Ch. 14-treatments for schizophrenia and other severe mental disorders

Institutional care in the past

1793: asylums to large mental hospitals, moral treatment, public mental hospitals

1955: overcrowding/understaffing create dramatic changes, began using restraints, isolation, lobotomy

Leucotomy

-two holes drilled in either side of the skull, and an instrument resembling an icepick was inserted into the brain tissue to cut/destroy the nerve

Lobotomy

-a needle was inserted thru the eye socket and rotated to destroy tissue

-caused brain seizures, wt gain, loss of motor, poor intellectual/emotional responsiveness

-antipsycho drugs put an end to this

Milieu therapy (Maxwell Jones)-1950

-institutions cant help patients unless the enviro promotes productive activity, self-respect, and responsibility

-respect, support, openness

-many leave at higher rates

-combined w other community programs

Token economy

-operant conditioning techniques to change patient behaviors

-rewarded w tokens for acceptable behavior

Limitations: uncontrolled studies, ethical/legal concerns ab controlling rewards, question whether they are imitating normal behavior, real-world may be difficult

Antipsychotic drugs in 1950s

-antihistamines to calm patients before surgery

-chlorpromazine for calming effect, approved for sale

Effectiveness of antipsychotic drugs

-symptoms reduce in ab 70%

-most effect in first 6 months

-pos symptoms reduced more than neg

First-generation antipsychotic drugs-neuroleptic

-parkinsonian and related symptoms: reduction of dopamine

-neuroleptic malignant: fatal reaction in elderly

-tardive dyskinesia: similar to psychotic symptoms/overlooked

Prescribing first-generation antipsychotic drugs

-lowest effective dose

-gradually get off

-for many, symptoms do not return

When patients do not improve: inc dose, add additional drug, stop drugs

Second-generation antipsychotic drugs

-received at fewer dopamine and serotonin receptors

-sometimes more effective than first-gen

-reduce pos/some second symptoms

-carry a risk of life-threatening drop in WBC

-wt gain, dizziness, elevation in blood sugar

Community Mental Health Act-1963

-patients w a variety of psych disorders

-patients should be offered a range of health services

-”revolving door” if inadequate quality of community

Community treatment failure

-fewer than half all people who need them receive appropriate community health services

-poor communication between agencies

Two factors: poor coordination of services, shortage of services

Solution: community therapists as case managers

Consequences of inadequate community treatment

-many receive no or inadequate treatment

-premature discharge: not enough follow-up

-house settings vary

-many become homeless