PSYCHOEDUCATION

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• PSYCHOEDUCATION
• WORKSHOP
• FOR FAMILIES
• Raising the Bar Project
• Valley Nonprofit Resources

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Stages of a Psychoeducational Multifamily Group

Educa- tional workshop
Ongoing MFG Families patients bi-weekly for
1 year
Joining
Family and patient separately 3-6 weeks
Families only 1 day
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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

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SCHIZOPHRENIAS ARE NOT

• All psychoses
• Split personality
• Contagious
• Anyones fault
• Hopeless

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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

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SYMPTOM CLUSTERS

• POSITIVE NEGATIVE
• Hallucinations Few feelings
• Delusions Lack of drive
  IMPAIRMENTS
• Work
• 
  Relationships
• 
  Self-care
• COGNITIVE MOOD
• Memory Depression
• Problem solving Hopelessness

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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

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FIRST EXPRESSION OFSCHIZOPHRENIA

• 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

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BETTER PROGNOSISTREATMENT VARIABLES

• Treatment begins soon after onset
• Good response to medication
• New medications are available
• Psychosocial rehabilitation is available
• Person participates in best treatments

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BETTER PROGNOSIS FAMILY VARIABLES

• Family understands the illness
• Family helps the person get treatment
• Family assists in recovery
• Family provides opportunities for success

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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

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POSSIBLE CAUSESFOR SCHIZOPHRENIA

• PURELY GENETIC
• BIOLOGICAL NOT GENETIC
• Intrauterine Trauma
• Brain Virus
• GENETIC VULNERABILITY PLUS
• Biological Stress
• Psychosocial Stress

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GENETIC RISK OF SCHIZOPHRENIA

• RISKS
• Identical Twin 46
• Both Parents 48
• Sibling or Parent 12
• Aunt, Nephew, Grandparent 5
• First cousin, great Aunt 2
• No relative 1

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BIOLOGICAL RISK FACTORS (NOT GENETIC)

• Winter birth
• Viral infection in the 20th-30th week of
  pregnancy
• Rh incompatibility
• Starvation during pregnancy
• Anoxia at birth

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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
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STRESS DOES NOT DIRECTLY CAUSE SCHIZOPHRENIA

• Strong Genetic Predisposition
• Weak Genetic Predisposition
• No Genetic Predisposition

Schizophrenia
High Stress

Schizophrenia
High Stress
Other Disorders No Schizophrenia

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SCHIZOPHRENIA ALTERSBRAIN FUNCTIONING
Normal
Schizophrenic
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FRONTAL LOBES GOVERN

• Empathy
• Mood
• Insight
• Impulsivity
• Judgment
• Abstraction
• Working memory

• Drive and Ambition
• Problem solving
• Cognitive flexibility
• Capacity to plan
• Time sequential thinking
• Social awareness

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TEMPORAL LOBE FUNCTIONS

• Perception
• Reality Orientation
• Memory

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REDUCED TEMPORALLOBE STRUCTURES
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BASAL GANGLIA FUNCTIONS

• Inhibit unwanted sensory input
• Filter out irrelevant sensory input
• Regulate arousal
• Govern concentration

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LIMBIC SYSTEM FUNCTIONS

• Understanding emotional events
• Linking current perception to past memories
• Learning from experience

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REDUCED LIMBICSYSTEM STRUCTURES
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TANGLED CELLS INLIMBIC SYSTEM
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DOPAMINE BINDING TOA DOPAMINE RECEPTOR
Dopamine
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DOPAMINE HYPOTHESIS
Signal Nerves
D
D
D D D
D
D
D
D
M
D
D
Synapse
M
M
D
D
D
D
D
Receptor Nerves
Untreated Schizophrenic
Medicated Schizophrenic
Normal
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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

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TREATMENT OF SCHIZOPHRENIA
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Meds Family Skills Training
Meds Rehabilitation Program
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Meds Specialized Therapy
20
30
Meds Traditional Psychotherapy
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Antipsychotic Medication
70
Any Treatment w/o Medication
70
No Treatment
Relapse Rate Per Year
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SCHIZOPHRENIA WITH THE BEST TREATMENT
Premorbid
Prodromal
Stable Relapsing
Stable
Deterioration
Good
Function
Begin Medication, Rehabilitation, Family
skills Training
Poor
0
10
20
30
40
50
60
70
AGE
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ANTIPSYCHOTIC MEDICATION

• Reduces relapse
• Reduces brain dysfunction
• Improved medications available
• Unique individual response
• First step to recovery

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ANTIPSYCHOTIC MEDICATIONS REDUCE

• Hallucinations and delusions
• Bizarre behavior
• Agitation and pacing
• Hostility and aggression
• Disordered thinking
• Insomnia

