Transcript Psychoeducation Workshop for Families

PSYCHOEDUCATION
WORKSHOP
FOR FAMILIES
Raising the Bar Project –
Valley Nonprofit Resources
Stages of a Psychoeducational
Multifamily Group
Joining
Family and patient
separately
3-6 weeks
Educational
workshop
Families only
1 day
Ongoing
MFG
Families &
patients
bi-weekly for
1 year
SCHIZOPHRENIA
• Is a no-fault biological illness
• Causes immense suffering for the person
and family
• Is a handicap but does not need to be a
disability
• Recovery is possible
• New treatments increase recovery
• Families can help in many ways
SCHIZOPHRENIAS ARE NOT
•
•
•
•
•
All psychoses
Split personality
Contagious
Anyone’s fault
Hopeless
DIAGNOSIS OF
SCHIZOPHRENIA




Symptoms: two or more of the following:
Delusions
Hallucinations
Disorganized speech
Grossly, disorganized behavior
Lack of feelings of drive
That produce marked impairment,
Last more than 6 months, and
Are not due to drugs or medical condition
SYMPTOM CLUSTERS
POSITIVE
Hallucinations
Delusions
NEGATIVE
Few feelings
Lack of drive
IMPAIRMENTS
Work
Relationships
Self-care
COGNITIVE
Memory
Problem solving
MOOD
Depression
Hopelessness
SCHIZOPHRENIA IS THE SAME IN
ALL COUNTRIES
• Occurs in 1% of all types of people
• First occurs between age 15 and 30
• Has the same core symptoms
• Has the same pattern of relapse and
remission
• Is a lifelong illness
FIRST EXPRESSION OF
SCHIZOPHRENIA

Usually seen between age 15 and 30

Occurs during cortical pruning process

Causes progressive damage during the first few
years (autotoxicity)

Severity of damage can be lessened

May sometimes be preventable
BETTER PROGNOSIS:
TREATMENT VARIABLES

Treatment begins soon after onset

Good response to medication

New medications are available

Psychosocial rehabilitation is available

Person participates in best treatments
BETTER PROGNOSIS:
FAMILY VARIABLES

Family understands the illness

Family helps the person get treatment

Family assists in recovery

Family provides opportunities for success
SCHIZOPHRENIA


A no-fault illness…
With genetic and biological causes…

Supersensitive to stress, drugs and family
atmosphere…

With initial deterioration that is lessened
Can have good long-term prognosis

POSSIBLE CAUSES
FOR SCHIZOPHRENIA
PURELY GENETIC
BIOLOGICAL NOT GENETIC
Intrauterine Trauma
Brain Virus
GENETIC VULNERABILITY PLUS
Biological Stress +
Psychosocial Stress
GENETIC RISK OF
SCHIZOPHRENIA
RISKS
Identical Twin
Both Parents
Sibling or Parent
Aunt, Nephew, Grandparent
First cousin, great Aunt
No relative
46%
48%
12%
5%
2%
1%
BIOLOGICAL RISK FACTORS
(NOT GENETIC)


Winter birth
Viral infection in the 20th-30th week of
pregnancy

Rh incompatibility

Starvation during pregnancy

Anoxia at birth
Factors that affect Mental Capacity
Socio-Environmental Stressors
Psychological Vulnerability
Preventative Factors
•Social Support
•Developmental Skills
•Rehabilitation Program
•Antipsychotic Medication
Impairment
Disabilities
Handicaps
Results from Rehabilitation
Good
Bad
STRESS DOES NOT DIRECTLY
CAUSE SCHIZOPHRENIA
Strong Genetic
Predisposition
Schizophrenia
Weak Genetic + High
Predisposition
Stress
Schizophrenia
No Genetic
High
Predisposition + Stress
Other Disorders
No Schizophrenia
SCHIZOPHRENIA ALTERS
BRAIN FUNCTIONING
Normal
Schizophrenic
FRONTAL LOBES GOVERN
• Drive and Ambition
• Empathy
• Problem solving
• Mood
• Cognitive flexibility
• Insight
• Capacity to plan
• Impulsivity
• Time sequential thinking • Judgment
• Abstraction
• Social awareness
• Working memory
TEMPORAL LOBE FUNCTIONS
Perception
Reality Orientation
Memory
REDUCED TEMPORAL
LOBE STRUCTURES
BASAL GANGLIA FUNCTIONS
• Inhibit unwanted sensory input
• Filter out irrelevant sensory input
• Regulate arousal
• Govern concentration
LIMBIC SYSTEM FUNCTIONS
• Understanding emotional events
• Linking current perception to
past memories
• Learning from experience
REDUCED LIMBIC
SYSTEM STRUCTURES
TANGLED CELLS IN
LIMBIC SYSTEM
Dopamine
DOPAMINE BINDING TO
A DOPAMINE RECEPTOR
DOPAMINE HYPOTHESIS
Signal
Nerves
D D D
D D D
Synapse
D
D
D
D
D D D
M
D D
M M
D
Receptor
Nerves
Normal
Untreated
Schizophrenic
Medicated
Schizophrenic
TREATMENT OF
SCHIZOPHRENIA

Medication controls symptoms and relapse

Psychosocial rehabilitation teaches (Vocational)

Family skills and atmosphere support

Early intervention prevents deterioration

Lifetime treatment is required
TREATMENT OF
SCHIZOPHRENIA
Meds + Family Skills Training
Meds + Rehabilitation Program
Meds + Specialized Therapy
Meds + Traditional Psychotherapy
Antipsychotic Medication
Any Treatment w/o Medication
No Treatment
8%
8%
20%
30%
30%
70%
70%
Relapse Rate Per Year
SCHIZOPHRENIA WITH THE
BEST TREATMENT
Good
Premorbid ProdromalDeterioration Stable Relapsing
Stable
Function Begin
Medication,
Rehabilitation,
Family skills
Training
Poor
0
10
20
30
40
AGE
50
60
70
ANTIPSYCHOTIC
MEDICATION

