Transcript long version

Module Two
SCHIZOPHRENIA
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Lesson 1:What is schizophrenia and who it is manifested
(2 training hours)
Lesson 2:How the patient himself experience Schizophrenia
(2 training hours)
Lesson 3:What are the causes of Schizophrenia
(2 training hours)
Lesson 4: Ways of treatment for Schizophrenia
(2 training hours)
Lesson 5:Schizophrenia and Family
(2 training hours)
Lesson 6:Other psychotic disorders
(1 training hour)
TOTAL TIME: 11 TRAINING HOURS OF 45 MINUTES
Lesson 1
WHAT IS SCHIZOPHRENIA AND HOW
IT IS MANIFESTED
TIME :
90 minutes (2 training hours of 45 minutes)
Step 1: Introduction (5΄)
The subject of Schizophrenia preoccupy the
society and attracts the Media.
Unfortunately what is said or written is
often inaccurate and create false
impressions, which, in their turn, block the
more efficient treatment of this serious
problem.
Step 2: Brainstorming and
discussion (15΄)
Write everything you know, you have heart
or read regarding to Schizophrenia.
Step 2 (continued)
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The person that suffers from Schizophrenia has
not got “split mind” or “dual personality”
He is not “dotty”, “nutty”, cracked” or “loony”
etc. these terms are not used in Psychiatry.
He is no a criminal or violent.
His disease is not a punishment for his or his
parents sins.
This did not occur because of his improper sexual
behavior
The fact that there is no treatment is mistaken.
Step 2 (continued)
Schizophrenia is:
 A serious mental disorder
 It belongs to psychotic disorders.
 Influences the way in which the person think,
feels and behaves.
 It is usually manifested to young persons but
sometimes can also be manifested to middlesaged, or even elderly.
 From this disorder suffer about one every
hundred persons.
Step 3:Slide projection and
discussion (25΄)
Slide 2.1.1: Symptoms of Schizophrenia
 POSITIVE SYMPTOMS
Aberrant ideas (hallucinations)
Delusions
Disorganized speech
Abnormal behavior
 NEGATIVE SYMPTOMS
Reduction of emotions
Poor content of though and speech
Lack of desire and pleasure
Step 3 (continued)
Slide 2.1.2: different types of Schizophrenia
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Paranoid
Catatonic
Disorganized
Undifferentiated
Residual
Step 4: Exercise (15΄)
leaflet 1.1: Clinical case
Mark with the sign + the characteristics you
consider that have positive prognostic
significance and with the sing – those you
think that have negative.
Step 5:Slide Projection (20΄)
Slide 2.1.3: Clinical case
(-) It is about a man.
(-) In young age.
(+) He suffers after the failure in exams and
relapsed after his grandfather’s death.
(-) It is not clear when exactly his disease was
manifested.
(-) He isolated a few months a few months before
he got sick.
Step 5 (continued)
(-)between two incidents he could not work.
(+) Among other symptoms he manifests
depression.
(-) His symptoms responded to the
treatment slowly.
(+) Nobody in the family suffered from
Schizophrenia.
(+) The father had manifested depression.
Step 5 (continued)
Slide 2.1.4: Factors that influence negatively the
progress of Schizophrenia?
 Insidious outbreak
 Onset in early age
 Isolation before the manifestation of the disorder
 Male gender
 Απουσία εκλυτικών γεγονότων
 Absence of emotional elements
 Long duration of acute phase
Step 5 (continued)
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Important functionality decrease
Many residuary elements
Coexistence of neurological diseases
Existence of family history
retreat from reality(?)
Substance use
Step 6:Questions and Comments
(5΄)
Step 7:Lesson’s evaluation
(5΄)
Lesson 2
HOW THE PATIENT HIMSELF
EXPERIENCE SCHIZOPHRENIA
TIME :
90 minutes (2 training hours of 45
minutes)
Step 1: Introduction (5΄)
It is really important to try to understand how
exactly thinks and feels a person who is
under the effect of hallucinating disorders
and auditory delusions and why his
behavior is disordered.
