Unit 7: Schizophrenia

Question 1

Schizophrenia

Answer 1

A severe mental health disorder marked by disturbances in thought, behavior, and perception
-Not very common, but the symptoms may be very severe if not properly treated.

Question 2

Onset of Schizophrenia

Answer 2

• People with schizophrenia tend to develop symptoms in their late teens and throughout their 20s.
• There have been rare cases of children with schizophrenia.
• These symptoms often begin in the late teenage years through the early 30s, though some early warning signs such as cognitive and social relationship changes may be present years before other more serious symptoms manifest.

Question 3

Occupational therapists can address the needs of people with schizophrenia by…

Answer 3

Helping them to develop roles, habits, and routines that support their ongoing treatment and management of schizophrenia-related symptoms, enabling them to successfully engage in occupations.

Question 4

Diagnosing Schizophrenia

Answer 4

-Difficult to diagnose because there is no blood test for psychiatric conditions, but also because the symptoms can be complex and individuals with schizophrenia may lack the insight to condition so obtaining a personal history could be unreliable.
-A psychiatrist would make the diagnosis by examining behaviors, medical
history, client/family/caregiver report, and determining if this person fit the diagnostic criteria for schizophrenia according to the DSM-5)
-This manual outlines the criteria in which mental health professionals can make diagnoses of psychological conditions.
-While OTs cannot make a diagnosis, understanding the diagnostic criteria for schizophrenia is very helpful when working with our clients that have this diagnosis.

Question 5

Diagnostic Criteria Schizophrenia

Answer 5

• Made if a person has two or more core symptoms, one of which must be hallucinations, delusions, or disorganized speech for at least one month.
• The other core symptoms are gross disorganization and diminished emotional expression (negative symptoms).
• These symptoms alone are not enough, though.
• These symptoms must be taking place in the context of a decline in functioning: whether that be at work, with interpersonal relationships, and/or self-care.
• These disturbances must also be present for 6 months, not be attributed to any other psychiatric illness, medical condition, or substance abuse.

Question 6

Some symptomatic behaviors may include:

Answer 6

• Inappropriate affect (laughing in the absence of a stimulus)
• Disturbed sleep pattern
• Dysphoric mood (can be depression, anxiety, or anger)
• Anxiety and phobias
• Depersonalization (detachment or feeling of disconnect from self)
• Derealization (a feeling that surrounding aren’t real)
• Cognitive deficits impacting language, processing, executive function, and/or memory
• Lack of insight into disorder
• Social cognition deficits
• Hostility and aggression

Question 7

Onset of Schizophrenia Symptoms

Answer 7

Symptoms often begin in the late teenage years through the early 30s, though some early warning signs such as cognitive and social relationship changes may be present years before other more serious symptoms manifest.

Question 8

Types of Schizophrenia

Answer 8

• Out in practice someone may refer to a “type” of schizophrenia.
• In the past, the DSM differentiated subtypes of schizophrenia that were associated with the dominant core symptom the person was experiencing.
• They were paranoid schizophrenia, disorganized, or hebephrenic schizophrenia, catatonic schizophrenia, childhood schizophrenia, and schizoaffective disorder.
• Clinicians found these sub-types to be unhelpful since people with schizophrenia can fluctuate how it is manifested symptomatically.
• May still hear these phrases and descriptions used clinically to describe someone, but the newest edition of the DSM no longer differentiates schizophrenia into subtypes
• However schizoaffective disorder is categorized as it’s own separate disorder and is present in the DSM-V.

Question 9

Prevalence of Schizophrenia

Answer 9

Only about 0.5% of the population will have schizophrenia in their lifetime, it is the
15th leading cause of disability worldwide and people with schizophrenia have a higher rate of suicide and substance abuse as compared to people without schizophrenia.

Question 10

Life Difficulties for individuals with Schizophrenia

Answer 10

-Based on the diagnostic criteria and related behaviors, you can imagine that having a diagnosis of schizophrenia could make life challenging.
-For example, people with schizophrenia can have difficulty maintaining interpersonal relationships due to their diminished social-cognition, difficulty maintaining employment due to disorganization which leads to the person missing shifts, or not seeking treatment and self-medicating with illicit substances due to a lack of insight.
-Despite these challenges, recovery and effective management of schizophrenia
is absolutely possible.

Question 11

WHo it on the treatment team for individuals with Schizophrenia?

Answer 11

• The treatment team that aides in a person with the recovery journey for schizophrenia can include a psychiatrist, psychologist, social worker, nursing, vocational rehab, and, of course, an occupational therapist.
• Medications in conjunction with supportive services and psychotherapy can make a positive impact in the life of someone with schizophrenia.

Question 12

Medications for Schizophrenia Treatment

Answer 12

There are many specific types of medications for schizophrenia, too many to list here, but important to know that they are in the class of anti-psychotic medications.

• They help to treat the psychotic features of schizophrenia, like hallucinations and delusions.
• It is important that the person with schizophrenia takes the medications as prescribed, does not abruptly stop taking medications, and may need medications lifelong.
• This is only one part of the treatment of schizophrenia though.

Question 13

Psychosocial Treatments for Schizophrenia

Answer 13

• Family education
• Illness management skills
• Cognitive behavioral therapy
• Rehabilitation to get back to daily living
• School
• Work skills
• Peer counseling
• Self- help groups
• Treatment for drug and alcohol misuse (if an issue is present).

Question 14

Early Intervention for Psychosis in Schizophrenia

Answer 14

-Emerging and compelling evidence suggests that this is key in decreasing long-term disability for people with schizophrenia
-This early intervention approach typically uses a Coordinated Specialty Care approach where the whole treatment team works with the individual and their family and support
system to provide medication, psychosocial therapies, case management, and supported education and employment services to promote recovery, improve independence, and improve quality of life.

Question 15

The role of occupational therapy on the treatment team for Schizophrenia

Answer 15

-OTs work with the client toward goals that are established collaboratively.
-An OT may perform functional assessments to determine needs for rehabilitation or support to live as independently as possible.
-An OT may also perform a sensory assessment and give strategies to help the
person with schizophrenia manage their sensory experiences and symptoms.
-They may also help the person identify early-signs of a psychotic episode so the client, family, and team can intervene early to prevent hospitalization.
-Overall, the OT works from a place of hope and recovery to promote this person’s independence and quality of life.
-This does not happen in a vacuum and it is crucial for the OT to collaborate with the treatment team to ensure the most effective care possible.