Module Two SCHIZOPHRENIA

1
Module TwoSCHIZOPHRENIA

• Lesson 1What is schizophrenia and who it is
  manifested (2 training hours)
• Lesson 2How the patient himself experience
  Schizophrenia
  (2 training hours)
• Lesson 3What are the causes of Schizophrenia
• 
  (2 training hours)
• Lesson 4 Ways of treatment for Schizophrenia
• 
  (2 training hours)
• Lesson 5Schizophrenia and Family
  
• 
  (2 training hours)
• Lesson 6Other psychotic disorders
• 
  (1 training hour)
• TOTAL TIME 11 TRAINING HOURS OF 45 MINUTES

2
Lesson 1

• WHAT IS SCHIZOPHRENIA AND HOW IT IS MANIFESTED
• TIME
• 90 minutes (2 training hours of 45 minutes) 

3
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.

4
Step 2 Brainstorming and discussion (15?)

• Write everything you know, you have heart or read
  regarding to Schizophrenia.

5
Step 2 (continued)

• 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.

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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 middles-aged,
  or even elderly.
• From this disorder suffer about one every hundred
  persons.

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Step 3Slide 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

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Step 3 (continued)

• Slide 2.1.2 different types of Schizophrenia
• Paranoid
• Catatonic
• Disorganized
• Undifferentiated
• Residual

9
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.

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Step 5Slide 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 grandfathers death.
• (-) It is not clear when exactly his disease was
  manifested.
• (-) He isolated a few months a few months before
  he got sick.

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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.

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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
• ?p??s?a e???t???? ?e????t??
• Absence of emotional elements
• Long duration of acute phase

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Step 5 (continued)

• Important functionality decrease
• Many residuary elements
• Coexistence of neurological diseases
• Existence of family history
• retreat from reality(?)
• Substance use

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Step 6Questions and Comments (5?)

15
Step 7Lessons evaluation(5?)

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Lesson 2

• HOW THE PATIENT HIMSELF EXPERIENCE SCHIZOPHRENIA
• TIME
• 90 minutes (2 training hours of 45 minutes)
•  

17
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.

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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).

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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.

20
Step 4 Brainstorming (15?)

• Paper and pen
• Write all the reasons that might lead people with
  Schizophrenia to aggressive behavior.

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Step 5 Exercise (20?)

• In what way is influenced the biological,
  psychological and social efficiency of the person
  from Schizophrenia?

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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

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Step 6 (continued)

• Psychological
• Perception of other people, objects and the
  environment.
• Mood and emotional reactions
• The idea of himself, ability of self-examination
  and self esteem
• Concentration, thinking and learning
• Adaptability

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Step 6 (continued)

• Social
• Communication with other people (verbal or not
  verbal)
• Personal relationships
• Manifestation of sexuality
• Employment
• Entertainment

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Step 7Questions and comments (5?)

26
Step 8 Lessons evaluation (5?)

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Lesson 3

• CAUSES OF SCHIZOPHRENIA
• TIME
• 90 minutes (2 training hours of 45 minutes)
•  

28
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.

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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.

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Step 3Slide Projection (20?)

• Slide 2.3.1 Causal factors of Schizophrenia
•      Genetic
•      Neurochemical
•      Neurodevelopmental
•      Environmental

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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.

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Step 5 Slide Projection (15?)

• Slide 2.3.1Possibility 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.

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Step 6 Questions and Comments (5?)

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Step 7 Lessons Evaluation (5?)

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Lesson 4

• WHICH IS THE THERAPEUTICAL TREATMENT OF
  SCHIZOPHRENIA
•  
• TIME
• 90 minutes (2 training hours of 45 minutes)
•  

36
Step 1 Brainstorming and discussion (15?)

• Paper and pen
• Describe the problems of a person that suffers
  from Schizophrenia which require therapeutical
  intervention.

37
Step 1 (continued)

• Symptoms
• Problems that occur from the duration of the
  disease
• Biological consequences to the person
• Psychological consequences
• Social difficulties

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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.

