Schizophrenia
 An individual may have hallucinations, delusions,
abnormal emotions, impaired thinking, and behavioral
changes.
 Abnormal thinking and behavior are the most obvious
symptoms. These are called positive symptoms.
 Greatly reduced emotional responsiveness is called
negative symptoms. There is little enthusiasm, little
enjoyment of people and events (anhedonia), and a
marked loss of energy (anergia).
Course of Schizophrenia
 Schizophrenia, which affects about 1 in 100
individuals, is unusual before adolescence and after
age 45.
 Often develops slightly later and less severely in
women than in men.
 Traditionally, the following five subtypes of
schizophrenia have been recognized: Catatonic,
Paranoid, Disorganized, Undifferentiated, Residual.
Bipolar Disorder
 Normal moods become exaggerated and cycle with
one another.
 On the depressive side: leadenness, increased sleep,
inability to move, and the inability to eat. Thinking
may be confused.
 On the manic side: inflated self-confidence, selfimportance, euphoria, expansive ideas and actions,
elevated levels of energy, exuberance, extreme
irritability, paranoia and, at times, delusions and
hallucinations.
Course of Bipolar Disorder
 Bi-Polar disorder can begin at any age, but in many
individuals begins during adolescence.
 Most clients who receive treatment gradually become
more stable; their mood swings become less frequent
and less severe.
 Compared with the rest of society, individuals with
bi-polar illness are at a greatly increased risk for
suicide.
The Recovery Concept
 Coping with stress
 Being aware of the nature of one’s challenges
 Avoiding relapse triggers
 Recognizing the perpetual need for recovery
efforts in one’s life
 Use of a support system for motivation and to
structure a helpful environment
Psychiatric Illness Involves
the Pairing of Two Things
1. Vulnerability, biological predisposition to
illness acquired through inheritance.
2. Stress, environmental demands and
pressures that interact with vulnerability to
produce symptoms of the illness.
Methods to Prevent Relapse
 Self-regulation and attention training has been
used to avoid distractions, and maintain
posture and eye contact during conversations.
 They can also be used to counteract deficits in
reasoning and problem solving.
 Clients have been helped to challenge content
of hallucinations and delusions by practicing
the ability to give self-directed messages such
as“that’s not real” and “don’t listen to that
voice.
Relaxation Training
This method has been effective in
helping people cope with anger.
The person is taught to relax through
isometric exercising of muscle groups,
coupled with calming guided imagery.
Self-Regulation Training
This approach is used to help a person
manage daily stress.
Self-regulation involves scheduling of
daily activities such as personal
affirmations, yoga, physical exercise,
meditation, positive imaging, and
attention to holistic wellness concerns
such as diet and sleep.
Attention Training
 Attention deficits are a feature of many
psychiatric disorders.
 Attention training encourages people to talk
to themselves and focus on tasks, give
calming messages, and resist distractions.
Signs of Medication Non-Compliance
 Tension, agitation, anxiety
 Eating more or less
 Sleeping too little or too much
 Depression
 Social withdrawal, isolation
 Irritability, mood changes
Common Medication Side Effects
 Drowsiness -- increased need for sleep,
appears lethargic
 Dizziness -- light headedness, especially
when standing up too fast.
 Muscle Stiffness -- results awkward gait,
spasms and poor posture.
 Photosensitivity - sensitivity to the sun,
can burn on a cloudy day.
Common Medication Side Effects
 Tardive Dyskinesia -- Tremors. People who take
phenothiazine drugs sometimes develop
uncoordinated, rhythmic shaking of the body. A
medication given for that condition called cogentin.
 Akinesia – lack of facial expression, diminished
arm swings when walking, slowed movements,
drooling.
 Akathesia – restlessness and agitation, inability to
sit still, fidgeting when sitting, shaking in the arms
and legs
Strategies for Coping with Side Effects
 Drowsiness -- schedule naps, change time of
taking medications.
 Increased appetite -- snack on ”good” food
(counsel on nutrition and diet) with exercise
program and stay away from lots sugar
 Restlessness – vigorous exercise (work the muscles)
 Muscle stiffness -- isometric exercises (hold a
movement and count slowly to five, stretching the
muscles
Strategies for Coping with Side Effects
 Dizziness -- sometimes called orthostatic
hypertension. Train yourself to rise slowly.
 Blurred vision -- inexpensive low vision aids can
help
 Photosensitivity – dressing carefully, use a plus 10
or better sun blocker
 Tardive Dyskinesia -- work with the person’s
psychiatrist to find the lowest threshold in the
therapeutic window. Always have a good support
group around that person to monitor carefully the
person’s behavior.
Disclosure?
 Many experts suggest waiting six months to a
year to disclose, in order to build relationships
with your employer and co-workers.
 Decide how much and to whom you should
disclose. No one has the right to know
everything.
 Be prepared with specific suggestions that
could improve your work.
Advice for Employees
 Know all you need to know for your first
day: time, location, transportation, clothing,
contacts, meals, and medication.
 If you feel overwhelmed or confused, don’t be
afraid to ask for help and support.
 Carry a pad and pen with you to take notes
and to write down people’s names.
Advice for Employees
 Until you have learned about your coworkers, it is a good idea to keep personal
issues out of the workplace.
 Do the work that is in your job description.
Learn the rules you are expected to follow.
Follow all the rules and policies.
Advice for Employees
 Try to look for natural cues from other employees
and don’t be afraid to ask questions. Sometimes, a coworker will take on the responsibility of showing the
“new guy/girl” the ropes.
 If you are having trouble at your job, you might feel
the impulse to quit. Take time and try to figure out
what the problem is. You may find that you can get
help from co-workers, supervisors, a job coach, or
friends.
Advice for Employees
 Take care of yourself. Eat well and get enough rest.
 Pay attention to your mental health; monitor
yourself closely, and if you need medications take
them regularly.
 Pay attention to your stress level, you need time for
relaxation and recreation. And pay attention to your
social and relational needs: identify the people in
your life who can provide support and/or
companionship for you.
Advice for Employers
 List critical skills – name the most important skills
needed to be successful on the job and discuss them
in ways that are understandable.
 Explain their importance - help the employee
understand a skill and know why it is important.
There are intellectual skills, behavioral skills,
emotional skills and they are all different.
 Coach - show, model, explain and always try to
provide motivation. It’s helpful to think of skills
coming to a person through coaching.
Advice for Employers
 Employers should keep employee
disclosures of mental illness confidential.
 Written consent from the employee
should be obtained before information
about their illness with can be shared with
others.
 Do not tolerate workplace bullying.
Advice for Employers
 Encourage appropriate use of sick leave.
 Encourage an employee with a mental illness
to seek professional assistance.
 Encourage a supportive environment.
 Offer support for people who have a disability
by maintaining close links to employment
support agencies.
Advice for Employers
 Have frequent employee training on the
topics of stress management, communication
skills, diversity and disability awareness.
 Work closely with mid-level managers and
employee representatives.
 Take a flexible management-by-objective,
team-oriented focus.