A-Level Abnormal- Schizophrenia AICE Psychology Syllabus Seth M. Alper, Ph.D. Schizophrenic & Psychotic Disorders

Transcription

1 A-Level Abnormal- Schizophrenia AICE Psychology Syllabus Seth M. Alper, Ph.D. Schizophrenic & Psychotic Disorders

2 Syllabus Content Topic 1: Characteristics of Schizophrenia Spectrum & Psychotic Disorders Definitions, types, examples, and case studies Schizophrenia & Delusional Disorders Virtual Reality Symptom Assessment (Freeman, 2008) Topic 2: Explanations of Schizophrenia Genetic (Gottesman & Shields, 1972) Biomedical- Dopamine Hypothesis (Lindstrom, 1999) Cognitive (Frith, 1992) Topic 3: Treatment of Schizophrenia Biomedical (antipsychotics & atypical antipsychotics) ECT CBT (Sensky, 2000) Token Economy (Paul & Lentz, 1977)

3 Syllabus Content Topic 1: Characteristics of Schizophrenia Spectrum & Psychotic Disorders Definitions, types, examples, and case studies Schizophrenia & Delusional Disorders Virtual Reality Symptom Assessment (Freeman, 2008)

4 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Definitions Psychotic disorders- Psychological disorders that involve a major break from reality in which the individual perceives their world in a way that is very different from how others perceive it Schizophrenia- a psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of strange perceptions, disturbed thought processes, unusual emotions, and motor abnormalities Psychosis- A specific aspect of these disorders when the individual loses contact with reality in key ways Such as the ability to understand the real world compared to the imagined world that they believe

5 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Diagnosing The DSM-5 now includes the Schizophrenia Spectrum Allows for the severity and/or type of schizophrenia to be recognized allows clinicians to classify both the duration and severity of an individual's schizophrenia A patient is evaluated based on the symptoms displayed May be mild (hearing one word in their head) to severe (seeing pink elephants chasing them down the hallway) Schizophrenics may have positive and/or negative symptoms

6 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Schizophrenia DSM-5 Criteria 1. At least two of the following symptoms present for a significant portion of a 1-month period Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior. Negative symptoms 2. Functioning markedly below the level achieved prior to onset 3. Continuous signs of the disturbance for at least 6 months at least 1 month of full active symptoms

7 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Phases of Schizophrenia Promodal phase-symptoms not yet obvious but persons are beginning to deteriorate Active phase - symptoms often become apparent Often triggered by a life stressor (think diathesis stress model) Residual phase - Return to a promodal phase like situation including normal functioning. Up to 25% recover completely but most still have some negative symptoms

8 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Course of Schizophrenia 30 Usually appears in the late teens to early 30 s Males Females to to to to to to to to to to 59

9 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Symptoms of Schizophrenia Schizophrenia has both positive and negative symptoms Do NOT think positive is good and negative is bad!! Positive symptoms mean that something has been added or changed that was not a part of your normal functioning previously; a voice in your head, seeing something that is not physically present, and so on. Negative symptoms are the most common in mental health disorders- as the name implies, you ve lost something; this usually refers to your normal functioning (speech, facial expressions, sleep, affect.)

10 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Positive Symptoms of Schizophrenia Symptoms of schizophrenia that seem to be excesses of or bizarre additions to normal thought, emotions or behaviors. Delusions = a strange, false belief firmly held despite evidence to the contrary (discussed more under Delusional disorders) Disorganized Speech/Thoughts May not be able to think/speak logically- aka Loose Associations Often incoherent, making person difficult to understand or follow Schizophrenic patient asked about his itchy arms replied 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 television. Disorganized Behavior- possibly in arms/leg movement, running around, faces, etc

11 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Positive Symptoms of Schizophrenia Hallucinations - The experiencing of sights, sounds, or other perceptions in the absence of external stimuli. The voices were in different parts of the room. Every voice was different, and each beautiful, and generally, speaking or singing in a different tone and measure, and resembling those of relations or friends. There appeared to be many in my head, I should say upwards of fourteen. I divide them, as they styled themselves, or one another into voices of contrition, and voices of joy and honor. Auditory MUCH more common than visual

12 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Negative Symptoms of Schizophrenia Symptoms of schizophrenia that seem to be deficits in normal thought, emotions or behavior. These symptoms are typically more difficult to diagnose in a patient Alogia- a decrease in speech or speech content (also known as poverty of speech) Flat affect - a marked lack of expressed emotions or to a lesser degree a blunted affect Anhedonia- no longer interested in things that brought you pleasure Such as hobbies, friends, sex, etc.