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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
• ????e?pa?de?s? (?)
• Intervention in the family
• Intervention in the environment
• Supporting therapy

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Step 3 (continued)

• Group therapy
• Learning of social skills
• Cognitive therapy
• Professional education
• Work rehabilitation
• Home ensuring
• Entertainment

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Step 4 Exercise and Discussion (15?)

• Paper and pen
• Write the advantages and the disadvantages of
  antipsychotic medication for a schizophrenic
  person.

42
Step 4 (continued)

• Legends spread regarding antipsychotic medication
  
• The are all the same and notorious and we
  should avoid taking
• ?a ????f??µa?a 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.

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Step 4 (continued)

• The medication must always be taken in respect
  with the doctors 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.

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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.

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Step 5 Slide projection and Discussion (20?)

• Slide 2.4.2 Common antipsychotic drugs
• Conventional
•     Chlorpromazine (Largactil)
•      Thiriodazine (Melleril)
•      Triflupromazine (Stelazine)
•      Haloperidol (Aloperidin)
•     Loxapine (Loxapac)
•  unconventional
•     Clozapine (Leponex)
•      risperidone (Risperdal)
•      Olanzapine (Zyprexa)
• Quetiapine (Seroquel)

46
Step 5 (continued)

• Slide 2.4.3 Side effects of antipsychotic drugs
• Parkinsonism.
• Anxiety
• low blood pressure
• restlessness
• muscle stiffness
• milk secretion
• sexual dysfunction
• dry mouth, or constipation or blurred vision
• F?t?e?a?s??s?a light sensitiveness?
• weight gain
• ?a????e? s??d??µ??

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Step 6 Questions and comments (5?)

48
Step 7 Lessons Evaluation (5?)

49
Lesson 5

• FAMILY AND SCHIZOPHRENIA
•  
• TIME
• 90 minutes (2 training hours of 45 minutes)
•  

50
Step 1 Discussion (10?)

• Can the family cause Schizophrenia?

51
Step 1 (continued)

• 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.

52
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.

53
Step 2 (continued)

• 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 family?
  s??a?s??µat??? ?pe?eµp???? t??
• ???????e?a?
• 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.

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Step 2 (continued)

• 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 Schizophrenias. It is
  a factor that increases stress and consequently
  aggravates the situation of the patient.

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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.

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Step 4 theory presentation (10?)

• The charge of the family
• Even though the interest of Psychiatry is mainly
  focused on the familys 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.

57
Step 4 (continued)

• 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).

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Step 5 Discussion (15?)

• Which do you consider that are the most common
  difficulties that face the family of the
  schizophrenic person.

59
Step 6 Theory Presentation (10?)

• 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.
•  

60
Step 7 Questions and comments (5?)

61
Step 8 Lessons Evaluation (5?)

62
Lesson 6

• OTHER PSYCHOTIC DISORDERS
•  
• TIME
• 45 minutes (1 training hour of 45 minutes)
•  

63
Step 1 Slide projection (10?)

• Other psychotic disorders
• Schizophreniform Disorder
• Schizoeffective Disorder S????s??a?s??µat???
  ??ata?a??
• Delusional Disorder
• Brief Psychotic Disorder.
• Psychotic Disorder Not Otherwise Specified
  ?p??eµ?µe?? ??ata?a??
• Psychotic Disorder Due to a General Medical
  Condition
• Substance-Induced Psychotic Disorder. (alcohol or
  other substance)

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Step 2 Theory Presentation (25?)

• Schizophreniform Disorder
• 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. 

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Step 2 (continued)

• S????s??a?s??µat??? ??ata?a??
• 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 schizophrenias
  (but worse in relation to depressions)
• Common to women
• Treatment regarding to the symptoms
  (antipsychotic drugs, antidepressants and other
  psychosocial interventions)

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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.

67
Step 2 (continued)

• Brief Psychotic Disorder
• It is called a psychotic episode with symptoms
  alike to schizophrenias 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.

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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.

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Step 3 Questions and comments (5?)

70
Step 4 Lessons evaluation (5?)