Transcript Psychotic Disorders and Skill Training

Psychotic Disorders and Skill
Training
Basic information
• Schizophrenia and Other Psychotic
Disorders
• Thought Disorders is another term
• Prevalence: about .5-1.5%; COD=about
47% of people with schizophrenia
• In King County: 750-1000 individuals are
defined as “high utilizers”
Sx associated with psychotic d/o
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Positive vs. negative sx
Hallucinations
Delusions
Disorganized speech
Thought process
Behavior disturbance
Affect disturbance
Avolition
Disorders
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Schizophrenia
Schizophreniform
Schizoaffective
Delusional Disorder
Brief Psychotic Disorder
Shared Psychotic Disorder
Psychotic Disorder due to medical condition
Psychotic Disorder NOS
Key Treatment Issues
• Engagement
• Screening and Assessment
High risk conditions
– Medical risks
– Psychological risks
– Social risks
Medical Risks
• Need for detox
• Polysubstance abuse
• Health conditions
– Underlying chronic conditions
– Acute health issues resulting from
decompensation, homelessness, etc.
Psychological Risks
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Suicidality
Danger to others
Grave disability
Decompensation
Cognitive difficulties = impaired judgment,
poor decision making, difficulty
concentrating or following through
Social Risks
• Basic needs: Food, shelter, clothing,
money, etc.
• Victimization due to heightened
vulnerability
• Social support: family, friends, faith, 12
step, etc.
Treatment Strategies
• Crisis stabilization
• Therapeutic coercion: What is it? Why
use it?
• Case management
– Financial, health, vocational, educational,
legal, medication management, etc.
• Groups
– Client should be stable first
– Modified 12 step groups
– Skills training
Matching strategy to readiness for
change
1. Establish a therapeutic allianceprecontemplation
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Meet the cx where she/he is
Provide basic resources
Be supportive & nonconfrontational
Evaluate costs and benefits-contemplation
Individualize the goals-planning/determination
Build a recovery lifestyle-action/maintenance
Cope with crisis-relapse
Article discussion
Family Support
1. Discuss the difficulties families of people with
COD face.
2. What are the benefits for cxs when they have
family support?
Family Intervention Program
1. Describe the 5 stages of FIDD.
2. Identify and discuss what families need.
Both
What are one or two skills family members could
learn that would improve the situation?
Skills Training Model
Substance Abuse Management Model
What is something you have learned to do
recently?
How did you learn to do it?
Three stagesBasic training
Skills training
Practice
Step 1: Basic Training
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Psychoeducational approach
Information, ideas, concepts
Knowledge base from which to build skills
Examples of concepts:
– Damage control
– Emergency card
– High risk situations
– Warning signs
– Healthy pleasures and habits
Step 2: Skills training
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Focus is on skill development
Multistep process
– Introduce the goal
– Have participants state their understanding of the goal
– Review relevant terms/concepts
– Develop the steps required to complete the goal
– Watch a video or live demonstration of the skill
– Explain how to role play
– Have participants role play
– Give corrective feedback
– Role play again with a more challenging situation
Step 3: Practice
• Clients discuss their use
• Identify common problems, difficulties,
successes
• Set up role plays, incorporating client’s
actual experience
• Give feedback and facilitate discussion
• Plan homework for coming week
Skills relevant to psychotic d/o &
s-r disorder
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Quitting after a slip
Reporting a slip
Refusing drugs offered by a dealer
Refusing drugs offered by a friend or family member
Getting an appointment with a busy person
Getting a support person
Reporting sx and side effects to a doctor
Inviting someone to do something healthy
Negotiating with a rep. payee
Quiz 3 review
• Mood disorders – recognize episodes and disorders
• Cognitive-behavioral therapy – event to behavior sequence model,
abc’s
• Suicide risk and responses
• Anxiety disorders – recognize them
• PTSD – Key issues, treatment strategies & tools
• Psychotic disorders – recognize them
– Terms: positive & negative symptoms, hallucinations, delusions,
decompensation, avolition
– Therapeutic coercion
– Case management
• Family role
– Issues faced
– Family intervention program
Case Study Discussion
1. Discuss signs and sx of mental disorder
and substance related disorder.
2. Discuss medical, psychological and
social risks.
3. What further information would be
helpful?