13 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Negative Symptoms of Schizophrenia Loss of Volition - feelings of apathy, lack of energy or interest in normal goals. Social withdrawal- withdrawal from the social environment and a retreat into their own needs and fantasies. Catatonia - a pattern extreme psychomotor symptoms found in some schizophrenia, which may include catatonic stupor, rigidity, posturing, or repetitive actions (bouncing a ball)

14 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Examples of Hallucinations Auditory Hallucinations through the eyes of Schizophrenic: Auditory & Visual Hallucinations through the eyes of a Schizophrenic Anderson Cooper & the Schizophrenia Simulator:

15 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Main Types of Schizophrenia Simple - when people gradually withdraw themselves from reality Paranoid - when people have delusional thoughts of prosecution or grandeur Catatonic - when people have motor activity disturbances that may involve them sitting or standing in the same position for hours Disorganized - when people have disorganized thoughts or behavior. Also known as hebephrenic Undifferentiated - does not fit neatly into any of the above categories

16 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Case Study- John Nash a brilliant mathematician who developed paranoid schizophrenia in his 30s believed that people who wore red ties were part of a communist conspiracy he was hospitalized several times in his life he was able to use cognitive processing to deal with his paranoid thinking he stopped taking medication

17 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Fiction A Beautiful Mind Fact and Fiction Fact Nash s hallucinations begin at age 20 as a grad student Vivid visual hallucinations with whom he regularly interacts Hospitalized once Start when he is 30 and a teacher at MIT Only auditory, NEVER visual ones Hospitalized many times Married to his wife who sticks with him despite illness Divorced because she is frightened of him, but they eventually remarry Stopped taking drugs but then resumed with the atypical antipsychotics Has one child with no schizophrenia Stopped drugs in 1970 and never took them again His son actually developed schizophrenia and also got a Ph.D. in math.

18 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Virtual Reality Symptom Assessment (Freeman, 2008) Freeman wanted to attempt a more standardized, novel way of diagnosing Schizophrenia the traditional route was a structured interview, but because of the paranoid and distrustful nature of schizophrenics, this was not reliably successful Decided to incorporate virtual reality into the diagnostic process Allowed for a decrease in demand characteristics and social pressure to conform when answering questions Method was hypothesized to be highly effective It would instead provide genuine behavior that is being measured, even though the social environment was artificial

19 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Virtual Reality Symptom Assessment (Freeman, 2008) Before the experiment began, the active group of 200 students (a non-clinical population) took diagnostic assessments to determine their baseline levels of paranoid thinking, emotional distress, and other basic cognitive and social traits. This included the Greene Paranoid Thoughts Scale, Part B (GPTS-B) Then, the participants put on the Virtual Reality (VR) headset and were immersed in an environment of either an underground train station or a library. Neutral avatars existed around them, giving neutral facial expressions. Finally, the participants exited the simulation and completed more diagnostic assessments of their experience, and emotions.

20 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Virtual Reality Symptom Assessment (Freeman, 2008) Main findings/conclusions Participants who had scored high on the pre-vr assessment of paranoia experienced high levels of prosecutorial ideation (the feeling/idea one is being persecuted or judged by others) during the VR trial This means that paranoid participants (who received the same neutral feedback as the other participants) perceived they were being persecuted, attacked, or judged by the virtual people they encountered in the simulation. In a related study, Freeman reported that even in a false or constructed environment, individuals diagnosed with Schizophrenia still experience auditory hallucinations

21 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Virtual Reality Symptom Assessment (Freeman, 2008) Freeman s Experiment:

