features of Effective Community Care? Occupational training Many people recovering from schizophrenia receive occupational training in a sheltered workshop a supervised workplace for employees who are not ready for competitive or complicated jobs Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 78 How Has Community Treatment Failed? There is no doubt that effective community programs can help people with schizophrenia recover However, fewer than half of all people who need them receive appropriate community mental health services In any given year, 40% to 60% of all people with schizophrenia receive no treatment at all Two factors are primarily responsible: Poor coordination of services Shortage of services 79 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 How Has Community Treatment Failed? Poor coordination of services Mental health agencies in a community often fail to communicate with one another To combat this problem, a growing number of community therapists have become case managers for people with schizophrenia Case managers offer therapy and advice, teach problemsolving and social skills, and ensure compliance with medications Case managers also try to coordinate available community services for their clients 80 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 How Has Community Treatment Failed? Shortage of services The number of community programs available to people with schizophrenia is woefully inadequate The centers that do exist generally fail to provide adequate services for people with severe disorders This shortage is due to: A lack of mental health professionals who wish to work with severely disturbed patients Objections to such programs by neighborhood residents Funding shortages (primary reason) Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 81 What Are the Consequences of Inadequate Community Treatment? When community treatment fails, many people with schizophrenia receive no treatment at all Some return to their families and receive medication and perhaps emotional and financial support, but little else in the way of treatment Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 82 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 83 What Are the Consequences of Inadequate Community Treatment? About 8% of patients enter an alternative care facility (such as a nursing home), where they receive custodial care and medication About 18% are placed in privately run residences (such as foster homes or boardinghouses) where supervision is provided by untrained individuals As many as 34% of patients are placed in single room occupancy hotels, generally in rundown environments, where they survive on government disability payments 84 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 What Are the Consequences of Inadequate Community Treatment? Finally, a great number of people with schizophrenia become homeless Approximately onethird of the homeless people in America have a severe mental disorder, commonly schizophrenia Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 85 The Promise of Community Treatment Despite these very serious problems, proper community care has shown great potential for assisting in the recovery from schizophrenia Task forces have been created to find more effective ways for all levels of government to meet the needs of people with such disorders Another important advancement has been the formation of national interest groups, including the National Alliance for the Mentally Ill (NAMI) 86 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 The Promise of Community Treatment Today community care is a major feature of treatment for people recovering from schizophrenia in countries around the world Both in the U.S. and abroad, varied and well coordinated community treatment is seen as an important part of the solution to the problem of schizophrenia 87 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 12 ...
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FAP5_Lecture_Ch12 - Chapter 12 Schizophrenia Comer,...

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