Download Schizophrenia

Schizophrenia
Chapter 12
Fundamentals of Abnormal Psychology, 4e
Ronald J. Comer
PowerPoint Outline created by
Karen Clay Rhines, Ph.D., Seton Hall University
Psychosis
 Psychosis is a state defined by a loss of contact with reality
 The ability to perceive and respond to the environment is significantly disturbed; functioning is impaired
 Symptoms may include hallucinations (false sensory perceptions) and/or delusions (false beliefs)
 Psychosis may be substance-induced or caused by brain injury, but most psychosis appears in the form of
schizophrenia
Schizophrenia
 Schizophrenia affects approximately 1 in every 100 people in the world
 About 2.5 million Americans currently have the disorder
 The financial and emotional costs are enormous
 One estimate is $100 billion per year
 Sufferers have an increased risk of suicide and illness
Schizophrenia
 Schizophrenia appears in all socioeconomic groups, but is found more frequently in the lower levels
 Leading theorists argue that the stress of poverty causes the disorder
 Other theorists argue that the disorder causes victims from higher social levels to fall and remain at lower levels
• This is called the “downward drift” theory
Schizophrenia
 Equal numbers of men are women are diagnosed
 In men, symptoms begin earlier and are more severe
 Rates of diagnosis differ by marital status:
 3% of divorced or separated people
 2% of single people
 1% of married people
• It is unclear whether marital problems are a cause or a result
Schizophrenia
 Rates of the disorder differ by ethnicity and race
 About 2% of African Americans are diagnosed, compared with 1.4% of Caucasians
• According to the census, however, African Americans are also more likely to be poor and to experience marital
separation
• When controlling for these factors, rates of schizophrenia are equal for the two racial groups
The Clinical Picture of Schizophrenia
 Schizophrenia produces many “clinical pictures”
 The symptoms, triggers, and course of schizophrenia vary greatly
 Some clinicians have argued that schizophrenia is actually a group of separate disorders that share common features
What Are the Symptoms of Schizophrenia?
 Symptoms can be grouped into three categories:
 Positive symptoms
 Negative symptoms
 Psychomotor symptoms
What Are the Symptoms of Schizophrenia?
 Positive symptoms
 These “pathological excesses” are bizarre additions to a person’s behavior
 Positive symptoms include:
• Delusions – faulty interpretations of reality
– Delusions may have a variety of bizarre content: being controlled by others; persecution; reference;
grandeur; control
• Disordered thinking and speech
– May include loose associations; neologisms; perseverations; and clang
What Are the Symptoms of Schizophrenia?
 Examples of positive symptoms
 Loose associations:
• “The problem is insects. My brother used to collect insects. He’s now a man 5 foot 10 inches. You know, 10 is my
favorite number; I also like to dance, draw, and watch TV.”
 Neologisms:
• “This desk is a cramstile”; “He’s an easterhorned head”
 Clang:
• How are you? “Well, hell, it’s well to tell”
• How’s the weather? “So hot, you know it runs on a cot”
What Are the Symptoms of Schizophrenia?
 Examples of positive symptoms
 Heightened perceptions and hallucinations
• People may feel that their senses are being flooded by sights and sounds, making it impossible to attend to anything
important
• Another kind of perceptual problem is hallucinations – perceptions that occur in the absence of external stimuli
– Most common are auditory
 Generally involve a running commentary and/or accusations
 Spoken directly to or overheard by the hallucinator
– Hallucinations can involve any of the other senses: tactile, somatic, visual, gustatory, or olfactory
 Inappropriate affect
What Are the Symptoms of Schizophrenia?
 Negative symptoms
 These “pathological deficits” are characteristics that are lacking in an individual, including:
• Poverty of speech (alogia)
– Long lapses before responding to questions, or failure to answer
– Reduction of quantity of speech
– Slow speech
• Blunted and flat affect
What Are the Symptoms of Schizophrenia?
 Examples of negative symptoms
 Blunted and flat affect
• Avoidance of eye contact
• Immobile, expressionless face
• Monotonous voice, low and difficult to hear
What Are the Symptoms of Schizophrenia?
 Examples of negative symptoms
 Loss of volition (motivation or directedness)
• Feeling drained of energy and interest in normal goals
• Inability to start or follow through on a course of action
 Social withdrawal
• Withdrawal from social environment
• Seems to lead to a breakdown of social skills, including the ability to accurately recognize other people’s needs and emotions
What Are the Symptoms of Schizophrenia?