22 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Schizotypal Personality Disorder Delusional Disorder Brief Psychotic Disorder Schizophrenia Schizoaffective Disorder Substance/Medication Induced Psychotic Disorder Psychotic Disorder due to another Medical Condition Related Disorders: The Schizophrenia Spectrum Schizophrenia is one of 9 disorders that fall under the umbrella of psychotic disorders. Though all are broadly similar, they may have significant differences, such as severity and underlying cause. They range from Schizotypal Personality Disorder (a well documented and thoroughly researched disorder) to Unspecified Schizophrenia Spectrum and Other Psychotic Disorder (a simple grouping of symptoms that fall under the psychotic umbrella; without known cause.) In this way, you should view these disorders from most organized at the top, to least organized at the bottom. Catatonia associated with another Mental Disorder or Condition Unspecified Schizophrenia Spectrum and other psychotic Disorder

23 Characteristics of Schizophrenia Spectrum & Psychotic Disorders Delusional Disorders Defined- A psychological disorder in which the individual exclusively suffers from delusions, and does not suffer from any other symptoms of related disorders such as the hallucinations or disorganized speech like in schizophrenia The 4 main types of Delusional Disorder are as follows: Erotomanic (the delusion of love) Grandiose (the delusion of power, status, or skill) Jealous (the delusion of jealousy) Persecutory (the delusion of paranoia or harm)

24 Video: Elyn Saks, Schizophrenia from the inside

25 Syllabus Content Topic 2: Explanations of Schizophrenia Genetic (Gottesman & Shields, 1972) Biomedical- Dopamine Hypothesis (Lindstrom, 1999) Cognitive (Frith, 1992)

26 Explanations of Schizophrenia Genetic Explanations Research, such as pedigree studies, have shown that schizophrenia is more common in people who have a schizo 1 st degree relative Gottesman & Shields (1972)- genetic link in twins research 57 pairs of twins (24 MZ pairs & 33 DZ pairs) who at least one had schizo Research with interviews and cognitive tests for both twins Case summaries independently judged for validity Found that 50% of MZ twins share schizophrenic status, but only in 9% of DZ This confirms their theory of concordance and genetic markers In MZ twins, if both twins have Schizophrenia, and one twins condition is severe, it is very likely that the other, second twins condition, is also severe In MZ twins, the above finding does not apply if the Schizophrenia is classified as mild

27 Genetic Explanations Explanations of Schizophrenia Gottesman (1991)- meta-analysis of over 40 twin studies conducted in Europe The concordance rate for MZ is 48% while for DZ is only 17% These concordance rates are not 100% therefore this tends to suggest that people may be born predisposed to schizophrenia but it takes environmental stimuli to cause it to develop Torrey et al. (1994) study of discordant MZ twins Examined 27 pairs of MZ twins where one has a Dx of schizophrenia and the other twin does not (discordant) The discordant twins were described as different from each other as children (shy vs outgoing, aggressive vs passive) Found prominent differences in rcbf between discordant twins

28 Concordance Rates for Schizophrenia 48 Offspring of 2 Schiz Offspring of 1 Schiz 13 9 Parent 6 Uncle/Aunt 0 2 General Pop st Degree 2nd Degree 3rd Degree

29 Explanations of Schizophrenia Genetic Explanations Genetic linkage & molecular biology studies Collect DNA from all members of a family in which schizophrenia is common. Then compare the DNA of those with a Dx and those without a Dx Yang et al (2013) analyzed 10 candidate genes that could be responsible for schizophrenia in 512 participants. did not identify a single gene that causes schizophrenia, but found the DAO gene was strongly correlated with schizophrenia

30 Explanations of Schizophrenia Genetic Explanations Adoption studies Tienari et al. (1994) looked at the adopted children of women with and without a Dx of schizophrenia found a high concordance rate for the children of women with the Dx of schizophrenia however, the concordance rate was even higher when the researchers factored in the level of quality of adoptive care when the quality was low, the Dx rate among the children was even greater

31 Genetic Explanations The Genian Quadruplets (Case Study) Explanations of Schizophrenia Quads born in 1930 s- EACH developed schizophrenia (1:1.5 billion odds) Even though they are quads they had different environmental and health environments. They all developed schizophrenia at different ages from Hester, the runt, developed it the earliest and it was the most severe Myra developed it the latest and also had the least severe Nora was most often the target of her father s sexual advances