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DOPAMINE HYPOTHESIS
Signal Nerves
D
D
D D D
D
D
D
D
M
D
D
Synapse
M
M
D
D
D
D
D
Receptor Nerves
Untreated Schizophrenic
Medicated Schizophrenic
Normal
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LONG-ACTING INJECTION

• Advantages Disadvantages
• -More easily absorbed -Blood level
  declines
• -More convenient -Less convenient
• -Compliance assured -Choices limited

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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

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DOSE AND RELAPSE
Relapse/Year
1/10 Dose
Standard Dose
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PROBLEMATIC SIDE EFFECTS

• Dysphoric response (feel less alive)
• Extrapyramidal Side Effects (EPS)
• Akathisia (restlessness)
• Parkinsonian (tremors, drooling)
• Acute dystonia (rigidity, spasms)

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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

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SELECTING MEDICATION DOSAGE
Optimum Dose
Symptoms
Side Effects
Dose
Less
More
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INEFFECTIVE TREATMENTS

• Megavitamins or diet
• Dialysis
• Insight-oriented psychotherapy
• individual or familiar
• Folk and religion healing
• Hypnosis

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TREATMENT OFSCHIZOPHRENIA

• 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

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FAMILIES CAN HELP

• Learn about schizophrenia
• Find good treatment
• Provide a healing environment
• Have realistic hope
• Keep the whole family strong

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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

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FAMILIES INFLUENCE OUTCOME

• Natural skills
• fit schizophrenia
• No family
• Poor fit of skills

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RELAPSE RATE
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CONSEQUENCES OF EXPECTATIONS

• Too High Repeated failure
• Relapse
• Realistic Best Functioning
• Success, Joy
• Too Low Institutionalization
• Despair, Giving up

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FAMILYEVENTSAND THECOMPARISONWITH OTHERS
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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.

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THE EASIEST TASKS BECOME EXTREMELY DIFFICULT
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HELP FOR FAMILIES

• Friends and extended family
• Books and classes
• National Alliance on Mental Illness (NAMI)
• Knowledgeable professionals

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PRIMARY PATHS OF HELPING FAMILIESCREATE 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

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MAINTAIN HOPE
Functional Level
Time
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PRIMARY PATHS OF HELPING FAMILIESCREATE 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

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PRIMARY PATHS OF HELPING FAMILIESCREATE AN
OPTIMAL SOCIAL ENVIRONMENT

• 3. PROVIDE ENOUGH PERSONAL SPACE
• Privacy is important
• It is okay to offer it
• It is okay to reject it

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PRIMARY PATHS OF HELPING FAMILIESCREATE AN
OPTIMAL SOCIAL ENVIRONMENT
4. SETTING LIMITS AND NORMS -Everyone should
be aware of norms -With a few norms, everything
is clearer
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PRIMARY PATHS OF HELPING FAMILIESCREATE AN
OPTIMAL SOCIAL ENVIRONMENT

• 5. ACCEPTING WHAT WE CANNOT CHANGE
• Understanding what you can give up
• Do not ignore violent behavior

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PRIMARY PATHS OF HELPING FAMILIESCREATE AN
OPTIMAL SOCIAL ENVIRONMENT

• 6. EXPRESS YOURSELF CLEARLY, CALMLY AND
  CONSTRUCTIVELY
• Simplifying things lead to better understanding

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PRIMARY PATHS OF HELPING FAMILIESCREATE AN
OPTIMAL SOCIAL ENVIRONMENT

• 7. TEMPORARILY REDUCE EXPECTATCTION
• Use personal experience
• Compare this month with previous good months,
  rather than last year or next.

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PRIMARY PATHS OF HELPING FAMILIESCREATE AN
OPTIMAL SOCIAL ENVIRONMENT

• 8. FOLLOW DOCTORS SUGGESTIONS
• TAKE MEDICATION AS PRESCRIBED
• Do not take medication that is not prescribed to
  you

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PRIMARY PATHS OF HELPING FAMILIESCREATE 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

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PRIMARY PATHS OF HELPING FAMILIESCREATE AN
OPTIMAL SOCIAL ENVIRONMENT
10. ABSTAIN FROM DRUGS AND ALCOHOL -Voids effects
of medication -Worsens treatment -Worsens side
effects
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PRIMARY PATHS OF HELPING FAMILIESCREATE AN
OPTIMAL SOCIAL ENVIRONMENT

• 11. DETECTING RELAPSE WARNING SIGNS
• Observe relevant changes
• Immediately consult with case manager or
  psychiatrist

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PRIMARY PATHS OF HELPING FAMILIESCREATE AN
OPTIMAL SOCIAL ENVIRONMENT
12. SOLVE PROBLEMS STEP-BY-STEP -Gradually
introduce changes -Work on one thing at a time
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Intervention Techniques IThe 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!