Reduces relapse

Reduces brain dysfunction

Improved medications available

Unique individual response

First step to recovery
ANTIPSYCHOTIC
MEDICATIONS REDUCE:






Hallucinations and delusions
Bizarre behavior
Agitation and pacing
Hostility and aggression
Disordered thinking
Insomnia
DOPAMINE HYPOTHESIS
Signal
Nerves
D D D
D D D
Synapse
D
D
D
D
D D D
M
D D
M M
D
Receptor
Nerves
Normal
Untreated
Schizophrenic
Medicated
Schizophrenic
LONG-ACTING INJECTION
Advantages
Disadvantages
-More easily absorbed
-Blood level declines
-More convenient
-Less convenient
-Compliance assured
-Choices limited
NEW ANTIPSYCHOTICS

Improve negative symptoms

Probably reduce cognitive deficits

Cause no or few movement side effects

Result in less use of side effect medication

Produce better compliance
DOSE AND RELAPSE
100%
80%
70%
60%
56%
40%
24%
20%
14%
0%
Placebo
1/10
Dose
1/4 Dose
Standard
Dose
PROBLEMATIC
SIDE EFFECTS

Dysphoric response (feel less alive)

Extrapyramidal Side Effects (EPS)
Akathisia (restlessness)
Parkinsonian (tremors, drooling)
Acute dystonia (rigidity, spasms)
METHODS FOR MANAGING
SIDE EFFECTS

Waiting until the body adjusts

Taking medication at night

Medication with different side effects

Antiparkinsonian medication

Reducing dosage of antipsychotic

Using techniques to treat side effects
SELECTING MEDICATION
DOSAGE
Optimum Dose
Symptoms
Side Effects
Less
Dose
More
INEFFECTIVE TREATMENTS





Megavitamins or diet
Dialysis
Insight-oriented psychotherapy:
individual or familiar
Folk and religion healing
Hypnosis
TREATMENT OF
SCHIZOPHRENIA

Doctor or program that specializes

Medication controls symptoms and relapse

Psychosocial rehabilitation teaches

Family skills and atmosphere support

Early intervention prevents deterioration

Lifetime treatment is required
FAMILIES CAN HELP:

Learn about schizophrenia

Find good treatment

Provide a healing environment

Have realistic hope

Keep the whole family strong
HELPFUL FAMILIES








Accept the person as ill
Attribute symptoms to the illness
Set realistic, attainable goals
Include the ill person in the family
Keep a loving distance
Have a calm atmosphere
Give frequent praise
Give specific criticism
FAMILIES INFLUENCE
OUTCOME
Natural skills
fit schizophrenia
No family
21%
30%
Poor fit of skills
48%
RELAPSE RATE
CONSEQUENCES OF
EXPECTATIONS
Too High
Repeated failure
Relapse
Realistic
Best Functioning
Success, Joy
Too Low
Institutionalization
Despair, Giving up
FAMILY
EVENTS
AND THE
COMPARISON
WITH OTHERS
LOVE THE PERSON
HATE THE ILLNESS

Understand which behaviors are symptoms

No one is to blame for symptoms

Never take symptoms personally

Reach out to the person, not the symptoms.
THE EASIEST TASKS BECOME
EXTREMELY DIFFICULT
HELP FOR FAMILIES

Friends and extended family

Books and classes

National Alliance on Mental Illness
(NAMI)

Knowledgeable professionals
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
1. MOVE FORWARD ONE STEP AT A TIME
•Recovery is a slow process
•Staying calm and relaxed is important
•Maintain optimism
MAINTAIN HOPE
Functional
Level
Time
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
2. MAINTAIN A RELAXED ENVIRONMENT
•Being enthusiastic is normal  do not get excited
•Disagreement and getting mad is normal  do not
get excited
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
3. PROVIDE ENOUGH PERSONAL SPACE
•Privacy is important
•It is okay to offer it
•It is okay to reject it
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
4. SETTING LIMITS AND NORMS
-Everyone should be aware of norms
-With a few norms, everything is clearer
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
5. ACCEPTING WHAT WE CANNOT CHANGE
•Understanding what you can give up
•Do not ignore violent behavior
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
6. EXPRESS YOURSELF CLEARLY, CALMLY
AND CONSTRUCTIVELY
•Simplifying things lead to better understanding
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
7. TEMPORARILY REDUCE EXPECTATCTION
•Use personal experience
•Compare this month with previous good months,
rather than last year or next.
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
8. FOLLOW DOCTOR’S SUGGESTIONS
•TAKE MEDICATION AS PRESCRIBED
•Do not take medication that is not prescribed to
you
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
9. REESTABLISH FAMILY RELATIONSHIPS
AND DAILY ROUTINES ASAP
•Return to a good routine ASAP
•Maintain strong ties with family and friends
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
10. ABSTAIN FROM DRUGS AND ALCOHOL
-Voids effects of medication
-Worsens treatment
-Worsens side effects
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
11. DETECTING RELAPSE WARNING SIGNS
•Observe relevant changes
•Immediately consult with case manager or
psychiatrist
PRIMARY PATHS OF HELPING
FAMILIES
CREATE AN OPTIMAL SOCIAL ENVIRONMENT
12. SOLVE PROBLEMS STEP-BY-STEP
-Gradually introduce changes
-Work on one thing at a time
Intervention Techniques I:
The Problem Solving Method
Stop and Think
 Define the Problem
 Possible Solutions
 Evaluate each Solution
 Choose and Plan to Implement your Solution
 Resource Management
 Pick a Time and Do It!