 Psychomotor symptoms
 People with schizophrenia sometimes experience psychomotor symptoms
• Awkward movements, repeated grimaces, odd gestures
• The movements seem to have a magical quality
 These symptoms may take extreme forms, collectively called catatonia
• Includes stupor, rigidity, posturing, and excitement
What Is the Course of Schizophrenia?
 Schizophrenia usually first appears in the late teens and mid-30s
 Many sufferers experience three phases:
 Prodromal – beginning of deterioration; mild symptoms
 Active – symptoms become increasingly apparent
 Residual – a return to prodromal levels
• One-quarter of patients fully recover; three-quarters continue to have residual problems
What Is the Course of Schizophrenia?
 Each phase of the disorder may last for days or years
 A fuller recovery from the disorder is more likely in people:
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With high premorbid functioning
Whose disorder was triggered by stress
With rapid onset
With later onset
Diagnosing Schizophrenia
 The DSM-IV calls for a diagnosis only after signs of the disorder continue for six months or more
 People must also show a deterioration in their work, social relations, and ability to care for themselves
Diagnosing Schizophrenia

The DSM-IV distinguishes five subtypes:
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Disorganized – characterized by confusion, incoherence, and flat or inappropriate affect
Catatonic – characterized by psychomotor disturbance of some sort
Paranoid – characterized by an organized system of delusions and auditory hallucinations
Undifferentiated – characterized by symptoms which fit no subtype; vague category
Residual – characterized by symptoms which have lessened in strength and number; person may continue to display
blunted or inappropriate emotions
Diagnosing Schizophrenia
 Apart from the DSM-IV categories, many researchers make a distinction between Type I and Type II schizophrenia…
Diagnosing Schizophrenia
 Type I is dominated by positive symptoms



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Better adjustment prior to onset of symptoms
Later onset of symptoms
More positive outcome
Symptoms tied to biochemical abnormalities
Diagnosing Schizophrenia
 Type II is dominated by negative symptoms



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Poorer adjustment prior to onset of symptoms
Earlier onset of symptoms
Less positive outcome
Symptoms tied to structural abnormalities
How Do Theorists Explain Schizophrenia?
 While there is no known cause, research has focused on:
 Biological factors (most promising)
 Psychological factors
 Sociocultural factors
 A diathesis-stress relationship may be at work
 People with a biological predisposition will develop schizophrenia only if certain kinds of stressors or events are also
present
Biological Views
 Genetic and biological studies of schizophrenia have dominated clinical research in the last several decades
 These studies have revealed the key roles of inheritance and brain activity
 The studies have opened the door for changes in treatment
Biological Views
 Genetic factors
 Following the principles of a diathesis-stress approach, genetic researchers believe that some people inherit a biological predisposition
to schizophrenia
• This disposition is triggered by later exposure to stress
• This theory has been supported by studies of relatives, twins, and adoptees, and by genetic linkage studies
Biological Views
 Genetic factors
 Family pedigree studies have repeatedly shown that schizophrenia is more common among relatives of people with the
disorder
• The more closely related they are to the person with schizophrenia, the greater their likelihood for developing the
disorder
Biological Views
 Genetic factors
 Twins have received particular research study
• Studies of identical twins have found that if one twin develops the disorder, there is a 48% chance that the other twin
will do so as well
• If the twins are fraternal, the second twin has a 17% chance of developing the disorder
Biological Views
 Genetic factors
 Adoption studies have compared adults with schizophrenia who were adopted as infants with both their biological and
adoptive relatives
• Because they were reared apart from their biological relatives, similar symptoms in those relatives would indicate
genetic influences; similarities to their adoptive relatives would suggest environmental influences
 Researchers have repeatedly found that the biological relatives of adoptees with schizophrenia are more likely to display
schizophrenic symptoms than are their adoptive relatives
Biological Views
 Genetic factors
 Genetic linkage and molecular biology studies indicate that possible gene defects on numerous chromosomes may predispose
individuals to develop schizophrenia
• These varied findings may indicate:
– A case of “mistaken identity,” that is, some of these gene sites do not contribute to the disorder;
– Various types of schizophrenia are linked to different genes; or
– Schizophrenia, like many disorders, is a polygenic disorder, caused by a combination of gene defects
Biological Views
 Genetic factors
 Genetic factors may lead to the development of schizophrenia through two kinds of (potentially inherited) biological
