Chapter 15 - Treating Schizophrenia

Question 1

Philippe Pinel

Answer 1

“unchained the insane” Asylum
- began the practice of moral treatment and treated patients as human beings who should be cared for the first time in centuries

Question 2

State Hospitals

Answer 2

Public mental hospitals in the united states run by the individual states

Question 3

What happened to state hospitals between 1845 and 1955

Answer 3

• overcrowded
• states could not keep up with the expansion
• started with 2,000 in 1845, ended with 600,000 by 1955
• responsibility fell on nurses and attending’s with limited knowledge and experience
• in 110 years shifted from humanitarian care to keeping order

Question 4

Social breakdown Syndrome

Answer 4

Extreme withdrawal, anger, physical aggressiveness and loss of interest in personal appearance and functioning
– often patients couldn’t return to society

Question 5

Milieu Therapy

Answer 5

Institutions cannot be of help to patients unless they can somehow create a social climate, or milieu, that promotes productive activity, self-respect and individual responsibility (patients viewed as residents)
- Maxwell Jones

Question 6

Token economy program

Answer 6

A behavior-focused program in which a person’s desirable behaviors are reinforced systematically by awarding tokens that can be exchanged for goods or privileges

Question 7

Antipsychotic drugs

Answer 7

• discovered in the 1950’s
• drugs that help correct grossly confused or distorted thinking
• reduce symptoms in 70% of patients

Question 8

Chlorpromazine

Answer 8

• most impressive phenothiazines (first generation)
• it provokes not any loss of consciousness, not any change in the patients mentality but a slight tendency to sleep and above all disinterest for all that goes on around the patient

Question 9

Neuroleptic Drugs

Answer 9

Another name for first generation drugs because they often produce undesired movement effects similar to the symptoms of the neurological diseases 
Ex: - Mellaril 
      - Prolixin 
      - Stelazine 
      - Haldol

Question 10

Extrapyramidal Effects

Answer 10

Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body and extreme restlessness, sometimes produced by antipsychotic drugs

Question 11

Tardive Dyskinesia

Answer 11

Extrapyramidal effect involving involuntary movements that some patients have after they have taken antipsychotic drugs for a long period of time

Question 12

What is the most common Extrapyramidal effect?

Answer 12

Parkinsonian symptoms

Question 13

Neuroleptic malignant syndrome

Answer 13

A severe, potentially fatal reaction consisting of muscle rigidity, fever, altered consciousness, and improper functioning of the ANS

Question 14

Second Generation antispsychotic drugs

Answer 14

• “atypical antipsychotic drugs”
• as effective or more effective than first generation drugs
• reduce positive symptoms and also a small amount of negative symptoms
• Cause fewer Extrapyramidal Effects
• Most common are:
• • Clozapine
• • Risperidone
• • Olanzapine
• • Quetiapine
• • Ziprasidone
• • Aripiprazole

Question 15

Agranulocytosis

Answer 15

a life threatening drop in WBCs

- caused by clozapine

Question 16

Psychotherapy

Answer 16

• most famous is Fromm-Reichmann

- Believed you would be successful if you gained the patients trust and build a close relationship with them

Question 17

What are the most helpful forms of psychotherapy?

Answer 17

• Cognitive-behavioral therapy
• Family therapy
• Social therapy
• • various approaches are combined

Question 18

Cognitive Remediation

Answer 18

A treatment that focuses on the cognitive impairments that often characterize people with schizophrenia - particularly their difficulties in attention, planning and memory

Question 19

Hallucination Reinterpretation and acceptance

Answer 19

Therapists try to provide patients with information about their disorder and evidence that they are having a hallucination. To which the patients will then learn about their hallucinations as they come and go and the therapist then challenges their inaccurate ideas about the power of their hallucinations. They then try to accurately interpret their hallucinations and are taught coping mechanisms

Question 20

Acceptance and Commitment Therapy

Answer 20

Can be used to further dilute the unpleasantry’s of hallucinations in patients
- become aware of their hallucinations and accept that they are simply harmless events of the mind

Question 21

Family Therapy

Answer 21

When combined with drug therapy it helps reduce tensions within the family an relapse and readmission to hospitals decrease.
- Helps family have realistic expectations and become more tolerant, less guilt-ridden and more willing to try new patterns of communication

Question 22

Social Therapy

Answer 22

Helps people stay out of hospitals by practical, active and broad approach
- offer practical advice, work with problem solving, memory enhancement, decision making, and social skills

Question 23

deinstitutionalization

Answer 23

The discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs
- Caused State institutions to drop from 600,00 to 42,000 today

Question 24

Community Mental Health Center

Answer 24

A treatment facility that provides medication, psychotherapy and emergency care for psychological problems and coordinates treatment in the community

Question 25

Aftercare

Answer 25

A program of posthospitalization care and treatment in the community

Question 26

Day center

Answer 26

A program that offers hospital-like treatment during the day only
- “day hospitals”

Question 27

Community Approach

Answer 27

• broadest approach for treatment
• government said that they are supposed to get treated in the community by outpatient therapy, inpatient treatment, emergency care, preventative care and aftercare

Question 28

Short-term hospitalization

Answer 28

• treated as outpatients first by a combination of antipsychotic drugs and psychotherapy
• if that fails, then they are put into a state institution for a few weeks rather than months or years
• usually leads to more improvement and less rehospitalization than long-term institutions

Question 29

Semihospital/Residential crisis center

Answer 29

These are houses or other structures in the community that proved 24 hour nursing care for people with severe mental disorders

Question 30

Halfway Houses

Answer 30

“crisis houses or group homes”

• serve individuals well
• help people recovering from schizophrenia and other severe disorders adjust to community life to prevent rehospitalization

Question 31

Sheltered Workshop

Answer 31

A supervised workplace for employees who are not ready for competitive or complicated jobs.

• replicates a typical work environment
• not consistently available in the U.S.

Question 32

Case Manager

Answer 32

A community therapist who offers and coordinates a full range of services for people with severe mental disorders, including therapy, advice, medication, guidance and protection of patients rights

Question 33

How has the community treatment failed?

Answer 33

• Poor coordination of services

- Shortage of Services

Question 34

What is the reason for shortage of services

Answer 34

Financial burdens

Question 35

How many homeless people are there in the united states? How many of them have a mental disorder?

Answer 35

• 565,000 total

- about 1/4 = 140,000

Question 36

How many people with mental disorders are in jail or prison?

Answer 36

440,000 or more