Step 2: Exercise (15΄)
Paper and pen
While the person A (or B) writes, the B (A)
should keep whispering a short phrase
that he will invent, with negative content
for the person A (or (B).
Step 3: Discussion (10΄)
Describe what were you thinking and how
did you feel while you were trying to write
the letter and what was the quality of your
task.
Step 4 : Brainstorming (15΄)
Paper and pen
Write all the reasons that might lead people
with Schizophrenia to aggressive
behavior.
Step 5: Exercise (20΄)
In what way is influenced the biological,
psychological and social efficiency of the
person from Schizophrenia?
Step 6: Slide Projection (15΄)
Slide 2.2.1: Fields of human functionality that
might be influenced from Schizophrenia
Biological:
 Sleep
 Nutrition
 Mobility
 Function of intestines and cysts
 Physical health
Step 6 (continued)
Psychological:
 Perception of other people, objects and the
environment.
 Mood and emotional reactions
 The idea of himself, ability of selfexamination and self esteem
 Concentration, thinking and learning
 Adaptability
Step 6 (continued)
Social:
 Communication with other people (verbal
or not verbal)
 Personal relationships
 Manifestation of sexuality
 Employment
 Entertainment
Step 7:Questions and comments
(5΄)
Step 8 : Lesson’s evaluation (5΄)
Lesson 3
CAUSES OF SCHIZOPHRENIA
TIME :
90 minutes (2 training hours of 45 minutes)
Step 1: Introduction (5΄)
In reality, we do not know yet the causes of
Schizophrenia. Scientists have studied
many different factors who could possibly
explain the reason why people manifest
Schizophrenia. At present we have not
found a concrete causal factor. But as it
appears there are plenty factors that
contribute in combination with each other
to its manifestation.
Step 2: Exercise (20΄)
Leaflet 2.3.1: Clinical case
List the factors that can influence positively
and negatively the development or not of
Schizophrenia from B.
Step 3:Slide Projection (20΄)
Slide 2.3.1: Causal factors of Schizophrenia
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Genetic
Neurochemical
Neurodevelopmental
Environmental
Step 4: Exercise (20΄)
Leaflet 2.3.2: possibility of appearance of
Schizophrenia to relatives.
Use four different colors for four different levels of
high probability of appearance of the disease to
relatives of a patient as following: red the
persons that have the most possibilities to
manifest the disease, orange for those that have
the immediately less possibilities, blue for those
that have even less, and green for those that are
not influenced at all.
Step 5: Slide Projection (15΄)
Slide 2.3.1:Possibility of manifestation of
Schizophrenia to relatives
Monozygotic twins (identical twins) 45% (100%
similar genetic material)
 Immediate family connection - parents, siblings,
children - 10% (50% similar genetic material)
 Non immediate family connection – uncle,
nephew - 3% (25% similar genetic material)
Probability of the manifestation of the disease to the
general population is estimated to 1%.
Step 6: Questions and Comments
(5΄)
Step 7: Lesson’s Evaluation (5΄)
Lesson 4
WHICH IS THE THERAPEUTICAL
TREATMENT OF SCHIZOPHRENIA
TIME :
90 minutes (2 training hours of 45 minutes)
Step 1: Brainstorming and
discussion (15΄)
Paper and pen
Describe the problems of a person that
suffers from Schizophrenia which require
therapeutical intervention.
Step 1 (continued)
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Symptoms
Problems that occur from the duration of
the disease
Biological consequences to the person
Psychological consequences
Social difficulties
Step 2: Exercise (10΄)
Leaflet 2.4.1: Problems and adequate
therapeutical interventions
Join each problem that appears in the first
column with the appropriate therapeutical
intervention in the second column.
