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13 Cards in this Set
- Front
- Back
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Sociocultural View of Schizophrenia Family Dysfunction |
Family Dysfunction: Studies suggest it is often linked to family of high stress
Parents of people with disorder often: - Display more conflict - Have greater difficulty communicating - Are more critical and over-involved with their children than other parents *Families high in "expressed emotion" often frequently express criticism, hostility, and intrude on each other's privacy |
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How Schizophrenia Is Treated |
Historically: Considered beyond help - Discovery of antipsychotic drugs has helped somewhat - Better psychotherapies (behavioral & cognitive-behavioral) have helped patients as well |
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Schizophrenia Treatment Timeline 20th Century |
People considered insane; institutionalized in public mental hospitals - Failed to respond to traditional treatments, so they were restrained & given food, shelter, and clothing |
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Schizophrenia Treatment Timeline 1950s: Milieu & Token Economies |
Clinicians develop 2 institutional approaches - Milieu Therapy - Token Economies
Milieu: Based on humanistic principles - Creating a social climate ("milieu") that promotes productive activity, self respect, individual responsibility
Token Economies: Based on behavioral principles - Based on operant conditioning; used to change the behavior of patients - Rewarded when they behave in socially acceptable ways, not rewarded otherwise *Acceptable behaviors: care for oneself and possessions, work program, showing self-control - Reward tokens can later be exchanged for food, cigarettes, privileges, etc.
*Found that it can help change psychotic & related behavior |
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Schizophrenia Treatment Timeline 1950s: Antipsychotic Drugs |
Discovered a group of antihistamines - phenothiszines - can be used to calm patients - Chlorpromazine (one drug in the group) was tested on patients; saw sharp reduction in their symptoms 1954: Chlorpromazine approved for sale in US as an antipsychotic drug |
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Schizophrenia Treatment Timeline 1960s ++: Antipsychotic Drugs |
- Other antipsychotic drugs have been developed since then - Referred to as "conventional" antipsychotic drugs from 1960s-1980s - More recently known as "atypical" or "second-generation" antipsychotics |
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How Effective are Antipsychotic Drugs? |
- Help reduce schizophrenia symptoms in many patients - Produce maximum level of improvement within the first 6 months of treatment *Symptoms may return if patients stop taking drugs too soon - Reduce positive symptoms more quickly/completely than the negative symptoms *People with more positive symptoms tend to have better rates of recovery |
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Unwanted Effects of Conventional Antipsychotic Drugs |
Extrapyramidal effects: Appear to be caused by drugs' impact on extrapyramidal areas of the brain - So common that they are listed as a separate category of disorders: medication-induced movements disorders
Parkinsonian symptoms - Muscle tremor - Dystonia (bizarre movements in face, neck, tongue, back) - Akathisia (restlessness, agitation, discomfort in limbs) *Mostly can be reversed if anti-Parksinonian drug is taken with antipsychotic
Neuroleptic Malignant Syndrome - 1% of patients develop this - Severe, potentially fatal *Symptoms: muscle rigidity, fever, altered consciousness, improper functioning of autonomic nervous system
Tardive Dyskinesia - Affects more than 10% of patients - Involuntary movements; usually mouth, lips, tongue, legs, body - Can be irreversible
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New Antipsychotic Drugs |
"Atypical" - Biological operation differs from conventional antipsychotics - Appear more effective - Cause few extrapyramidal side effects *Carry risk of agranulocytosis (potentially fatal drop in white blood cells) |
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Psychotherapy: Cognitive-Behavioral Therapy |
- Therapists take on active role, set limits, express opinions, challenge the patients' statements - Improves coping of patients through improved adherence and symptom management
Techniques: - Development of trust - Normalizing experience - Coping strategy enhancement - Reality testing - Work with dysfunctional affective & behavioral reactions to psychotic symptoms |
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Psychotherapy: Family Therapy |
- Around 25% of recovering patients live with family - Causes significant family stress - High levels of expressed emotion are at greater risk for relapse than those who live with more positive/supportive families - Attempts to address issues, create more realistic expectations, provide psychoeducation about the disorder |
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Psychotherapy: Social Therapy |
Treatment should include techniques that address social/personal difficulties such as: - Practical advice - Problem solving - Decision making - Social skills training - Medication management - Employment counseling - Financial assistance - Housing
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Community Approach |
Broadest approach for treatment - 1963 Congress passed Community Mental Health Act stating patients should be able to receive care within their own communities rather than institutions far from home - Led to massive de-institutionalization of patients - Still inadequate *Revolving door syndrome |