abnormalities:
• Biochemical abnormalities
• Abnormal brain structure
Biological Views
 Biochemical abnormalities
 One promising theory is the dopamine hypothesis:
• Neurons using dopamine fire too often, producing symptoms of schizophrenia
 This theory is based on the effectiveness of antipsychotic medications (dopamine antagonists)
Biological Views
 Biochemical abnormalities
 Originally developed for treatment of allergies, antipsychotic drugs were found to cause a Parkinson’s disease-like tremor
response in patients
 Scientists knew that Parkinson’s patients had abnormally low levels of dopamine which caused their shaking
 This relationship between symptoms suggested that symptoms of schizophrenia were related to excess dopamine
Biological Views
 Biochemical abnormalities
 Research since the 1960s has supported and clarified this hypothesis
• Example: patients with Parkinson’s develop schizophrenic symptoms if they take too much L-dopa, a medication that
raises dopamine levels
• Example: people who take high doses of amphetamines, which increase dopamine activity in the brain, may develop
amphetamine psychosis – a syndrome similar to schizophrenia
Biological Views
 Biochemical abnormalities
 Investigators have also located the dopamine receptors to which antipsychotic drugs bind
• The drugs are apparently dopamine antagonists which bind to the receptors, preventing further dopamine binding
and neuron firing
 These findings suggest that, in schizophrenia, messages traveling from dopamine-sending neurons to dopaminereceptors (particularly D-2) may be transmitted too easily or too often
• An appealing theory because certain dopamine receptors are known to play a role in guiding attention
Biological Views
 Biochemical abnormalities
 Dopamine may be overactive in people with schizophrenia due to a larger-than-usual number of dopamine receptors
(particularly D-2)
• Autopsy findings have found an unusually large number of dopamine receptors in people with schizophrenia
Biological Views
 Biochemical abnormalities
 Though enlightening, the dopamine hypothesis has limitations
• It has been challenged by the discovery of a new type of antipsychotic drugs (“atypical” antipsychotics) which are
more effective than traditional antipsychotics and which also bind to serotonin receptors
Biological Views
 Abnormal brain structure
 During the past decade, researchers have also linked schizophrenia to abnormalities in brain structure
• For example, brain scans have found that many people with schizophrenia have enlarged ventricles; these patients
are also more likely to display symptoms of Type II schizophrenia
– This enlargement may be a sign of poor development in related brain regions
• People with schizophrenia have also been found to have smaller temporal and frontal lobes, and abnormal blood
flow to certain brain areas
Biological Views
 Viral problems
 A growing number of researchers suggest that the brain abnormalities seen in schizophrenia result from exposure to
viruses before birth
• Circumstantial evidence for this theory comes from the unusually large number of people with schizophrenia born in
winter months
• More direct evidence comes from studies showing that mothers of children with schizophrenia were more often
exposed to the influenza virus during pregnancy than mothers of children without schizophrenia
• Other studies have found a link between schizophrenia and pestiviruses, a particular group of viruses found in
animals
Biological Views
 While the biochemical, brain structure, and viral findings are beginning to shed much light on the mysteries of
schizophrenia, they offer only a partial explanation
 Some people who have these biological problems never develop schizophrenia
• May be because biology sets the stage for the disorder, but psychological and sociocultural factors must be present
for it to appear
Psychological Views
 As schizophrenia investigators began to identify genetic and biological factors of schizophrenia, clinicians largely
abandoned psychological and sociocultural theories
 In the past decade, however, psychological and sociocultural factors are again being considered important
• Leading psychological explanations come from the psychodynamic and cognitive perspectives
Psychological Views
 The psychodynamic explanation
 Freud believed that schizophrenia developed from two processes:
• Regression to a pre-ego stage
• Efforts to reestablish ego control
 He proposed that when their world is extremely harsh, people who develop schizophrenia regress to the earliest points in
their development (primary narcissism), in which they recognize and meet only their own needs
• This regression leads to self-centered symptoms such as neologisms, loose associations, and delusions of grandeur
Psychological Views
 The psychodynamic explanation
 Freud’s theory posits that attempts to reestablish ego control from such a state fail and lead to further schizophrenic
symptoms
 Years later, another psychodynamic theorist elaborated on Freud’s idea of harsh parents
• The theory of schizophrenogenic mothers proposed that mothers of people with schizophrenia were cold,
