Psychosis
- a loss of contact with reality
- hallucinations/illusions
Schizophrenia
- literally means “split-mind”
- split between thought processes, emotions, and perception of reality
- tend to be lower in socioecominc status
Downward drift theory
schizophrenics in underdeveloped countries tend to do better than in developed countries
Positive Symptoms
-delusions, disorganized thinking and speech, heightened perceptions and hallucinations, inappropriate effect
Negative Symptoms
-pathological deficits, poverty of speech, blunted and flat affect, loss of volition, social withdrawal, psychomotor symptoms
Course of Schizophrenia
- beings b/t late teens and mid 30’s
- prodromal: symptoms are not yet obvious but functional deterioration has begun
- active:full expression of positive and negative symptoms
- residual: similar to prodromal phase in function, decrease in positive symptoms
Type 1 schizophrenia
- mostly positive symptoms
- may be related more to dopeamine disturbances
Type 2 schizophrenia
- mostly negative symptoms
- may be more related to brain structural abnormalities
Explanations of Schizophrenia
- assumed to be a polygenic disorder
- dopeamine hypothesis
- abnormal brain structure
- viral damage: more schizophrenic patients are born in the winter months
- social labeling:labeling people leads them to behave as expected
Treatment
- has gone through many cycles
- begins with good skilled providers
- cycles are used to provide adequate care and support for the seriously mental ill and provide appropriate environment
Milieu Therapy
-desiged to promote productive activity, self-respect, and individual responsibility
Token economy
- based on operant conditioning
- focuses on rewards, not punishments
- concerns:does the token economy change symptoms or just improve ability to imitate normal behavior
Antipsychotic medications
- the most effective treatment for psychosis
- function primarily by blocking dopamine D- receptors
Parkinsonian symptoms
- caused by dopeamine blockade in the basal ganglia
- tremor
- muscle stiffness
- shuffling gait
- decreased facial expression
- treated by decreasing dose of antipsychotic
Psychotherapy
- Cognitive-tries to change how patients understand and react to hallucinations
- educates
- help define the situations that promote and ameliorate the hallucinations
- teach improved coping and relaxation during hallucinations
- Family-helps manage stress at home
- setting realistic expectations
- Social-improve problem solving
- improve decision making
- improve social skills
- ensure proper housing
Community Care
- intended to provide community mental health center
- provides medication, psychotherapy, and inpatient emergency care
Short-term hospitalization
- used when outpatient care fails
- lasts days to a few weeks
- followed by aftercare
Partial hospitalization
- all day therapy programs
- therapy
- social skills programs
- daily supervised activities
Sheltered workshop
- replicated a typical work environment
- used to develop work skills and ability to accommodate to and tolerate work-like demands
Services
- less than 1/3 of planned community mental health centers were built
- increased emphasis on case managers
Consequences of Inadequate treatment
- 50% are not getting any treatment
- many are living in improperly supervised settings
- untrained family members
- unsupervised living
- nursing homes
- privately run residences
