psychoeducation workshop for families

PSYCHOEDUCATIONPSYCHOEDUCATIONWORKSHOPWORKSHOP

FOR FAMILIESFOR FAMILIES

Raising the Bar Project – Raising the Bar Project – Valley Nonprofit ResourcesValley Nonprofit Resources

Stages of a Psychoeducational

Multifamily Group

JoiningFamily and patient

separately3-6 weeks

Educa-tional

workshopFamilies only

1 day

Ongoing MFG

Families & patients

bi-weekly for 1 year

SCHIZOPHRENIA SCHIZOPHRENIA • Is a no-fault biological illness• Causes immense suffering for the person

and family• Is a handicap but does not need to be a

disability• Recovery is possible• New treatments increase recovery• Families can help in many ways

SCHIZOPHRENIAS ARE NOTSCHIZOPHRENIAS ARE NOT

• All psychoses • Split personality• Contagious• Anyone’s fault• Hopeless

DIAGNOSIS OF DIAGNOSIS OF SCHIZOPHRENIASCHIZOPHRENIA

SymptomsSymptoms: two or more of the following:: two or more of the following:DelusionsDelusionsHallucinationsHallucinationsDisorganized speechDisorganized speechGrossly, disorganized behaviorGrossly, disorganized behaviorLack of feelings of driveLack of feelings of drive

That produce marked impairment,That produce marked impairment, Last more than 6 months, andLast more than 6 months, and Are not due to drugs or medical conditionAre not due to drugs or medical condition

SYMPTOM CLUSTERSSYMPTOM CLUSTERSPOSITIVEPOSITIVE NEGATIVENEGATIVEHallucinationsHallucinations Few feelingsFew feelingsDelusionsDelusions Lack of driveLack of drive

IMPAIRMENTS IMPAIRMENTS WorkWork RelationshipsRelationships Self-careSelf-careCOGNITIVECOGNITIVE MOODMOODMemoryMemory DepressionDepressionProblem solvingProblem solving HopelessnessHopelessness

SCHIZOPHRENIA IS THE SAME IN SCHIZOPHRENIA IS THE SAME IN ALL COUNTRIESALL COUNTRIES

• Occurs in 1% of all types of people• First occurs between age 15 and 30• Has the same core symptoms• Has the same pattern of relapse and

remission• Is a lifelong illness

FIRST EXPRESSION OFFIRST EXPRESSION OFSCHIZOPHRENIASCHIZOPHRENIA

Usually seen between age 15 and 30Usually seen between age 15 and 30 Occurs during cortical pruning processOccurs during cortical pruning process Causes progressive damage during the first few Causes progressive damage during the first few

years (autotoxicity)years (autotoxicity) Severity of damage can be lessenedSeverity of damage can be lessened May sometimes be preventableMay sometimes be preventable

BETTER PROGNOSIS:BETTER PROGNOSIS:TREATMENT VARIABLESTREATMENT VARIABLES

Treatment begins soon after onsetTreatment begins soon after onset Good response to medicationGood response to medication New medications are availableNew medications are available Psychosocial rehabilitation is availablePsychosocial rehabilitation is available Person participates in best treatmentsPerson participates in best treatments

BETTER PROGNOSIS: BETTER PROGNOSIS: FAMILY VARIABLESFAMILY VARIABLES

Family understands the illnessFamily understands the illness Family helps the person get treatmentFamily helps the person get treatment Family assists in recoveryFamily assists in recovery Family provides opportunities for successFamily provides opportunities for success

SCHIZOPHRENIASCHIZOPHRENIA A no-fault illness…A no-fault illness… With genetic and biological causes…With genetic and biological causes… Supersensitive to stress, drugs and family Supersensitive to stress, drugs and family

atmosphere…atmosphere… With initial deterioration that is lessenedWith initial deterioration that is lessened Can have good long-term prognosisCan have good long-term prognosis

POSSIBLE CAUSESPOSSIBLE CAUSESFOR SCHIZOPHRENIAFOR SCHIZOPHRENIA

PURELY GENETICPURELY GENETICBIOLOGICAL NOT GENETICBIOLOGICAL NOT GENETICIntrauterine TraumaIntrauterine TraumaBrain VirusBrain Virus GENETIC VULNERABILITY PLUSGENETIC VULNERABILITY PLUSBiological StressBiological Stress + +Psychosocial StressPsychosocial Stress