domineering, and uninterested in their children’s needs
 Both of these theories have received little research support and have been rejected by most psychodynamic theorists
Psychological Views

The cognitive view
 Leading cognitive theorists agree that biological factors produce symptoms
 They theorize that further features of the disorder develop due to faulty interpretation and a misunderstanding of
symptoms
• Example: a man experiences auditory hallucinations and approaches his friends for help; they deny the reality of his
sensations; he concludes that they are trying to hide the truth from him; he begins to reject all feedback and starts
feeling persecuted
 There is little clear, direct research support for this view
Sociocultural Views
 Sociocultural theorists believe that people with mental disorders are victims of two main social forces:
 Social labeling
 Family dysfunction
Sociocultural Views
 Social labeling
 Many sociocultural theorists believe that the features of schizophrenia are influenced by the diagnosis itself
• Society labels people who fail to conform to certain norms of behavior
• Once assigned, the label becomes a self-fulfilling prophecy
 The dangers of social labeling have been well demonstrated
• Example: Rosenhan “pseudo-patient” study
Sociocultural Views
 Family dysfunctioning
 A number of studies suggest that schizophrenia is often linked to family stress:
• Parents of people with the disorder often:
– Display more conflict
– Have greater difficulty communicating
– Are more critical of and overinvolved with their children than other parents
• Family theorists have long recognized that some families are high in “expressed emotion” – family members
frequently express criticism and hostility and intrude on each other’s privacy
– Individuals who are trying to recover from schizophrenia are almost four times more likely to relapse
if they live with such a family
Sociocultural Views
 Although social and family forces are considered important in the development of schizophrenia, research has
not yet clarified what their precise relationships might be
How Is Schizophrenia Treated?
 Historically, people with schizophrenia were considered beyond help and without hope
 Though schizophrenia is still hard to treat, the discovery of antipsychotic drugs has enabled people with the
disorder to think clearly and profit from psychotherapies
Institutional Care in the Past
 For more than half of the 20th century, people with schizophrenia were considered insane and were
institutionalized in public mental hospitals
 Because patients failed to respond to traditional therapies, the primary goals of the hospitals were to restrain
them and give them food, shelter, and clothing
Institutional Care in the Past
 The move toward institutionalization began in 1793 with the practice of “moral treatment”
 Hospitals were created in isolated areas to protect patients from the stresses of daily life and to offer them a
healthful psychological environment
Institutional Care in the Past
 States throughout the U.S. were required by law to establish public mental institutions (state hospitals) for
patients who could not afford private care
 Unfortunately, problems with overcrowding, understaffing, and poor patient outcomes led to loss of individual care and
the creation of “back wards” – human warehouses filled with hopelessness
Institutional Care Takes a Turn for the Better
 In the 1950s, clinicians developed two institutional approaches that brought some hope to chronic patients:
 Milieu therapy
• Based on humanistic principles
 Token economies
• Based on behavioral principles
 These approaches particularly helped improve the personal care and self-image of patients, problem areas that
were worsened by institutionalization
Institutional Care Takes a Turn for the Better
 Milieu therapy
 The guiding principle is that institutions can help patients make clinical progress by creating a social climate (“milieu”)
that promotes productive activity, self-respect, and individual responsibility
 Milieu programs have been set up in institutions throughout the Western world with moderate success
• Research has shown that patients with schizophrenia in milieu programs often leave the hospital at higher rates than
patients receiving custodial care
Institutional Care Takes a Turn for the Better
 The token economy
 Based on operant conditioning principles, token economies are used in institutions to change the behavior of patients
with schizophrenia
 Patients are rewarded when they behave in socially acceptable ways and are not rewarded when they behave
unacceptably
• Immediate rewards are tokens that can later be exchanged for food, cigarettes, privileges, and other desirable
objects
• Acceptable behaviors likely to be targeted include care for oneself and one’s possessions, going to a work program,
and showing self-control
Institutional Care Takes a Turn for the Better
 The token economy
 Researchers have found that token economies do help change psychotic and related behavior
 However, questions have been raised about such programs:
• Are such programs ethical and legal? Aren’t all humans entitled to basic rights, some of which are compromised in a
strict token economy system?
