Schizophrenia Presentation PDF

Schizophrenia Alicia Kuhr, CTRS Mohawk College Tuesday January 21, 2025  About Us! Recreation Therapist at St. Joseph’s Healthcare Recreation Therapist at St. Joseph’s Hamilton in Forensic Psychiatry since Sept 2021 Healthcare Hamilton in F...

Schizophrenia Alicia Kuhr, CTRS Mohawk College Tuesday January 21, 2025  About Us! Recreation Therapist at St. Joseph’s Healthcare Recreation Therapist at St. Joseph’s Hamilton in Forensic Psychiatry since Sept 2021 Healthcare Hamilton in Forensic Psychiatry since Sept 2022 Current Graduate Student in MA of Applied Health Sciences at Brock U Bachelors in TR from University of Waterloo (2022) Bachelors in TR from Brock U (2021) Diploma in TR from Mohawk (2019)  Questions for You! What do you Know about Schizophrenia? What terms come to mind when you hear “Schizophrenia?”  Myth or Fact? Schizophrenia occurs in every 4% of the world’s population ethnicity, culture, and has Schizophrenia. socio-economic group. Fact Myth 0.3% - 0.7%  Myth or Fact? Schizophrenia means you Schizophrenia causes have multiple personalities. aggression. Myth Myth Different than Dissociative Less than 5% will engage in Identity Disorder violence  Myth or Fact? Schizophrenia can be treated You will never recover from with medication and Schizophrenia. therapy. Fact Myth  What is Schizophrenia? Is a complex mental illness Affects how a person thinks, feels, behaves, and relates to others. Occurs in both men and women – slightly more common in men First episode typically occurs in the late teens / early twenties – usually earlier for men than for women  Causes & Risk Factors Genetics (60% - 80%) Influence of brain development around birth & childhood Trauma or life altering events Cannabis & other substance use in youth Environmental factors (i.e., urban living)  Positive Symptoms Those that add to or distort the person’s normal functioning, including: Hallucinations: Sensory experiences of things that aren’t there (auditory, tactile, visual) Delusions: False beliefs that a person holds firmly Confused thoughts Disorganized speech Trouble concentrating Agitation Anxiety  Negative Symptoms Involve normal functioning becoming lost or reduced, including: Lack of / inability to experience pleasure Trouble with speech Restricted or flat affect Withdrawal Struggling with ADL’s Decreased desire to socialize Lack of motivation Trouble sleeping Functional Impairment  Psychosis One symptom of Schizophrenia A group of symptoms that indicate a loss of touch with reality 2 main symptoms include hallucinations & delusions May be caused by mental health disorders, substance use, or other medical conditions (e.g., dementia, brain tumors) Other symptoms of a psychotic episode: difficulty concentrating, withdrawal from others, decline in hygiene  Other Spectrum Disorders Schizoaffective Disorder Characterized by a mix of Schizophrenia symptoms (i.e., hallucinations & delusions), and mood disorder symptoms (i.e., depression, mania) Bipolar or depressive in type Delusional Disorder Characterized by fixed false beliefs (delusions), that persist for more than a month Do not experience hallucinations or other psychotic symptoms  Treatment Options Medication (Often First) Brain Stimulation Therapies Psychosocial Therapies  Medications Antipsychotic Medications: Reduce or relieve symptoms of psychosis First generation (typical) antipsychotics: Block dopamine Types: Haldol; Loxapine; Prolixin Side Effects: Drowsiness; Constipation; Muscle stiffness/spasms Second generation (atypical) antipsychotics: Block dopamine & serotonin Types: Clozapine; Olanzapine; Risperidal; Invega; Abilify; Seroquel Side Effects: Weight Gain; Sexual dysfunction; Dry Mouth Trial & error for most individuals to find the one that works best  Medications Antidepressant Medications: Work by altering the balance of certain chemicals in the brain Types: Lexapro, Prozac, Zoloft Side Effects: Jitteriness; Dry mouth; Nausea; Increased appetite & weight gain; Loss of sexual desire; Fatigue & drowsiness; Anxiety; Irritability; Agitation; Dizziness; Constipation; Blurred vision  Brain Stimulation Therapies Electroconvulsive Therapy (ECT) One of the oldest effective treatments for mental health conditions such as depression, mania, schizophrenia, and delusional disorders Short, controlled electrical pulses stimulate the brain which triggers a short seizure, and overtime the brain reacts by changing mood Usually, a last resort if medications don’t work Transcranial Magnetic Stimulation (TMS) Uses magnetic pulses to stimulate nerve cells in the prefrontal cortex of the brain (regulation of mood) Does not require anesthesia May help with auditory hallucinations, negative symptoms & cognitive deficits  Psychosocial Therapies Psychoeducation