GENETIC RISK OF GENETIC RISK OF SCHIZOPHRENIASCHIZOPHRENIA

RISKSRISKS

Identical TwinIdentical Twin 46% 46% Both ParentsBoth Parents 48%48%Sibling or ParentSibling or Parent 12%12%Aunt, Nephew, GrandparentAunt, Nephew, Grandparent 5% 5%First cousin, great AuntFirst cousin, great Aunt 2% 2%No relativeNo relative 1% 1%

BIOLOGICAL RISK FACTORS BIOLOGICAL RISK FACTORS (NOT GENETIC)(NOT GENETIC)

Winter birthWinter birth Viral infection in the 20Viral infection in the 20 thth-30-30thth week of week of

pregnancypregnancy Rh incompatibilityRh incompatibility Starvation during pregnancyStarvation during pregnancy Anoxia at birthAnoxia at birth

Factors that affect Mental Capacity

Socio-Environmental Stressors Psychological Vulnerability

Preventative Factors•Social Support•Developmental Skills•Rehabilitation Program•Antipsychotic Medication

Results from Rehabilitation

ImpairmentHandicaps

Disabilities

Good Bad

STRESS DOES NOT DIRECTLY STRESS DOES NOT DIRECTLY CAUSE SCHIZOPHRENIACAUSE SCHIZOPHRENIA

Strong Genetic Strong Genetic PredispositionPredisposition

Weak Genetic Weak Genetic PredispositionPredisposition

No Genetic No Genetic PredispositionPredisposition

+

+

HighStress

HighStress

Schizophrenia

Schizophrenia

Other Disorders No Schizophrenia

SCHIZOPHRENIA ALTERSSCHIZOPHRENIA ALTERSBRAIN FUNCTIONINGBRAIN FUNCTIONING

Normal Schizophrenic

FRONTAL LOBES GOVERNFRONTAL LOBES GOVERN

• Drive and Ambition• Problem solving• Cognitive flexibility• Capacity to plan• Time sequential thinking• Social awareness

• Empathy• Mood• Insight• Impulsivity• Judgment• Abstraction• Working memory

TEMPORAL LOBE FUNCTIONSTEMPORAL LOBE FUNCTIONS

PerceptionPerception

Reality OrientationReality Orientation

MemoryMemory

REDUCED TEMPORALREDUCED TEMPORALLOBE STRUCTURESLOBE STRUCTURES

BASAL GANGLIA FUNCTIONSBASAL GANGLIA FUNCTIONS

• Inhibit unwanted sensory input

• Filter out irrelevant sensory input

• Regulate arousal

• Govern concentration

LIMBIC SYSTEM FUNCTIONSLIMBIC SYSTEM FUNCTIONS

• Understanding emotional events

• Linking current perception to

past memories

• Learning from experience

REDUCED LIMBICREDUCED LIMBICSYSTEM STRUCTURESSYSTEM STRUCTURES

TANGLED CELLS INTANGLED CELLS INLIMBIC SYSTEMLIMBIC SYSTEM

DOPAMINE BINDING TODOPAMINE BINDING TOA DOPAMINE RECEPTORA DOPAMINE RECEPTOR

Dopamine

DOPAMINE HYPOTHESISDOPAMINE HYPOTHESIS

NormalUntreated

SchizophrenicMedicated

Schizophrenic

Signal Nerves

Synapse

Receptor Nerves

D D D

D

D D D D D D

D D DM M

D

D DM

TREATMENT OF TREATMENT OF SCHIZOPHRENIASCHIZOPHRENIA

Medication controls symptoms and relapseMedication controls symptoms and relapse Psychosocial rehabilitation teaches (Vocational)Psychosocial rehabilitation teaches (Vocational) Family skills and atmosphere supportFamily skills and atmosphere support Early intervention prevents deteriorationEarly intervention prevents deterioration Lifetime treatment is requiredLifetime treatment is required