• Are such programs truly effective? For example, patients may change overt behaviors but not underlying psychotic
beliefs
Institutional Care Takes a Turn for the Better
 Token economies are still used in many mental hospitals, usually along with medication, and have also been
applied to other clinical problems
Antipsychotic Drugs
 While milieu therapy and token economies helped improve treatment outcomes, it was the discovery of
antipsychotic drugs in the 1950s that revolutionized treatment for those with schizophrenia
Antipsychotic Drugs
 The discovery of antipsychotic medications dates back to the 1940s, when researchers developed antihistamine drugs for
allergies
 It was discovered that one group of antihistamines, phenothiazines, could be used to calm patients about to undergo surgery
 Psychiatrists tested one of the drugs, chlorpromazine, on six patients with psychosis and observed a sharp reduction in their symptoms
 In 1954, chlorpromazine (under the trade name Thorazine) was approved for sale in the U.S. as an antipsychotic drug
Antipsychotic Drugs
 Since the discovery of the phenothiazines, other kinds of antipsychotic drugs have been developed
 Those developed throughout the 1960s, 1970s, and 1980s are now referred to as “conventional” antipsychotic drugs
• These drugs are also known as neuroleptic drugs because they often produce undesired movement effects similar to
symptoms of neurological diseases
 Drugs developed in recent years are known as “atypical” antipsychotics
How Effective Are Antipsychotic Drugs?
 Research has repeatedly shown that antipsychotic drugs reduce schizophrenia symptoms in the majority of
patients
 In direct comparisons, drugs appear to be more effective than any other approach used alone
 In most cases, the drugs produce the maximum level of improvement within the first six months of treatment
 Symptoms may return if patients stop taking the drugs too soon
How Effective Are Antipsychotic Drugs?
 Although the use of such drugs is now widely accepted, patients often dislike the powerful effects of the drugs,
and some refuse to take them
The Unwanted Effects of Conventional Antipsychotic Drugs
 In addition to reducing psychotic symptoms, conventional antipsychotic drugs sometimes produce disturbing
movement problems
 These are called “extrapyramidal effects” because they appear to be caused by the drugs’ impact on the extrapyramidal
areas of the brain
The Unwanted Effects of Conventional Antipsychotic Drugs
 The most common of these effects produce Parkinsonian symptoms, reactions that closely resemble the
features of the neurological disorder Parkinson’s disease, including:
 Muscle tremor and rigidity
 Bizarre movements of the face, neck, tongue, and back
 Akathisia (great restlessness, agitation, and discomfort in the limbs)
The Unwanted Effects of Conventional Antipsychotic Drugs
 In most cases, the symptoms can be reversed if an anti-Parkinsonian drug is taken along with the antipsychotic
Unwanted Effects of Conventional Antipsychotic Drugs
 A more difficult side effect of conventional antipsychotic drugs appears up to one year after starting the
medication
 This reaction, called tardive dyskinesia, involves involuntary movements, usually of the mouth, lips, tongue, legs, or body
• It affects up to 20% of those taking the drugs
• It can be IRREVERSIBLE!
Unwanted Effects of Conventional Antipsychotic Drugs
 Since learning of the unwanted side effects of conventional antipsychotic drugs, clinicians have become more
careful in their prescription practices:
 They try to prescribe the lowest effective dose
 They gradually reduce or stop medication weeks or months after the patient begins functioning normally
New Antipsychotic Drugs
 In recent years, new antipsychotic drugs have been developed
 Examples: Clozaril, Risperdal, Zyprexa, Seroquel, Zeldox
New Antipsychotic Drugs
 These drugs are called “atypical” because their biological operation differs from that of conventional
antipsychotics
 They appear more effective than conventional drugs, especially for negative symptoms
 They cause few extrapyramidal side effects
Psychotherapy
 Before the discovery of antipsychotic drugs, psychotherapy was not an option for people with schizophrenia
 Most were simply too far removed from reality to profit from psychotherapy
Psychotherapy
 Today, psychotherapy can be very helpful when used in combination with medication
 The most helpful forms of psychotherapy include insight therapy and two broader sociocultural therapies: family therapy
and social therapy
 These approaches are often combined
Psychotherapy
 Insight therapy
 A variety of insight therapies have been used to treat schizophrenia
 Studies suggest that the orientation of the therapist is less important than their experience with schizophrenia
• In addition, the most successful therapists are those who take an active role, set limits, express opinions, and
challenge the patients’ statements
Psychotherapy
 Family therapy
 Around 25% of persons recovering from schizophrenia live with family members
• This creates significant family stress
• Those who live with relatives who display high levels of expressed emotion are at greater risk for relapse than those
who live with more positive or supportive families
 Family therapy attempts to address such issues, create more realistic expectations, and provide psychoeducation about
the disorder
 Families may also turn to family support groups and family psychoeducation programs
Social Therapy
 Many clinicians believe that the treatment of people with schizophrenia should include techniques that address
social and personal difficulties in the clients’ lives
 These include: practical advice, problem solving, decision making, social skills training, medication management,
employment counseling, financial assistance, and housing
 Research finds that this approach reduces rehospitalization
The Community Approach
 The community approach is the broadest approach for the treatment of schizophrenia
 In 1963, Congress passed the Community Mental Health Act, which said that patients should be able to receive care
within their own communities, rather than being transported to institutions far from home
• This led to massive deinstitutionalization of patients with schizophrenia
• Unfortunately, community care was (and is) inadequate for their care
– The result is a “revolving door” syndrome
What Are the Features of Effective Community Care?