Step 3: Slide projection and
Discussion (20΄)
Slide 2.4.1: Therapeutical interventions used in
Schizophrenia
 Antipsychotic medication
 Trust relation with the therapeutical group
 Complete continuous assistance
 Ψυχοεκπαίδευση (?)
 Intervention in the family
 Intervention in the environment
 Supporting therapy
Step 3 (continued)
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Group therapy
Learning of social skills
Cognitive therapy
Professional education
Work rehabilitation
Home ensuring
Entertainment
Step 4 : Exercise and Discussion
(15΄)
Paper and pen
Write the advantages and the disadvantages
of antipsychotic medication for a
schizophrenic person.
Step 4 (continued)
Legends spread regarding antipsychotic
medication :
 The “” are all the same and notorious and
we should avoid taking
 Τα «ψυχοφάρμακα» are drugs that one can
be addicted.
 They might be useful for a patient, but they
should stop the medication as soon as the
symptoms subside.
Step 4 (continued)
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The medication must always be taken in
respect with the doctor’s instructions.
Stopping them for no reason increases the
possibilities of relapse.
Relapses might be also shown while the
patient is under the medication but are
usually more gentle.
Step 4 (continued)
The patients usually want to stop their medication
due to one of the following reasons:
 Because they cannot suffer the side effects.
 Because its reminds them of their disease,
 Perhaps because the symptoms have not totally
subside even though they are on medication,
 or because they cannot drink alcohol, as their
doctor have recommended.
Step 5: Slide projection and
Discussion (20΄)
Slide 2.4.2: Common antipsychotic drugs
Conventional
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Chlorpromazine
Thiriodazine
Triflupromazine
Haloperidol
Loxapine
(Largactil)
(Melleril)
(Stelazine)
(Aloperidin)
(Loxapac)
unconventional
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Clozapine
risperidone
Olanzapine
Quetiapine
(Leponex)
(Risperdal)
(Zyprexa)
(Seroquel)
Step 5 (continued)
Slide 2.4.3: Side effects of antipsychotic drugs
 Parkinsonism.
 Anxiety
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low blood pressure
restlessness
muscle stiffness
milk secretion
sexual dysfunction
dry mouth, or constipation or blurred vision
Φωτοευαισθησία light sensitiveness?
weight gain
Κακόηθες σύνδρομο?
Step 6: Questions and comments (5΄)
Step 7: Lesson’s Evaluation (5΄)
Lesson 5
FAMILY AND SCHIZOPHRENIA
TIME :
90 minutes (2 training hours of 45 minutes)
Step 1: Discussion (10΄)
Can the family cause Schizophrenia?
Step 1 (continued)
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In the past many theories were brought up
that put responsibility to the family for the
onset of schizophrenia. (Lidz: “schism and
skew”, Bateson: “double bind”, κ.ά.).
Today it is commonly acceptable that the
family do not cause Schizophrenia, but
contrary can have a major role to the
efficiency of the treatment.
Step 2: Theory presentation(15΄)
The meaning of Expressed Emotion (EE):
 The progress of Schizophrenia might be
affected by a way the family expresses its
emotions towards the patient.
Step 2 (continued)
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Three factors are closely associated with the
relapses of the disease. These are the following:
negative comments towards the patient
aggressive behavior towards him.
emotional overreaction? Of the familyΗ
συναισθηματική υπερεμπλοκή της
οικογένειας
In families where these factors appear in a
excessive way, are called family with high
Expressed Emotion and the danger of relapsing
the disease, if they have a schizophrenic
member, are extremely high.
Step 2 (continued)
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This theory has been proved by research studies
in which were used special evaluation research
tools for the communication of the family and the
relationship of their members.
The high emotional expression of the family
influences negatively the evolution of other
mental disorders not only Schizophrenia’s. It is a
factor that increases stress and consequently
aggravates the situation of the patient.
Step 3: Exercise (20΄)
Leaflet 2.5.1: fragment of family
conversation
Point out the points that indicate negative
judgment, aggressive behavior and
overreaction of the family towards the
schizophrenic member.
