CHapter 7: The Context of Mental Health Social Work Practice in Canada​

Factors Contributing to Schizophrenia​

• Social / familial​
  What is cause and what is effect?​

• Substance Use​
  Associated with first breaks and relapse​
  Cause or covariate?​

• Biological​
  -Genetics​
  -Obstetrical complications​
  -Neurobiology

Symptoms of Schizophrenia​: “Positive” psychotic symptoms

• Thought disorder​

• Hallucinations​

• Delusions​

• Paranoia​

Symptoms of Schizophrenia​: “Negative” functioning symptoms

• Impairment in emotional range​

• Reduced energy and motivation​

• Lack of enjoyment in activities

Course of Illness​

• Early intervention and engagement in high-risk populations could delay or prevent onset of psychosis​

• Untreated symptoms associated with poorer symptom reduction, less remission, lower social functioning and worse employment outcomes, and longer hospital stays​

• Previous well-adjusted personality, close friendships, acute onset, abstinence from drugs, being married and female associated with more positive outcomes​

• Hope and active engagement in treatment planning, intervention and recovery lead to more positive treatment outcomes​

Phases of Family Response to Schizophrenia ​

• Developing awareness​: Recognition of problem, increased concern​

• Crisis: Exacerbation of problems, emotional distress​

• Instability​: Searching for explanations, anger, grief, loss​

• Realigning​: Finding means for control, changing expectations​

• Mastering navigational skills​: Developing workable plans, using support systems​

Social Policy Challenges​

• Reduction in inpatient facilities resulting in increased homelessness has left few housing options​

• Increase in individuals with mental health problems who are incarcerated​

• 2010 study demonstrated 7% of individuals released from Ontario correctional facilities had diagnosis of schizophrenia and 67.5% were re-incarcerated within 5 years​

• Risk factors for incarceration include poverty, unemployment, inadequate service access, symptom intensity and substance abuse​

Other Related Psychotic Disorders (1 of 2)​

• Delusional disorder​: Delusional symptoms are confined to a single theme without other psychotic symptoms​

• Brief psychotic disorder: The sudden onset of at least one psychotic symptom such as delusions, hallucinations, or disorganized speech or behaviour ​

• Schizophreniform disorder​: Experiencing delusions accompanied by hallucinations for less than six months​

Other Related Psychotic Disorders ​(2 of 2)

• Schizoaffective disorder​: Symptoms are occurring at the same time as a severe depression or mania​

• Substance –induced psychotic disorder​: Development of symptoms while intoxicated or withdrawing from a substance without the presence of another psychotic disorder ​

The Recovery Model and Schizophrenia​

• Motivation: denial, confusion, hopelessness, withdrawal

• Awareness: glimmer of hope, view that recovery might be possible

• Preparation: taking stock, education, learning skills

• Rebuilding: taking control, taking risks, managing setbacks,

• Growth: resilience, hope for the future, positive sense of self

The Recovery Model and Schizophrenia ​

Community-based programs help support recovery​:

• Educational programs​

• Employment assistance programs​

• Supportive housing programs​

• Opportunities for social contacts​

• Development of client-operated services (e.g., The Raging Spoon in Toronto)​

Early Intervention and First Episode Clinics

• Prodromal stage proceeding first episode of psychosis​

• Psychotic-like, less severe, more transient with some insight into abnormal perceptions​

• Disturbances of thought, speech and perception​

• First episode clinics, early intensive psychosocial and pharmacological treatment may prevent negative effects​

• Benefits include prevention of frequent hospitalization, maintenance of involvement in school and work, decreased symptoms and more cost effective

Assertive Community Treatment ​

• Psychosocial services are provided directly by multidisciplinary ACT team members​

• The ACT team is mobile and provides services in the community where the client actually is​

• Services are highly individualized to each client’s concerns​

• Staff are available 24 hours per day, 7 days per week​

• Services are not time-limited​

• The ACT team works to adapt the environment to the client’s needs, rather than requiring the client to adapt to the rules of the program​

Psychoeducational Family Interventions​

• Individual and group interventions​

• Reduce isolation​

• Provide information regarding illness​

• Enhance problem-solving approaches​

• Enhance acceptance​

• Address stigma​

• Educate about resources​

Cognitive-Behavioural Treatment​

• In CBT, a client is taught to examine and then change the attributional processes that lead to emotional upset stemming from their delusions​

• Chadwick and Trower suggest a three-stage model of intervention:​

1. Therapist introduces the cognitive model and challenges the negative self-evaluative belief​

2. Therapist teaches client to challenge the negative self-evaluation​

3. Client is taught to rationally challenge the delusion​

• Studies indicate CBT has impacted positive symptoms and recovery time however has not impacted reduction of negative symptoms or severe psychotic symptoms​

Medication as Part of Recovery​

• Medication primary form of intervention coupled with psychosocial approaches​

• Control acute symptoms of psychosis, reduce negative symptoms ​

• Goal in recovery phase to minimize relapse and rehabilitate into community; medication reduced to lowest effective dose to prevent relapse