 Coordinated services
 Facilities provide medications, psychotherapy, and inpatient emergency care
 Coordination of services is especially important for mentally ill chemical abusers (MICAs)
 Short-term hospitalization
 If treatment on an outpatient basis is unsuccessful, patients may be transferred to short-term hospital programs
 After being hospitalized for up to a few weeks, patients are released to aftercare programs for follow-up in the community
What Are the Features of Effective Community Care?
 Partial hospitalization
 If patients’ needs fall between full hospitalization and outpatient care, day center programs may be effective
 These programs provide daily supervised activities and programs to improve social skills
What Are the Features of Effective Community Care?
 Supervised residences
 Halfway houses provide shelter and supervision for those patients who are unable to live alone or with their families but
who do not require hospitalization
 Staff are usually paraprofessionals
 Houses are run with a milieu therapy philosophy
 These programs help those with schizophrenia adjust to community life and avoid rehospitalization
What Are the Features of Effective Community Care?
 Occupational training
 Many people recovering from schizophrenia receive occupational training in a sheltered workshop – a supervised
workplace for employees who are not ready for competitive or complicated jobs
How Has Community Treatment Failed?
 There is no doubt that effective community programs can help people with schizophrenia recover
 However, fewer than half of all people who need them receive appropriate community mental health services
 In any given year, 40 to 60% of all people with schizophrenia receive no treatment at all
 Two factors are primarily responsible:
 Poor coordination of services
 Shortage of services
How Has Community Treatment Failed?
 Poor coordination of services
 Mental health agencies in a community often fail to communicate with one another
 To combat this problem, a growing number of community therapists have become case managers for people with
schizophrenia
• Case managers offer therapy and advice, teach problem-solving and social skills, and ensure compliance with
medications
• Case managers also try to coordinate available community services for their clients
How Has Community Treatment Failed?
 Shortage of services
 The number of community programs available to people with schizophrenia is woefully inadequate
 The centers that do exist generally fail to provide adequate services for people with severe disorders
 This shortage is due to:
• A lack of mental health professionals who wish to work with severely disturbed patients
• Objections to such programs by neighborhood residents
• Funding shortages (primary reason)
What Are the Consequences of Inadequate Community Treatment?
 When community treatment fails, many people with schizophrenia receive no treatment at all
 Some return to their families and receive medication and perhaps emotional and financial support, but little else in the
way of treatment
What Are the Consequences of Inadequate Community Treatment?
 About 8% of patients enter an alternative care facility (such as a nursing home), where they receive custodial care and
medication
 A great number of people with schizophrenia become homeless
 Approximately one-third of the homeless people in America have a severe mental disorder, commonly schizophrenia
The Promise of Community Treatment
 Despite these very serious problems, proper community care has shown great potential for assisting in the
recovery from schizophrenia
 Task forces have been created to find more effective ways for all levels of government to meet the needs of people with
such disorders
 Another important advancement has been the formation of national interest groups, including the National Alliance for the
Mentally Ill (NAMI)
The Promise of Community Treatment
 Today community care is a major feature of treatment for people recovering from schizophrenia in countries
around the world
 Both in the U.S. and abroad, varied and well-coordinated community treatment is seen as an important part of
the solution to the problem of schizophrenia