TREATMENT OF TREATMENT OF SCHIZOPHRENIASCHIZOPHRENIA

Relapse Rate Per Year

Meds + Family Skills Training

Meds + Rehabilitation Program

Meds + Specialized Therapy

Meds + Traditional Psychotherapy

Antipsychotic Medication

Any Treatment w/o Medication

No Treatment

8%

8%

20%

30%

30%70%

70%

SCHIZOPHRENIA WITH THE SCHIZOPHRENIA WITH THE BEST TREATMENTBEST TREATMENT

Good

Function

Poor

PremorbidProdromalDeterioration Stable Relapsing Stable

AGE0 10 20 30 40 50 60 70

BeginMedication,Rehabilitation,Family skillsTraining

ANTIPSYCHOTIC ANTIPSYCHOTIC MEDICATIONMEDICATION

Reduces relapseReduces relapse Reduces brain dysfunctionReduces brain dysfunction Improved medications availableImproved medications available Unique individual responseUnique individual response First step to recoveryFirst step to recovery

ANTIPSYCHOTIC ANTIPSYCHOTIC MEDICATIONS REDUCE:MEDICATIONS REDUCE:

Hallucinations and delusionsHallucinations and delusions Bizarre behaviorBizarre behavior Agitation and pacingAgitation and pacing Hostility and aggressionHostility and aggression Disordered thinkingDisordered thinking InsomniaInsomnia

DOPAMINE HYPOTHESISDOPAMINE HYPOTHESIS

NormalUntreated

SchizophrenicMedicated

Schizophrenic

Signal Nerves

Synapse

Receptor Nerves

D D D

D

D D D D D D

D D DM M

D

D DM

LONG-ACTING INJECTIONLONG-ACTING INJECTION

AdvantagesAdvantages DisadvantagesDisadvantages-More easily absorbed-More easily absorbed -Blood level declines-Blood level declines

-More convenient -More convenient -Less convenient-Less convenient

-Compliance assured-Compliance assured -Choices limited-Choices limited

NEW ANTIPSYCHOTICSNEW ANTIPSYCHOTICS

Improve negative symptomsImprove negative symptoms Probably reduce cognitive deficitsProbably reduce cognitive deficits Cause no or few movement side effectsCause no or few movement side effects Result in less use of side effect medicationResult in less use of side effect medication Produce better complianceProduce better compliance

DOSE AND RELAPSEDOSE AND RELAPSE

1/10Dose

100%

80%

60%

40%

20%

0%

70%

56%

24%14%

Placebo 1/4 Dose StandardDose

% R

elap

se/Y

ear

PROBLEMATIC PROBLEMATIC SIDE EFFECTSSIDE EFFECTS

Dysphoric response (feel less alive)Dysphoric response (feel less alive) Extrapyramidal Side Effects (EPS)Extrapyramidal Side Effects (EPS)

Akathisia (restlessness)Akathisia (restlessness)

Parkinsonian (tremors, drooling)Parkinsonian (tremors, drooling)

Acute dystonia (rigidity, spasms)Acute dystonia (rigidity, spasms)

METHODS FOR MANAGING METHODS FOR MANAGING SIDE EFFECTSSIDE EFFECTS

Waiting until the body adjustsWaiting until the body adjusts Taking medication at nightTaking medication at night Medication with different side effects Medication with different side effects Antiparkinsonian medicationAntiparkinsonian medication Reducing dosage of antipsychoticReducing dosage of antipsychotic Using techniques to treat side effectsUsing techniques to treat side effects

SELECTING MEDICATION SELECTING MEDICATION DOSAGEDOSAGE

Optimum Dose

Dose

Side Effects

Symptoms

Less More

INEFFECTIVE TREATMENTSINEFFECTIVE TREATMENTS

Megavitamins or dietMegavitamins or diet DialysisDialysis Insight-oriented psychotherapy:Insight-oriented psychotherapy:

individual or familiar individual or familiar Folk and religion healingFolk and religion healing HypnosisHypnosis

TREATMENT OFTREATMENT OFSCHIZOPHRENIASCHIZOPHRENIA

Doctor or program that specializesDoctor or program that specializes Medication controls symptoms and relapseMedication controls symptoms and relapse Psychosocial rehabilitation teachesPsychosocial rehabilitation teaches Family skills and atmosphere supportFamily skills and atmosphere support Early intervention prevents deteriorationEarly intervention prevents deterioration Lifetime treatment is requiredLifetime treatment is required

FAMILIES CAN HELP:FAMILIES CAN HELP:

Learn about schizophreniaLearn about schizophrenia Find good treatmentFind good treatment Provide a healing environmentProvide a healing environment Have realistic hopeHave realistic hope Keep the whole family strongKeep the whole family strong