Step 4: theory presentation (10΄)
The charge of the family
 Even though the interest of Psychiatry is
mainly focused on the family’s influence to
the disease, the last years it is accepted that
the families of schizophrenic persons are
also under great pressure, which has
negative effects to all the members of the
family, included the schizophrenic person.
Step 4 (continued)
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The families of the persons that manifest
schizophrenia at first cannot understand it and
later refuse to accept it. They usually wonder if it
was their fault or if another member of the family
might manifest the disease and want to know
which will be its evolution.
They need help and information from specialists.
The family charge is more important when the
symptoms of the patient are more intense
(frequent).
Step 5: Discussion (15΄)
Which do you consider that are the most
common difficulties that face the family of
the schizophrenic person.
Step 6: Theory Presentation (10΄)
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Most of the psychiatric services that are treating
schizophrenic persons dispose nowadays a
program of therapeutic treatment that includes the
relatives.
There are also specialized programs of Family
Therapy for decreasing the tension in the family
environment and supporting the family.
An important factor to these is training the family
in schizophrenia and ameliorating the
communication between its members.
Step 7: Questions and comments
(5΄)
Step 8: Lesson’s Evaluation (5΄)
Lesson 6
OTHER PSYCHOTIC DISORDERS
TIME :
45 minutes (1 training hour of 45 minutes)
Step 1: Slide projection (10΄)
Other psychotic disorders:
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Schizophreniform Disorder
Schizoeffective Disorder Σχιζοσυναισθηματική
Διαταραχή
Delusional Disorder
Brief Psychotic Disorder.
Psychotic Disorder Not Otherwise Specified Επινεμόμενη
Διαταραχή
Psychotic Disorder Due to a General Medical Condition
Substance-Induced Psychotic Disorder. (alcohol or other
substance)
Step 2: Theory Presentation (25΄)
Schizophreniform Disorder
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Clinical case (view) alike to schizophrenia,
without including necessarily social and
functional loss.
Duration less than 6 months (or it is
schizophrenia). So, it might also be temporary
diagnosis at the onset of schizophrenia.
2/3 of the people with this diagnosis, later on will
be diagnosed as schizophrenic, while 1/3
recovers.
The therapy is the same with the treatment of an
schizophrenic episode.
Step 2 (continued)
Σχιζοσυναισθηματική Διαταραχή
 Coexistence for a period of time of symptoms of
schizophrenia and Depression and manifestation
of schizophrenic symptoms periodically, while
depression symptoms last longer.
 Quite inaccurate diagnosis, but it is important that
it is better in relation to schizophrenia’s (but
worse in relation to depression’s)
 Common to women
 Treatment regarding to the symptoms
(antipsychotic drugs, antidepressants and other
psychosocial interventions)
Step 2 (continued)
Delusional Disorder
 Existence of aberrant ideas (hallucinations), but
not delusions.
 Aberrant but not bizarre ideas.
 Mainly ideas of persecution, grandeur, somatic,
jealousy or erotomania (sex-mania).
 Usually manifested at middle-age or later.
 No sufficient response to antipsychotic
medication. Developing a trust relation with the
therapist and after a series of gentle treatment
(handling) it is the best treatment.
Step 2 (continued)
Brief Psychotic Disorder
 It is called a psychotic episode with symptoms
alike to schizophrenia’s that is manifested
abruptly and lasts less than a month.
 It is a rare disorder mainly manifested to
adolescents and very young persons.
 The treatment includes antipsychotic medication
and supporting psychotherapy.
Step 2 (continued)
Psychotic Disorder Not Otherwise Specified
 It is a fairly rare situation in which a person
(usually relative) that lives close to the
schizophrenic person manifests similar aberrant
ideas.
 Usually manifested to women.
 As a therapy, it is recommended the elimination
from the psychotic person, so the aberrant ideas
subside.
Step 3: Questions and
comments (5΄)
Step 4: Lesson’s evaluation (5΄)