Psychosocial Treatment PDF

11/27/23, 3:42 AM Realizeit for Student Psychosocial Treatment In addition to pharmacologic treatment, many other modes of treatment can help the person with schizophrenia. Individual and group therapies, family therapy, family education, and social skills training can be instituted for clients in...

11/27/23, 3:42 AM Realizeit for Student Psychosocial Treatment In addition to pharmacologic treatment, many other modes of treatment can help the person with schizophrenia. Individual and group therapies, family therapy, family education, and social skills training can be instituted for clients in both inpatient and community settings. Individual and group therapy sessions are often supportive in nature, giving the client an opportunity for social contact and meaningful relationships with other people. Groups that focus on topics of concern such as medication management, use of community supports, and family concerns have also been beneficial to clients with schizophrenia (Schaub, Hippius, Moller, & Falkai, 2016). Clients with schizophrenia can improve their social competence with social skill training, which translates into more effective functioning in the community. Basic social skill training involves breaking complex social behavior into simpler steps, practicing through role-playing, and applying the concepts in the community or real-world setting. Cognitive adaptation training using environmental supports is designed to improve adaptive functioning in the home setting. Individually tailored environmental supports such as signs, calendars, hygiene supplies, and pill containers cue the client to perform associated tasks. This psychosocial skill training was more effective when carried out during in-home visits in the client’s own environment rather than in an outpatient setting. DSM-5 DIAGNOSTIC CRITERIA :Schizophrenia 295.90 (F20.9) A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3): 1. Delusions 2. Hallucinations 3. Disorganized speech (e.g., frequent derailment or incoherence) 4. Grossly disorganized or catatonic behavior 5. Negative symptoms (i.e., diminished emotional or avolition) B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve the expected level of interpersonal, academic, or occupational functioning). C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVD5YOX6GjyN8BXsE5kBD64UN3Harx67qLkpTVXS1upt… 1/4 11/27/23, 3:42 AM Realizeit for Student negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness. E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated). Reprinted with permission from the American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: Author. A newer therapy, cognitive enhancement therapy (CET), combines computer-based cognitive training with group sessions that allow clients to practice and develop social skills. This approach is designed to remediate or improve the clients’ social and neurocognitive deficits, such as attention, memory, and information processing. The experiential exercises help the client take the perspective of another person rather than focus entirely on him or herself. Positive results of CET include increased mental stamina, active rather than passive information processing, and spontaneous and appropriate negotiation of unrehearsed social challenges. CET has also been effective in decreasing substance misuse in people with schizophrenia (Sandoval et al., 2017). Family education and therapy are known to diminish the negative effects of schizophrenia and reduce the relapse rate. Although inclusion of the family is a factor that improves outcomes for the client, family involvement is often neglected by health care professionals. Families often have a difficult time coping with the complexities and ramifications of the client’s illness. This creates stress among family members that is not beneficial for the client or family members. Family education helps make family members part of the treatment team. In addition, family members can benefit from a supportive environment that helps them cope with the many difficulties presented when a loved one has schizophrenia. These concerns include continuing as a caregiver for the child who is now an adult; worrying about who will care for the client when the https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVD5YOX6GjyN8BXsE5kBD64UN3Harx67qLkpTVXS1upt… 2/4 11/27/23, 3:42 AM Realizeit for Student parents are gone; dealing with the social stigma of mental illness; and, possibly, facing financial problems, marital discord, and social isolation. Such support is available through the National Alliance for the Mentally Ill and local support groups. The client’s health care provider can make referrals to meet specific family needs. Mental Health Promotion Psychiatric rehabilitation has the goal of recovery for clients with major mental illness that goes beyond symptom control and medication management. Working with clients to manage their own lives, make effective treatment decisions, and have an improved quality of life—from the client’s point of view—are central components of such programs. Mental health promotion involves strengthening the client’s ability to bounce back from adversity and to manage the inevitable obstacles encountered in life. Strategies include fostering self-efficacy and empowering the client to have control over his or her life; improving the client’s resiliency, or ability to bounce back emotionally from stressful events; and improving the client’s ability to cope with the problems, stress, and strains of everyday living. Early intervention in schizophrenia is an emerging goal of research investigating the earliest signs of the illness that occurs predominately in adolescence and young adulthood. Accurate identification of individuals at highest risk is key to early intervention (Lynch & McFarlane, 2016). Initiatives of early detection, intervention, and prevention of psychosis have been established to work with primary care providers to recognize prodromal signs that are predictive of later psychotic episodes, such as sleep difficulties, change in appetite, loss of energy and interest, odd speech, hearing voices, peculiar behavior, inappropriate expression of feelings, paucity of speech (also known as alogia), ideas of reference, and feelings of unreality. After these high-risk individuals are identified, individualized intervention is implemented, which may include education or stress management or neuroleptic medication or a combination of these. Treatment also includes family involvement, individual and vocational counseling, and coping strategies to enhance self-mastery. Interventions are intensive, using home visits and daily sessions if needed. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVD5YOX6GjyN8BXsE5kBD64UN3Harx67qLkpTVXS1upt… 3/4 11/27/23, 3:42 AM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVD5YOX6GjyN8BXsE5kBD64UN3Harx67qLkpTVXS1upt… 4/4