Improves a person’s understanding of, and insight into, their illness and its treatment Positive thinking skills; Anger management; Medication management; Coping Skills Dialectical Behavior Therapy (DBT) Support people in managing their symptoms and improving quality of life Emotion regulation; Distress tolerance; Interpersonal Skills; Social skills; Relapse prevention  Psychosocial Therapies Cognitive Behavior Therapy (CBT) Support people in managing their symptoms and improving quality of life Identify & change thought patterns that cause distress; Coping skills; Problem Solving Cognitive Behavior Therapy for Psychosis (CBT-P) Support changing how one responds to psychotic experiences (ex. hallucinations and delusions)  Recreation Therapy & Schizophrenia Forensic Psychiatry Considerations (i.e., Effects of Medications, Barriers) Evidence Based Recreation Therapy Programs Community Integration  Forensic Psychiatry A focus on the relationship between psychiatry and the law 118 inpatient beds 22 assessment; 92 rehabilitation; 4 acute stabilization Provide assessments of fitness to stand trial and criminal responsibility and manage the care of individuals found NCR or UFST and are under the jurisdiction of the ORB Goal of rehabilitation and recovery, while managing risk they may pose to the community Forensic Psychiatry  Barriers to Engagement Illness Side Effects Medication Side Effects Stigma Lack of Resources Lack of Developed Skills & Competencies Other Time Commitments  Illness Side Effects Disorganized thinking Simple & consistent explanations Slow movement Additional staffing supports Rapid mood changes Adapted programming Lack of motivation Individualized care plans Firm limit setting Flexible program offerings Awareness of interests/goals Invitations to attend groups  Medication Side Effects Drowsiness Offering programs throughout the day Weight gain Variable program lengths Constipation Encourage physical activity / Muscle stiffness stretching Nausea Provide health teaching Fatigue Pre-planning Dry mouth Consider outing locations Irritability & agitation  Stigma Surrounding mental illness Advocacy & education (i.e., ‘dangerous’ label) Selection of community outing Reduced acceptance from locations community members Awareness of index offence & Stigma through social media associated news reports Shame related to diagnosis or Medication timing associated actions  Lack of Resources Financial (i.e., not able to work, Collaborating with multi-disciplinary ODSP, experience with team homelessness) Targeted interventions to support Social relationships (i.e., no goals (i.e., increasing social relationship with friends/family, engagement) lack of support due to illness) Community engagement & Education (i.e., lack of schooling awareness / knowledge) Leisure education  Lack of Developed Skills Social skills Social skills training Leisure skills 1:1 conversations Physical skills Leisure education Increased therapist intervention Having staff with physical-related certifications (i.e., yoga, personal trainer)  Other Time Commitments Other therapeutic programs Pre-planning with patients (i.e., SATP, DBT, CBT-P, money Working with the multidisciplinary management, life skills) team to book commitments at School / work priorities different times / dates / seasons Family visits Encouraging healthy balances  Take Home Considerations Length of Programs Time of Programs Program Variability Physical Activity Clearance PAR-Q Safety & Risk Considerations Recreation Therapy Interventions Yoga Goal Setting Cricut Armchair Travel Photovoice Nintendo Team Sports Board Games How of Happiness Cool Runnings Community Outings Growing Gratitude Pen to Paper Coming Soon!!! Chair One Fitness Recording Studio Sober Leisure Creative Expressions  Yoga Increased movement has beneficial effects on both physical and psychological well-being in people with schizophrenia Importance of relaxation in mental illness is being increasingly recognized Health benefits are endless as the practice involves multiple body systems simultaneously and may impact the regulation of the ANS Reduced blood pressure; Improve type 2 diabetes outcomes; Improve flexibility; Improve muscular strength; Enhance respiratory function Positive effects on depression; Decrease anxiety; Reduce stress; Improve emotional regulation; Increase mood  Yoga Offered 1-2x per month Both staff and patients participate 3 staff are currently yoga instructors If no staff are available to facilitate, guided videos are used Targeted Goals: Improve physical fitness (i.e., strength, flexibility) Reduce stress & anxiety (i.e., meditation, deep breathing) Promote positive thinking (i.e., gratitude, kindness)  Team Sports There are positive associations between therapeutic sport interventions and both