32 Biochemical Explanation Dopamine Hypothesis = the theory that schizophrenia results from excessive activity of dopamine in the brain theorized after the 1 st antipsychotic medications were developed to target and correct grossly confused and/or distorted thinking they were eventually discontinued because they produced tardive dyskenesia (a muscular disorder of involuntary movements) Lindstrom (1999) Explanations of Schizophrenia specifically says that the brains of schizophrenics are malfunctioning due to increased amount of dopamine in the synapse Findings have shown increased amounts of dopamine or dopamine receptors create more positive symptoms of schizophrenia by either firing too often, or sending too much information to the next neuron across the synapse also, a general increase in dopamine disrupts normal functioning in many brain regions, including Broca s area.

33 Biochemical Explanation- Dopamine Hypothesis (Lindström,1999) Explanations of Schizophrenia

34 Biochemical Explanation Explanations of Schizophrenia Support the Dopamine Hypothesis (Lindstrom, 1999) Amphetamine and cocaine increase dopamine production in non-clinical individuals, and elicit symptoms similar to schizophrenia (delusions, hallucinations, etc.) these same drugs, when administered to a clinical population (schizophrenics) worsen positive schizophrenic symptoms greatly. Parkinson s patients who are treated with a synthetic compound chemically similar to dopamine (L-Dopa) develop symptoms identical to schizophrenia if their dosage is too high

35 Biochemical Explanation Explanations of Schizophrenia Support for the Dopamine Hypothesis (Lindstrom, 1999) Autopsies preformed on schizophrenic patients found a greatly increased amount of dopamine receptors within the brain. Wise (1974) found an abnormally low amount of the enzyme that breaks down dopamine in the brains of schizophrenic individuals; this means,(in addition to have too much dopamine flooding the brain) a schizophrenics brain does break down dopamine efficiently, leaving it to linger in the synapse, and effect the individual for a longer period of time PET scans reveal increased dopamine receptors in the striatum, limbic system, and cortex of the brain in schizophrenic individuals; This is associated with an increase in positive symptoms. Nestler (1997) hypothesized, in contrast, that decreased dopamine in the prefrontal cortex leads to negative symptoms and flat affect

36 Explanations of Schizophrenia Abnormal Brain structure Research has linked brain structure with schizophrenia, especially with negative symptoms Has been linked to enlarged ventricles as seen in the brain scan May be a sign that the brain is not fully developed because these same ventricles are also associated with poor social skills prior to the development of schizophrenia Other findings Smaller temporal lobes Abnormal r-cbf Problems in the amygdalae, hippocampus and thalamus

37 Explanations of Schizophrenia Biological Basis- Viral problems Other researchers look at prenatal viruses that may be a cause Wright et al. (1995) found that maternal influenza in the second trimester is associated with impaired fetal growth and later-developing schizophrenia. Takei et al. (1997) found that the 5 th month is the most critical

38 Review Questions 5. Discuss the genetic model as an explanation for schizophrenia [4] 6. Discuss the dopamine hypothesis as an explanation for schizophrenia [4]

39 Cognitive Explanations Explanations of Schizophrenia Cognitive explanation focuses on the Dx as being a result of cognitive deficits *Frith (1992) Abnormality of self-monitoring - theorizes that schizophrenia is explained by a mental impairment in failing to understand if stimuli is real or imagined and internal or external Can be thought of as lacking theory of mind for those with ASD Believed that schizophrenics have problems with meta-representation (gives us the ability to reflect on our own thoughts, behaviors, and emotions) Those with more negative symptoms might have a dysfunctional supervisory attention system that is responsible for generating self-initiated actions Frith (1992) also identified a central monitoring system that allows a person to understand actions that are self-generated. This may explain why they can t distinguish that the voices they hear are self-generated

40 Cognitive Explanations *Frith (1992) Explanations of Schizophrenia To test this theory, patients were asked to determine if lines are being read by themselves, the experimenter, or a computer. Schizophrenic patients who failed at this task had the symptom of incoherent speech and had difficulty self-monitoring Normal self-talk (within the mind) may be perceived by the schizophrenic individual as an external voice (auditory hallucination) commanding certain actions, or planting specific illogical falsehoods ( I am the queen of England ) Delusional thinking may also be an abnormality of self-monitoring; what they consider delusions may simply be internal thoughts they perceive as coming from an external source (ex. alien control, thought insertion) As well, schizophrenics may not be able to understand the social cues and intentions of others (lacking theory of mind), leading to paranoia and distrust This also applies to negative symptoms- a lack of theory of mind intensifies the social isolation an individual may feel, leading to flat affect, withdrawal, and lack of speech

