Treatments for schizophrenia and other severe mental disorders

Token economy Program

A behavior-focused program in which a person’s desirable behaviors are reinforced systematically by the awarding of tokens that can be exchanged for goods or privileges.

Antipsychotic drugs

Drugs that help correct grossly confused or distorted thinking.

neuroleptic drugs

First-generation antipsychotic drugs, so called because they often produce undesired effects similar to the symptoms of neurological disorders.

Institutional Care in the Past (1793) Move from asylums to large mental hospitals

* Moral treatment with sympathy and kindness
* Public mental hospitals (State hospitals) for patients

Institutional Care in the Past (1955) Overcrowding and Understaffing create dramatic changes

* Shift to earlier treatment using restraints, isolation, and punishment
* Backward, straitjackets, handcuffs, lobotomy
* Most common pattern of decline is social breakdown syndrome

Institutional Alternatives

* Many people who would have been placed in psychiatric institutions in the past now reside in other settings, such as nursing homes and prisons
* Mental health care is typically minimal in these settings

Leucotomy

Two holes were drilled in either side of the skull, and an instrument resembling an icepick was inserted in the brain tissue to cut or destroy nerve.

Lobotomy

A needle was inserted through the eye socket and then rotated to destroy tissues.

Token economy limitations

* Uncontrolled studies
* Some ethical and legal concerns about controlling rewards related to basic needs
* Some question whether the change involves thoughts or perceptions or just imitations of normal behavior
* Transfer to real-world rewards may be difficult

What type of technique is Token economy

Operant conditioning

Antihistamines

* Used to calm patients about to undergo surgery
* Researchers developed this drug for allergies
* Also known as phenothiazines

Best known drugs (Neuroleptic drugs)

* thioridazine (mellaril)
* fluphenazine (Prolixin)
* Trifluperazine (stelazine)
* haloperidol (Haldol)

psychotherapy

* cognitive remediation
* cognitive-behavioral therapies

Cognitive remediation

* Focuses on difficulties in attention, planning, and memory
* provides increasingly more complex computer tasks until planning and social awareness tasks are reached
* provides for moderate improvement

\-improvement in attention, planning, memory, and problem- solving surpass those with other interventions

\-Extend to everyday client life and social relationship

cognitive behavioral therapies

* Therapists help change how clients view and react to their hallucinations
* Combination of behavioral and cognitive techniques

\-education and evidence about biological causes of hallucinations

\-identification of events and triggers of hallucinations

\-the challenge of inaccurate ideas of hallucination power

\-reattribution and more accurate interpretation of hallucinations

\-education for unpleasant sensation coping
* New-wave cognitive-behavioral therapies

\-posit that hallucinations should be accepted rather than misinterpreted or overreacted to

\-help clients accept their streams of problematic thoughts

\-help patients gain a greater sense of control, become more functional, and move forward in life

\-often produce helpful results

Family therapy

* Many persons recovering from schizophrenia and other severe disorders 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
* Addresses family-related issues, create more realistic expectations, provides psychoeducation about the disorder and emotional support and empathy
* When combined with drug therapy, helps relapse rates and hospital readmissions go down

Family support groups and family psychoeducation programs

* Provide encouragement and advice
* Usefulness not fully scientifically determined

Avatar therapy

* from of virtual reality therapy
* used by Leff and colleagues to treat people with schizophrenia
* Suggests confronting hallucinations in virtual world can help some patients