Treatment for Schizophrenia and Other Severe Disorders Flashcards

Treatment for Schizophrenia and Other Severe Disorders

• Treatment for schizophrenia and severe disorders: Varies significantly for patients, families, caregivers, and communities.
• Treatment outlook: Has improved due to antipsychotic drugs.
• Severity: Severe mental disorders remain difficult to treat; only 36% receive adequate care.

Institutional Care

• 1950s: Two institutional approaches developed.
  • Milieu therapy: Based on humanistic principles.
  • Token economies: Based on behavioral principles.

Milieu Therapy

• Principle: Institutions can aid patient progress by creating a social climate (milieu).
• Focus: Promotes productive activity, self-respect, and individual responsibility.

Token Economy

• Based on operant conditioning principles to change behaviors in hospital wards.
• Rewards: Patients are rewarded for socially acceptable behavior and not rewarded for unacceptable behavior.
• Limitation: Transfer to real-world rewards may be difficult.

Antipsychotic Drugs

• Discovery: Discovered in the 1950s.
• Development: Researchers developed antihistamine drugs for allergies.
• Application: Antihistamines (phenothiazines) were used to calm patients before surgery.
• Chlorpromazine (Thorazine):
  • Tested on patients with psychosis.
  • Observed sharp symptom reduction.
  • Approved in 1954 for sale in USA as an antipsychotic drug.

Types of Antipsychotic Drugs

• First generation antipsychotic drugs:
  • Also known as neuroleptic drugs or typical/conventional antipsychotic drugs.
• Second-generation antipsychotic drugs.
• Mechanism: Reduce psychotic symptoms by blocking excessive dopamine activity.

Effectiveness of Antipsychotic Drugs

• Symptom Reduction: Antipsychotic drugs reduce schizophrenia symptoms in at least 70% of patients.
• Timeline: Produce maximum improvement within the first 6 months of treatment.
• Symptom Specificity: Positive symptoms are reduced more quickly than negative symptoms.
• Relapse: Symptoms may return if patients stop taking the drugs too soon.
• Patient Compliance: Patients often dislike the powerful effects and may refuse to take them.

Unwanted Effects of First-Generation Antipsychotic Drugs

• Older drugs: Produce movement problems.
• Extrapyramidal Effects: Caused by the drugs’ impact on the extrapyramidal areas of the brain.

Extrapyramidal Effects

• Parkinsonian symptoms: Reactions closely resemble Parkinson’s disease due to reduced dopamine activity in the striatum.
  • Muscle tremor and rigidity.
• Dystonia: Bizarre movements of the face, neck, tongue, and back.
• Akathisia: Great restlessness, agitation, and discomfort in the limbs.
• Reversibility: Symptoms can be reversed with anti-Parkinsonian drugs, but sometimes medication must be halted.

Neuroleptic Malignant Syndrome

• Occurrence: In as many as 1% of patients, particularly elderly ones.
• Severity: Severe, potentially fatal reaction.
• Symptoms: Muscle rigidity, fever, altered consciousness, and improper functioning of the autonomic nervous system.
• Treatment: Drug use is discontinued, and each symptom is treated medically; dopamine-enhancing drugs may be given.

Tardive Dyskinesia

• Onset: Appears up to 1 year after starting medication.
• Symptoms: Writhing or tic-like involuntary movements, usually of the mouth, lips, tongue, legs, or body.
• Prevalence: Affects more than 10% of those taking the drugs.
• Reversibility: Can be difficult, sometimes impossible, to eliminate.

Second-Generation Antipsychotic Drugs

• Development: Newer antipsychotic drugs have been developed.
• Examples: Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, and Abilify.

Biological Operation

• Differs from first-generation antipsychotics.
• Receptor Activity: Received at fewer dopamine D-2 receptors; more D-1, D-4, and serotonin receptors than older drugs.

Strengths

• Effectiveness: As effective, often more effective, than first-generation drugs, especially for negative symptoms.
• Side Effects: Few extrapyramidal side effects and less tardive dyskinesia (D-2 receptors).

Challenges

• Agranulocytosis: Risk of a potentially fatal drop in white blood cells (e.g., Clozaril).
• Other side effects: May cause weight gain, dizziness, and significant elevations in blood sugar.

Psychotherapy

• Historical Context: Early psychotherapy was rare before antipsychotic drugs.
• Current Status: More successful in schizophrenia treatment nowadays.
• Combination: Very helpful when used with medication.
• Types: Cognitive-behavioral therapy, family therapy, and social therapy (coordinated specialty care).
• Approach: Often combined and tailored to individual needs.

Cognitive Behavioral Therapies

• Cognitive remediation
  • Focus: Difficulties in attention, planning, and memory.
  • Method: Increasingly complex computer tasks until planning and social awareness tasks are reached.
  • Outcome: Provides for moderate improvement.
• Hallucination reinterpretation and acceptance
  • Goal: Change how clients view and react to their hallucinatory experiences.
  • Methods:
    • Education and evidence about biological causes of hallucinations.
    • Identification of events and triggers of hallucinations.
    • Challenge of inaccurate ideas of hallucination power.
    • Reattribution and more accurate interpretation of hallucinations.
    • Education for unpleasant sensation coping.

Family Therapy

• Living Situation: Over 50% of persons recovering from schizophrenia live with family members.
• Family Stress: Creates significant family stress.
• Relapse Risk: High levels of expressed emotion increase relapse risk.
• Goals: Address issues, create realistic expectations, and provide psychoeducation.
• Support: Families may also turn to family support groups and family psychoeducation programs.

Coordinated Specialty Care (CSC)

• Original Name: Social Therapy.
• Focus: Addresses social and personal difficulties.
• Components:
  • Practical advice.
  • Problem-solving.
  • Decision-making.
  • Social skills training.
  • Medication management.
  • Employment counseling.
  • Financial assistance.
  • Housing.
• Outcome: Reduces rehospitalization.

Community Approach

• Definition: Broadest approach for treating schizophrenia.
• Community Mental Health Act (1963):
  • Goal: Patients should receive care within their communities.
  • Impact: Led to massive deinstitutionalization.
  • Problem: Community care was (and is) inadequate.
  • Result: “Revolving door” syndrome.

Features of Effective Community Care

• Multiple Types of Care: Combination of services.
• Assertive community treatment: Coordinated services (e.g., medications, psychotherapy, inpatient emergency care).
• Short-term hospitalization: Up to a few weeks, followed by aftercare programs.
• Partial hospitalization: Day center programs, semi-hospitals, or residential crisis center.
• Supervised residences: Halfway houses or group homes.
• Occupational training: Sheltered workshops.

Challenges to Community Treatment

• Service Gap: Fewer than half receive appropriate services.
• Factors Responsible: Poor coordination and shortages of services and funding.

Promise of Community Treatment

• Global Feature: Major treatment component worldwide.
• Importance: Varied and well-coordinated community treatment is crucial for addressing schizophrenia in the U.S. and abroad.