41 Syllabus Content Topic 3: Treatment of Schizophrenia Biomedical (antipsychotics & atypical antipsychotics) Electro-Convulsive Therapy (ECT) Cognitive-Behavioral Therapy (Sensky, 2000) Token Economy (Paul & Lentz, 1977)

42 Treatment of Schizophrenia Biomedical Treatment Antipsychotics (aka 1 st generation antipsychotics- FGAs) Popular in the 1950 s Works by blocking specific neurotransmitters & receptors in the brain, BUT it did not work exclusively with Dopamine Impacted levels of serotonin and norepinephrine Change in a patient can be seen short term (within 1 week) and long term (over many weeks) Examples include chlorpromazine (aka Thorazine) & Haloperidal (aka Haldol) Very strong tranquilizing effect known as chemical lobotomy Conventional antipsychotic drugs (aka neuroleptic drugs) often produced undesired effects similar to the symptoms of neurological disorders Extrapyramidal symptoms (EPS)- unwanted movements such as severe shaking, bizarre looking grimaces, twisting of the body, twitching/spasms, and/or extreme restlessness Tardive Dyskinesia (TD)- involuntary movement and loss of motor control of the face and mouth, including tongue rolling and sucking of the lips

43 Treatment of Schizophrenia Biomedical Treatment Antipsychotics (1 st generation antipsychotics -FGAs) Conventional antipsychotic drugs (aka neuroleptic drugs) often produced undesired effects similar to the symptoms of neurological disorders Extrapyramidal symptoms (EPS)- unwanted movements such as severe shaking, bizarre looking grimaces, twisting of the body, twitching/spasms, and/or extreme restlessness Tardive Dyskinesia (TD)- involuntary movement and loss of motor control of the face and mouth, including tongue rolling and sucking of the lips

44 Biomedical Treatment Treatment of Schizophrenia Antipsychotics Extrapyramidal symptoms

45 Biomedical Treatment Treatment of Schizophrenia Atypical Antipsychotics (aka 2 st generation antipsychotics-sgas) Popular in the 1990s present Newer drugs that do not have the severe side effects of the first generation antipsychotics (neuroleptic drugs). Examples include Seroquel Abilify The most common side effects include dry mouth, blurred vision, dizziness, lightheadedness, and weight gain. Sometimes atypical antipsychotics can cause problems sleeping, sexual side effects, extreme tiredness, and weakness.

46 Treatment of Schizophrenia Biomedical Treatment Antipsychotics Though antipsychotics (1 st & 2 nd gen) have shown to be highly effective, the relapse rate is rather high attributed to non-adherence to medication mainly due to periods of remission (no symptoms) or the side effects Leuct et al. (2013)- meta-analysis on efficacy of antipsychotics 212 studies with over 43,000 participants Finding that SGAs were consistently and significantly more effective than FGAs Guo et al (2010)- found that combining antipsychotics with psychosocial intervention was more effective than antipsychotics alone

47 Electro-Convulsive Therapy Falls under the biological treatments Treatment of Schizophrenia In the 1930 s, a false correlation was made b/w schizophrenia and epilepsy, sparking research into ECT treatments of schizophrenia Previous ECT treatments (without the use of accompanying anti-anxiety drugs or anesthetics) could cause a patient to suffer severe trauma, broken bones, or even death Even with modern improvements, serious risks are still associated Damage to the Central Nervous System (CNS) Damage to the Cardiovascular System Memory Loss Neurological Damage Death

48 Electro-Convulsive Therapy Treatment of Schizophrenia Modern ECT is more mild, controlled, and safe WVU Medicine A mild seizure is induced, which is the treatment. One lobe is treated, to reduce the potential for memory loss. The patient typically receives ECT twice a week, for 6 to 12 weeks There is still no single, agreed upon explanation for the effect Leading theory is that ECT manipulates post-synaptic responses to the central nervous system (CNS)

