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Schizophrenia Overview October 2011 Experience. Education. Excellence. Harvest is a leading full-service behavioral health provider, specializing in the delivery of progressive and innovative consultative behavioral health services for patients and residents residing in skilled nursing, rehabilitation, and assisted living facilities. Our multidisciplinary team of highly skilled professionals work together to offer a broad menu of services including but not limited to 24-hour prescriber on-call services and hospitalization support, comprehensive cognitive assessments, documentation review, OBRA compliance support and customized educational programs designed for the individual needs of your facility. Introduction to Harvest Healthcare This presentation was developed for the continuing education of health care providers. At the conclusion of this presentation, participants will have a basic understanding of schizophrenia including symptoms and treatment. Mental health professionals should be consulted in the management of patients with schizophrenia. Objectives Chronic mental illness that usually strikes in late adolescence or early adulthood. Signs and symptoms vary from individual to individual but all have one or more of the following: ◦ ◦ ◦ ◦ ◦ Delusions Hallucinations Bizarre behavior Disorganized speech Negative symptoms (lack of motivation or interest, diminished cognitive functioning, decreased emotional expression, decreased attention to personal hygiene, little interest in interacting with others and rarely seem to feel or express strong emotions) Schizophrenia People with schizophrenia suffer a decline in their level of functioning May lose all ability to withstand the pressures of the working world They may show a decline in their ability to attend to household chores or all the demands of raising their children, and or they may not be able to have a full social life anymore. Some may have constant symptoms and others may have periods when they are relatively symptom free. Schizophrenia Schizophrenia is a complex illness. Mental health experts are not sure what causes it. Genetic factors appear to play a role. ◦ Certain environmental events may trigger schizophrenia in people who are genetically at risk for it. ◦ One is more likely to develop schizophrenia if you have a family member with the disease. Causes, incidence, and risk factors Schizophrenia affects both men and women equally. Tends to start later for women. Childhood-onset schizophrenia begins after age 5. It is rare and can be difficult to differentiate from other childhood developmental disorders such as autism. Older people with schizophrenia are an often neglected group who are often at the mercy of the least expensive care available and sometimes no care at all. Causes, incidence, and risk factors Cognitive decline is often seen in schizophrenia Once a person with schizophrenia becomes elderly, it can be difficult to sort out cognitive decline related to schizophrenia versus dementia. Psychosis is chronic and does not subside if and when dementia develops which creates an even more complex clinical situation. Cognition The outlook for a person with schizophrenia is difficult to predict. Most times symptoms improve with medication. Some may have difficulty functioning and are at risk for repeated episodes acute symptoms. Research indicates that the more quickly the disease is diagnosed and properly managed the better the long term prognosis. Symptoms WILL return if the patient is noncompliant with medication. Most will need supportive housing, job training, and other community support programs. Those with the most severe form may not be able to live alone. Prognosis Two or more of the following, each present for a significant portion of time during a one month period (or less if successfully treated): • Delusions • Hallucinations • Disorganized speech (e.g., frequent derailment or incoherence) • Grossly disorganized or catatonic behavior • Negative Symptoms, i.e., affective flattening, alogia, or avolition Characteristic Symptoms Paranoid type: preoccupation with one or more delusions or frequent auditory hallucinations Disorganized type: disorganized speech, disorganized behavior, flat or inappropriate affect. Catatonic type: motoric immobility, excess motor activity, extreme negativism, mutism, peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms or prominent grimacing, echolalia or echopraxia. Types of Schizophrenia There are no medical tests to diagnose schizophrenia. The diagnosis is made based on a thorough interview of the person and family members. The practitioner will ask questions about: ◦ ◦ ◦ ◦ ◦ How long the symptoms have lasted How the person's ability to function has changed Developmental background Genetic and family history How well medications have worked Brain scans (such as CT or MRI) and blood tests may help to rule out other disorders that have similar symptoms to schizophrenia. Diagnosis Antipsychotic medications are the most effective treatment for schizophrenia. Medications change the balance of chemicals in the brain and can help control symptoms. Finding the right medication can be difficult, and a trial-and-error process may have to occur. It is also important to learn the contraindications of certain medications, such as the effects of alcohol or sunlight on the effectiveness of the medication. Treatment: Medication Common side effects from antipsychotics may include: ◦ ◦ ◦ ◦ Sleepiness Dizziness Weight gain Increased chance of diabetes and high cholesterol ◦ Feelings of restlessness or “jitters” ◦ Slowed movements ◦ Tremor Treatment: Medications Long term use of antipsychotic medications may increase risk for a movement disorder called tardive dyskinesia. This condition causes repeated movements that cannot be controlled, especially around the mouth. Health care providers are responsible for assessing for this potential side effect by using the Abnormal Involuntary Movement Scale (AIMS) examination. Treatment: Medications Supportive therapy may be helpful for many people with schizophrenia. Behavioral techniques, such as social skills training, can be used to improve social and work functioning. Job-training and relationship building classes are important. Therapy can help with problems that arise day to day, as well as setting realistic goals and defining strategies for reaching those goals. Individual, group, and family therapy These programs can help the person with schizophrenia reach his or her highest potential and greatest level of independence. Staff in these programs become wellacquainted with their clients and can help find living arrangements, work, and recreational activities that are well-suited to each client's needs. Residential, day-treatment, and vocational programs: Family members should be educated about the disease and offered support. Family members and caregivers are often encouraged to help people with schizophrenia stick to their treatment. Family should learn how to diminish stress and conflict, which can sometimes help spark a relapse. It is also important to learn what resources are available in the community for treating mental illnesses Education It is important that the person with schizophrenia learns how to: ◦ Take medications correctly and how to manage side effects ◦ Notice the early signs of a relapse and what to do if symptoms return ◦ Cope with symptoms that occur even while taking medication. A therapist can help. ◦ Manage money ◦ Use public transportation Education Important to understand the patient in terms of their diagnosis and history. Expectations for individuals should be based on diagnosis. Healthcare providers need to address their own fear (likely based in lack of education/understanding) about particular patients. Team strategies should be discussed regarding treatment approach for patients with behavior problems. Remember that all psychosis is not problematic. It is ok to ask the patient about their hallucinations, delusions, etc. Talking with the patient about their symptoms can create ease and open communication. Care Strategies What are common symptoms in Schizophrenia? What are the usual treatment approaches? Are people with Schizophrenia dangerous? How can you make a referral for a psychiatric evaluation for a patient with schizophrenia? Thought Provoking Questions