HELPFUL FAMILIESHELPFUL FAMILIES Accept the person as illAccept the person as ill Attribute symptoms to the illnessAttribute symptoms to the illness Set realistic, attainable goalsSet realistic, attainable goals Include the ill person in the familyInclude the ill person in the family Keep a loving distanceKeep a loving distance Have a calm atmosphereHave a calm atmosphere Give frequent praiseGive frequent praise Give specific criticismGive specific criticism

FAMILIES INFLUENCE FAMILIES INFLUENCE OUTCOMEOUTCOME

Natural skillsNatural skillsfit schizophreniafit schizophrenia

No familyNo family

Poor fit of skills

21%

48%

RELAPSE RATE

30%

CONSEQUENCES OF CONSEQUENCES OF EXPECTATIONSEXPECTATIONS

Too HighToo High Repeated failureRepeated failure RelapseRelapse

RealisticRealistic Best FunctioningBest FunctioningSuccess, JoySuccess, Joy

Too LowToo Low InstitutionalizationInstitutionalizationDespair, Giving upDespair, Giving up

FAMILYFAMILYEVENTSEVENTS

AND THEAND THECOMPARISONCOMPARISONWITH OTHERSWITH OTHERS

LOVE THE PERSON LOVE THE PERSON HATE THE ILLNESS HATE THE ILLNESS

Understand which behaviors are symptomsUnderstand which behaviors are symptoms No one is to blame for symptomsNo one is to blame for symptoms Never take symptoms personallyNever take symptoms personally Reach out to the person, not the symptoms.Reach out to the person, not the symptoms.

THE EASIEST TASKS BECOME THE EASIEST TASKS BECOME EXTREMELY DIFFICULTEXTREMELY DIFFICULT

HELP FOR FAMILIESHELP FOR FAMILIES

Friends and extended familyFriends and extended family Books and classesBooks and classes National Alliance on Mental Illness National Alliance on Mental Illness

(NAMI)(NAMI) Knowledgeable professionalsKnowledgeable professionals

PRIMARY PATHS OF HELPING PRIMARY PATHS OF HELPING FAMILIESFAMILIES

CREATE AN OPTIMAL SOCIAL ENVIRONMENTCREATE AN OPTIMAL SOCIAL ENVIRONMENT

1. MOVE FORWARD ONE STEP AT A TIME

•Recovery is a slow process

•Staying calm and relaxed is important

•Maintain optimism

MAINTAIN HOPEMAINTAIN HOPE

FunctionalLevel

Time



2. MAINTAIN A RELAXED ENVIRONMENT

•Being enthusiastic is normal do not get excited

•Disagreement and getting mad is normal do not get excited



3. PROVIDE ENOUGH PERSONAL SPACE

•Privacy is important

•It is okay to offer it

•It is okay to reject it



4. SETTING LIMITS AND NORMS

-Everyone should be aware of norms

-With a few norms, everything is clearer



5. ACCEPTING WHAT WE CANNOT CHANGE

•Understanding what you can give up

•Do not ignore violent behavior



6. EXPRESS YOURSELF CLEARLY, CALMLY AND CONSTRUCTIVELY

•Simplifying things lead to better understanding



7. TEMPORARILY REDUCE EXPECTATCTION

•Use personal experience

•Compare this month with previous good months, rather than last year or next.



8. FOLLOW DOCTOR’S SUGGESTIONS

•TAKE MEDICATION AS PRESCRIBED

•Do not take medication that is not prescribed to you



9. REESTABLISH FAMILY RELATIONSHIPS AND DAILY ROUTINES ASAP

•Return to a good routine ASAP

•Maintain strong ties with family and friends



10. ABSTAIN FROM DRUGS AND ALCOHOL

-Voids effects of medication

-Worsens treatment

-Worsens side effects



11. DETECTING RELAPSE WARNING SIGNS

•Observe relevant changes

•Immediately consult with case manager or psychiatrist



12. SOLVE PROBLEMS STEP-BY-STEP

-Gradually introduce changes

-Work on one thing at a time

Intervention Techniques I:Intervention Techniques I:The Problem Solving MethodThe Problem Solving Method

Stop and ThinkStop and Think Define the ProblemDefine the Problem Possible SolutionsPossible Solutions Evaluate each SolutionEvaluate each Solution Choose and Plan to Implement your SolutionChoose and Plan to Implement your Solution Resource ManagementResource Management Pick a Time and Do It!Pick a Time and Do It!

psychoeducation workshop for families

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