49 Cognitive Behavioral Therapy Treatment of Schizophrenia Sensky (2000)- looked at patients who did not respond to biochemical treatments (and before going to ECT) Wanted to asses the effectiveness of CBT compared to befriending (non-psychological treatment) As CBT is structured with specific stages, befriending is simply a form of discussion that would typically occur between friends about various topics of interest 90 patients (ages 16-60) were assigned to CBT or befriending groups CBT group followed distinct stages: engaging with the patient, discussing the emergence of the disorder, and finally discussing current specific symptoms, and their possible treatment. CBT patients kept voice diaries to record what they were hearing to later use to create coping strategies during treatment

50 Cognitive Behavioral Therapy Sensky (2000) Treatment of Schizophrenia Results showed that both the befriending group and the CBT group experienced a significant overall reduction in positive and negative symptoms of Schizophrenia However, at the 9-month follow up stage, only the CBT group continued to see a reduction in positive symptoms The befriending group did not see a long-term improvement regarding positive symptoms.

51 Cognitive Behavioral Therapy Treatment of Schizophrenia Other Research Findings on CBT Bechdolf et al (2005) assessed the effectiveness of CBT vs group psychoeducation on rehospitalization and med compliance CBT group had 71 fewer days of hospitalization Follow up study also found that the CBT group reported a greater quality of life at 6 months post treatment Ng, Hui, & Pau (2008) studied CBT in Hong Kong Found that at 6 months post Tx, there was a significant reduction in the symptoms of schizophrenia and an increase in self-esteem

52 Treatments of Schizophrenia Token Economy (Behavioral Treatment) Defined- based on operant conditioning principles, a behavioral program in which a person s desirable behaviors are reinforced systematically throughout the day by awarding of tokens that can be exchanged for goods or privileges Based on the notion that we know that change has occurred only through observable actions/behaviors Paul & Lentz (1977) wrote extensively on the purported success with schizophrenic patients Used tokens for engaging in self-care, attending therapy, and engaging in social situations Tokens could be exchanged for candies, clothing, cigarettes, and TV time

53 Treatments of Schizophrenia Token Economy (Behavioral Treatment) Paul & Lentz (1977) Patients were placed in 1 of 3 groups: Traditional Hospitalization (with no additional support) (control group) Traditional Hospitalization (with Milieu Therapy) Milieu Therapy: treatment using a therapeutic community, where patients live together and look after both themselves and each other, promote social engagement, and build relationships. Traditional Hospitalization (with Token Economy) Hypothesized that token economy patients: would see a reduction in symptoms have more successful long-term outcomes as discharged patients

54 Treatments of Schizophrenia Token Economy (Behavioral Treatment) Paul & Lentz (1977) Ps- 84 patients chronically admitted to psychiatric institutions over 4 ½ years Behavior was monitored through various means, including time-stamped observations, standardized questionnaires, and individual interviews Patients in the token economy group showed the most improved results both positive and negative symptoms were reduced very effective in treating catatonic behavior and social withdrawal but less effective in treating hallucinations & delusional thinking 97 % of token group lived independently after discharge Compared to 71% of the Milieu group & 45% of hospitalization Wakefield (2008) criticized research as not being generalizable outside of the clinical setting

55 Treatments of Schizophrenia The case for hospitalization Advantages of hospitalization Opportunity for greater observation Helps avoid emergency situations arising from the Dx Security and support for the patient Considerations for hospitalization Is the patient in an unstable mental state that includes suspiciousness or anger? Is the patient having auditory and/or visual hallucinations that might lead to self-harm or harm to others? Does the patient have behavioral disorganization? Are they experiencing major cognitive deficits that include lack of insight, impaired attention, and/or the inability to communicate meaningfully? Does the patient lack adequate social support?

56 Treatments of Schizophrenia The case for hospitalization Does this violate concepts of ethics? Most states have very specific laws governing when a person can be hospitalized against their will (FL allows it) Should patients be medicated against their will? Should they be able to refuse medication when they can t distinguish reality from hallucinations and delusions? Some studies point that the patients are later in agreement with the forced medication and take meds voluntarily.