Week 12 Deinstitutionalization and Schizophrenia Treatment PDF

Week 12 Deinstitutionalization and Schizophrenia Treatment PSY 2234 Fall 2024 Overview Deinstitutionalization Rosemary Kennedy and Lobotomy Back Wards and Social Breakdown Syndrome Thorazine Community Mental Health Act Goals and Impact Treatment for Sev...

Week 12 Deinstitutionalization and Schizophrenia Treatment PSY 2234 Fall 2024 Overview Deinstitutionalization Rosemary Kennedy and Lobotomy Back Wards and Social Breakdown Syndrome Thorazine Community Mental Health Act Goals and Impact Treatment for Severe Mental Illness Drug Therapies Antipsychotic Drugs Extrapyramidal Effects Tardive Dyskinesia Deinstitutionalization Rosemary Kennedy Rosemary Kennedy Sister to President John F. Kennedy Born in Brookline, MA Some evidence of mental illness and/or intellectual disability Emotional outbursts Delayed learning Possible seizures Rosemary Kennedy In 1941, family had her lobotomized Lobotomy Form of brain surgery developed to treat severe mental illness Lobotomy Procedure Doctor inserts metal tool into brain Early method: drilling holes in skull Later: tool inserted through eye socket Tool moved in “swishing” motion meant to sever connections within frontal lobes Lobotomy Patient would become subdued, withdrawn, calm, and lacking volition Could also cause paralysis, seizures, flat affect Lobotomy “…surgically induced childhood… the personality of the patient was changed in some way in the hope of rendering him more amenable to the social pressures under which he is supposed to exist.” —Walter Freeman (American lobotomist) Lobotomy R. Kennedy Lost ability to speak and walk Became incontinent “Mental age” approximated at 2 years Previously estimated at 14 years Sister described her “sparkle” being gone Lobotomy Procedure was developed in an effort to address overcrowding in state hospitals No other treatment for severe mental illness existed Lobotomizing some patients made them “manageable” enough that all could benefit State Hospitals Institutions opened in U.S. in 1800s to provide publicly funded mental health care State Hospitals For many with less severe mental illnesses (depression, PTSD, etc.) were helpful Until 1950s, no effective treatments for disorders like schizophrenia Resulted in development of back wards Back Wards Regions of state hospitals used to house patients who were considered beyond help System was forced into place by staff shortages, lack of funding If not isolated, patients with schizophrenia required enormous help and could pose danger to other patients and selves Back Wards Patients housed here often received basic maintenance care, but little else Given meals, baths, medical care, but little else Many were locked in or restrained Resulted in Social Breakdown Syndrome Social Breakdown Syndrome Symptoms Lack of bathing, eating, other self-care behaviors Aggression Loss of interest (anhedonia) Withdrawal and depression Rosemary Kennedy Case inspired John F. Kennedy to push for mental health reform during presidency Discussion Why is the Kennedy family considered important for U.S. history? Thorazine First antipsychotic drug ever developed Eliminates psychosis in about ~70% of users First effective treatment for schizophrenia Approved for U.S. use in 1954 Community Mental Health Act Signed into law 1963 by John F. Kennedy Stated those with severe mental illness would receive help in own communities Set aside funding for outpatient treatment Required deinstitutionalization Deinstitutionalization Goals Reduce number of people living in institutions Replace institutional care with outpatient and/or home care Prevent overcrowding, back wards, lobotomies, and Social Breakdown Syndrome Deinstitutionalization Impact Quality of life increase for many Americans with schizophrenia More options for outpatient care Patients who remained in hospitals received higher-quality care with less crowding Deinstitutionalization Impact Surge in risk of homelessness for those with severe mental illness Americans with schizophrenia more likely to be in prison than living independently Deinstitutionalization Impact Few options for modern Americans to get long-term in- patient mental health care Insurance usually only covers curative care, not maintenance care Many health services only covered if person is in crisis Discussion What else could the U.S. do to improve deinstitutionalization and bring it closer to the original goals? Treatment for Severe Mental Illness Treatment for Severe Mental Illness Treatment for Severe Mental Illness Drug therapies Highly effective for positive symptoms Major side effects Talk therapies Less effective for positive symptoms Fewer side effects Inpatient therapies Quality threatened by overcrowding Not often covered by insurance Drug Therapies Antipsychotic Drugs Drugs that reduce or eliminate positive symptoms of schizophrenia Less effective at treating negative symptoms First-Generation Antipsychotics Also called neuroleptic drugs More effective than any other treatment at reducing or eliminating psychosis Extrapyramidal Effects Side effects of antipsychotics, which can be severe and permanent All reflect drugs’ effect on dopamine systems associated with movement Major types Parkinsonian Symptoms Neuroleptic Malignant Syndrome Tardive Dyskinesia Parkinsonian Symptoms Patient experiences similar to Parkinson’s disease Slowed movements Flat affect Muscle tremors Restlessness in limbs Shuffling gait Occur in about 8% of antipsychotic users Neuroleptic Malignant Syndrome Patient experiences rigid muscles, fever, severe stiffness Can be fatal, if paralyzes respiratory system Occurs in about 1% of antipsychotic users Tardive Dyskinesia https://www.youtube.com/watch?v=7GYbX YMLgzw Tardive Dyskinesia “Late appearing movement disorder” Repeated involuntary movements of face and/or extremities (hands, feet) Occurs in about 24% of antipsychotic users Tardive Dyskinesia Usually permanent once develops Not considered dangerous, but has negative social impacts Extrapyramidal Effects Can be addressed through Using small doses of antipsychotic drugs Careful monitoring and ending use if necessary Increasing or decreasing dose gradually (titration) Using second-generation antipsychotics