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Schizophrenia

Bhavya, Carrie and Jasmin
by

Carrie Sun

on 28 February 2013

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Transcript of Schizophrenia

Finally Bhavya Sharma, Carrie Sun, Jasmin Filler Schizophrenia Myths Onset of schizophrenia appears after the age of 18
Schizophrenia is treated one on one
Individuals with schizophrenia do not regain normal functioning
Schizophrenia is purely a genetic disorder
Schizophrenia can only be treated with medication
Cognitive decline occurs in most people with schizophrenia
Individuals with schizophrenia have all the same symptoms All people with schizophrenia hear voices at some point
Schizophrenia develops quickly
People with schizophrenia either need to be hospitalized or put in long term care
Many people with schizophrenia have another personality
A person with schizophrenia needs to be on medication their whole life
Drug abuse causes schizophrenia
Poor, strict, and cold parenting causes a quicker onset of schizophrenia History Traced back to old Pharaonic Egypt, second millenium BC.

Awareness of psychotic disorders in general population

Strapping patients to chairs until they lost sensations and became calm.

Pinning patients down and pouring cold water on their face until they nearly drowned Demonic/supernatural possession was often implicated as cause of psychotic behaviours

Term coined by Eugen Bleuler in 1911
4As
First to describe positive/negative symptoms Most patients fall ill at 20 - 39 years of age

Men tend to succumb to it earlier but incidence in women increases after 30

1.5 million will be diagnosed this year worldwide

Over 280,000 people in Canada alone suffer from this illness Prevalence DSM-IV-TR (1) Delusions
(2) Hallucinations
(3) Disorganized speech
(4) Grossly disorganized or catatonic behaviour
(5) Negative symptoms Symptoms - Negative symptoms:
Affective flattening
Alogia
Avolition Disorganised
Catatonic
Paranoid
Residual
Undifferentiated Subtypes Assessment Scales BPRS PANSS Etiology Biological
Abnormally large lateral ventricles
Grey matter volume reduction
Genetics Environmental
Social Economic Status
In Utero
Seasonal Births Psychosocial
Traumatic events
Social isolation
Delayed developmental milestones Depression (54.2%)
Obsessive-Compulsive Disorder (59.2%)
Panic Disorder (29.5%)
Dementia syndrome
Aggressive Behaviour
Substance abuse
Schizotypal & Schizoid Personality Disorder Comorbidity Cognitive Behavioural Therapy
Interpersonal Therapy/Social Skills Training
Drug Therapy
Family Therapy
Group Therapy Psychotherapies Structured
Active
Time-limited (6-9 months)
Gentle questioning
Guided Discovery
Underlying beliefs and assumptions Cognitive Behavioural Therapy Types of Delusions
Grandiose
Persecutory
Referential
Religious
Somatic
Control Common characteristics
Egocentric bias
Externalizing bias
Intentionalizing bias Understand
Inquire
Identify
Question
Change Types of hallucinations
Auditory
Visual
Tactile
Olfactory 1) Identify, test and correct
2) Identify, question and construct

Goal/Aim: Help patients recognize that the voices reflects own attitudes Treating Negative symptoms
Behavioural self-monitoring
Graded Task Assignments
Activity Scheduling

Behavioural Experiments
Stimulate interests
Changing automatic thoughts IPT-Social Skills Training Difficulty learning appropriate social behaviors
Difficulty expressing emotional state
Difficulty in problem solving
Communication difficulties Issues with social behaviours
Subtle attention deficits during childhood
Age of onset
Problematic symptoms
Isolated lives
Affective states
Lack of resources/unemployment
Neurobiological factors Social Skills Training
Conversation skills
Community living skills
Friendship and dating skills
Medication management skills
Conflict management skills
Assertiveness skills Assessment of Skills
Does the client manifest some dysfunctional interpersonal behavior?
What are the specific circumstances in which the dysfunction occurs?
What is the probable source of the dysfunction? Role play example:
You have broken a vase belonging to your roommate. It was an accident, but you are blamed for breaking it.

Staff member: Did you break my vase?
Subject: ...
Staff member: How can you be so clumsy?
Subject: ...
Staff member: You can’t be trusted around any of my things.
Subject: ... Steps to Social Skills Training
1. Establishing a rationale
2. Discussing the steps of the skill
3. Modeling the skill in a role play
4. Engaging a client in a role play
5. Providing positive feedback
6. Providing corrective feedback
7. Engaging the client in another role play of the same situation TIPS
Gradual movement through all steps
Work on changing one component at a time
Client needs to feel rewarded - increases self-efficacy
After moving to new skills, old skills should be reviewed Additional Teaching Strategies
1. Supplementary modeling
2. Discrimination modeling
3. Coaching
4. Prompting Take home message
1. Listening to others
2. Making requests
3. Expressing positive feelings
4. Expressing unpleasant feelings Normalizes biochemical imbalances
Two types of anti-psychotics
Old: 'Typical' antipsychotics
Perphenazine
New: 'Atypical' antipsychotics
Clozapine (most effective)
Risperidone and Olanzapine Drug Therapy Side effects of antipsychotics:
Drowsiness
Blurred vision
Rapid heartbeat
Sensitivity to the sun
Skin rashes
Menstrual problems for women Other side effects:

Rigidity
Persistent muscle spasms
Tremors
Restlessness
Tardive Dyskinesia (TD) Family members talk to therapist
Psychoeducational workshop
Regular meetings
Support
High Expressed Emotion (EE) homes – more likely to relapse Family Therapy Family itself is the patient
Interventions: Education of family & patients, group meetings, meetings with the patient and family
Study done by Falloon et. al (1986) - family based management approach vs patient based approach At 9 months:
56% of patients in Family based group were in full remission
17% in individual group were in remission
50% of family based group were free of psychiatric symptoms, 67% showed no evidence of schizophrenia
83% in individual group showed persistence symptoms of schizophrenia Provides social experiences for patients
Increase self-esteem
Inpatient or Outpatient

Cognitive Behavioural Group Therapy
Focus on positive and negative symptoms
Very few studies

Self-help Group Therapy Individualized Substance
Abuse Counselling High prevalence of substance abuse in people with schizophrenia - 47%
Experiments with LSD in the '60s
Course of illness
Reduced symptoms
Lower hospital admissions Rigid 12 step systems do not work
Recreational drugs & their aid
Careful observation
Punishment over treatment
Issue of empiricism Study conducted by Goldberg and associates
Routine outpatient care vs. major role therapy
Consisted of: social casework + vocational counselling
Severely ill patients relapsed sooner with intensive social therapy
Stimulating but not stressful Unsuccessful Intervention Centre for Addiction & Mental Health (CAMH)
Family Outreach and Response Program
Schizophrenia Society of Ontario
Mood Disorders Society of Canada
International Schizophrenia Foundation Places in Ontario Eduard Einstein
Peter Green
Syd Barrett
Mary Todd Lincoln
Adèle Hugo
Darrell Hammond
A Beautiful Mind
Dirt - Donny. In The Media GAME TIME + Positive symptoms :
Delusions
Hallucinations
Disorganized thinking
Agitation Interviewing Techniques
Interpersonal history
Observational data
Perspective of significant others
Role play
Full transcript