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!