Transcript short version

Module Two
SCHIZOPHRENIA
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Lesson 1: What is schizophrenia and who it is manifested
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Lesson 2: How the patient himself experiences Schizophrenia
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Lesson 3: What are the causes of Schizophrenia
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Lesson 4: Ways of treatment for Schizophrenia
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Lesson 5: Schizophrenia and Family
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Lesson 6: Other psychotic disorders
Lesson 1
WHAT IS SCHIZOPHRENIA AND HOW
IT IS MANIFESTED
Step 1: Introduction
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
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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
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
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 4 (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 5:Questions and Comments
Lesson 2
HOW THE PATIENT HIMSELF
EXPERIENCE SCHIZOPHRENIA
Step 1: Introduction
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: Slide Projection
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 2 (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 2 (continued)
Social:
 Communication with other people (verbal
or not verbal)
 Personal relationships
 Manifestation of sexuality
 Employment
 Entertainment
Step 3: Questions and comments
Lesson 3
CAUSES OF SCHIZOPHRENIA
Step 1: Introduction
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:Slide Projection
Slide 2.3.1: Causal factors of Schizophrenia
 Genetic
 Neurochemical
 Neurodevelopmental
 Environmental
Step 3: Slide Projection
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 4: Questions and Comments
(10΄)
Lesson 4
WHICH IS THE THERAPEUTICAL
TREATMENT OF SCHIZOPHRENIA
Factors affecting treatment:
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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: Slide projection and
Discussion
Slide 2.4.1: Therapeutical interventions used in
Schizophrenia
 Antipsychotic medication
 Trust relation with the therapeutical group
 Complete continuous assistance
 Intervention in the family
 Intervention in the environment
 Supporting therapy
Step 2 (continued)
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Group therapy
Learning of social skills
Cognitive therapy
Professional education
Work rehabilitation
Home ensuring
Entertainment
Step 3
Legends spread regarding antipsychotic
medication :
 The psychiatric medication is all the same,
notorious and we should avoid taking it
 Psychiatric medication is drugs that one
can be addicted to.
 They might be useful for a patient, but they
should stop the medication as soon as the
symptoms subside.
Step 3 (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 3 (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 4: Slide projection
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 4 (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
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Photosensitivity
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Malignant sybdrom
weight gain
Step 5: Questions and comments (10΄)
Lesson 5
FAMILY AND SCHIZOPHRENIA
Step 1: Can the family cause
Schizophrenia?
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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”)
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
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.
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: 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 3 (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 4: Theory Presentation
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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 5: Questions and comments
(10΄)
Lesson 6
OTHER PSYCHOTIC DISORDERS
Step 1: Slide projection
Other psychotic disorders:
 Schizophreniform Disorder
 Schizoeffective Disorder
 Delusional Disorder
 Brief Psychotic Disorder.
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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
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)
Schizoeffective disorder
 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 (10΄)