psychological and physical effects The development of social competence (perspective taking, communication skills, social responsibility) through team sports such as Volleyball has been studied (Reimer et al., 2022) Social competence, competition, and team atmosphere can support with better aggression, impulse control, and conflict resolution strategies Cognitive Benefits: Improved problem solving, goal-setting skills, ability to follow directions, attention, memory, improved concentration Social Benefits: Improvements in social confidence, communication skills, reciprocal relationship skills  Team Sports Offered throughout the hospital, several times a week Volleyball; Baseball; Basketball; Badminton; Tennis; Pickleball; Flag Football; Kickball; Soccer Staff participation is encouraged Need to be aware of behavioral triggers and/or aggression from competitive environment Targeted Goals: Increased physical activity Encouragement of teamwork, sportsmanship, collaboration, and fair play Improvement in interpersonal communication skills & social connections  Goal Setting Recognized as an integral component of psychiatric rehabilitation and behavioral change Has been shown to enhance motivation, adherence, self-efficacy, and overall quality of life Goal planning theory suggests goals that are conscious and specific produce better results  Goal Setting Offered 1x per week, typically on Mondays Recreation therapist leads, however, other staff (occupational therapist, nurse, social worker) are encouraged to join and provide input/support Encourage SMART goals, normalize setback, and support with finding solutions Targeted Goals: To set realistic and achievable goals, applicable to recovery/rehabilitation To allow for increased daily structure and independence To improve self-awareness and increase motivation  Creative Expressions Provide opportunity to express emotions, enhance positive emotion, and to better understand oneself Evidence supports the use of arts as a therapeutic intervention in evoking emotional vulnerability in individuals with schizophrenia  Creative Expressions Offered approximately 1x per week Tracking supplies for safety purposes is crucial Can be offered using a variety of mediums such as paint, clay, markers, pottery, and oil pastels Targeted Goals: To allow opportunity for personal expression and self-discovery To promote relaxation and mindfulness To cultivate curiosity and exploration through different art mediums  Community Outings Aim to promote community reintegration and to support patients on their journey towards mental health recovery Allow patients to rebuild or maintain family ties, access community resources, and develop vocational & leisure skills The importance of patients being able to practice their skills and generalize them to the social environment is a pillar of mental health recovery Community outings provide clinical staff essential information to influence patient care / discharge  Community Outings Offered by the Recreation Therapy team approximately 3x per week Outings selected based on: Patients interests/abilities; Cost & location; Consideration for appropriateness of patient population / risk Some paid memberships available through program Examples: Art Gallery; Library; Bowling; Driving Range; Movies; Professional Sports Games; Hikes; Swimming; Art Studio Targeted Goals: To promote inclusion & community integration; To develop awareness & knowledge of resources; To assess rule adherence  Quotes from Patients "I love being able to just listen to music and do art, it feels so therapeutic and makes me feel calm." Patient response when asked about their thoughts on recreation therapy. "I always feel like all my stress from being in hospital just goes away.” Patient after completing a 30- minute group yoga program. "I hadn’t been to a store in 4 years because of being in jail and hospital, so thank you very much for that. I appreciate you guys." Patient after attending a community outing to Walmart with staff for the first time. "I never knew how relaxing painting could be.” Patient after engaging in a follow-along art program. "I feel a little bit nervous and a little bit excited, but more excited". Patient getting ready to run their first 5km race after completing a running program with a recreation therapist. "Recreation gave me the opportunity to try new things and pursue old passions. It allowed me to feel human again." Patient response when asked about their thoughts on recreation therapy. Thank you! Alicia Kuhr, CTRS [email protected] Jon Huys, CTRS [email protected] Activity – Hearing Voices  Debrief How do you feel? How was it completing tasks that were given? Were you distracted? How difficult was it to have a conversation? What did you learn from this experience?