2 Schizophrenia Case Study Mark James, 22 year old client is being discharged from his first hospital admission for schizophrenia to the home he shares with his father and his two sisters. Mark has been alienated from his mother since his parents’ divorce when he was 17 years old. Mark’s mother has failed to show up for the discharge conference. The mental health team has recommended family therapy to the James family. You perceive what you think is annoyance on Mr. James’s face, and one of Mark’s sisters appears embarrassed. Although you would not be the James family therapist because you are not a clinical specialize, you recognize how important Mark’s family can be to his progress. What actions can you take to address the family's unspoken concerns and needs?
3 Schizophrenia – the First Family Interview Use open-ended questions to gather each members’ concernsAsk how this illness has affected interaction with the familyAsk each person about his/her understanding of this illnessAsk how each perceives his/her role in management of this issueAsk what coping strategies have worked in the family in the past (divorce etc).Is there anything else you feel I must know to help you?Assess/evaluate family communication and need for intervention.Ask about burdens that the family may be facing
4 Schizophrenia – What it is/is not Schizophrenia isA brain disease, with concrete and specific symptoms due to physical and biochemical changes in the brainAn illness that strikes young people in their prime – age of onset is usually between 16 and 25Highly treatable with medication, although there is no cureMore common than most people think (1% worldwide)Schizophrenia is notA split personalityCaused by childhood trauma, bad parenting, or povertyThe result of any action or personal failure by the individual
5 Schizophrenia – medical management Positive Symptomshallucinationsdelusionsdisorganized speech and behaviorNegative Symptomsflat affectpoverty of speechan inability to pursue and persist in goal directed activitiesinability to enjoy anything, apathyDrug Therapy Two major classes of antipsychotic medications“Atypical” antipsychoticsNewer drugs that can help reduce both positive and negative symptoms with fewer side effectsConventional antipsychoticshelp reduce positive symptoms
6 Schizophrenia –Family Psychoeducation Benefits to the patient of family therapy:Family support has been shown to reduce psychotic relapseFamily support creates a safe setting in which the patient can share his feeling about his illnessFamily involvement demonstrates caring and trust and can help decrease stress in the patientFamily involvement enlists the family as an ally in promoting and bringing about therapeutic progress
7 Schizophrenia –Family Psychoeducation Benefits of Family therapy to the family caregivers:Continual learning about the disorder, treatments, and medsStrategies for handling day to day problems due to symptomsStrategies for helping the patient accept treatmentHelp in recognizing signs and symptoms of relapseProvides a safe place to share hopes, fears, and expectations of one anotherIntroductions to local and national support groups
8 Schizophrenia Recovery Services Area where assistance may be neededDaily ActivitiesHealthFamily LifeMedication SupportHousing Assistance
9 Schizophrenia Recovery Services Assistance Areas EntitlementFinancial ManagementSubstance Abuse TreatmentCounselingHow Do Families Benefit?
10 Schizophrenia – Resources Schizophrenics Anonymous – Southfield, Brighton, ClintonNational Organization for Mental IllnessNational Mental Health Information Center (part of SAMHSA Substance Abuse Mental Health Service Administration).Clinton Valley Center Citizens Advisory CouncilAssertive Community Treatment Association – Brighton MichiganMichigan Vocational RehabilitationMuesser, Kim and Gingerich, Susan (2006) “Complete Family guide to Schizophrenia.”
11 Schizophrenics Anonymous Support groups can help to move one to a direction of independence and renewed energy.Instill hopes to help one gain a sense of control in relationships by taking small manageable steps. Helps to promote a feeling of mastery and optimism.Support groups often lead to related social groups which further enhance the quality and quantity of client’s social behavior.Uncommunicative clients can benefit from being in the presence of others if they feel safe, and do not have to interact.Social activities are easier if a close friend initially accompanies client and if one knows it is possible to leave at any time.
12 Schizophrenia Sounds/Sights Enjoy a simulation of a schizophrenic as he tries to refill a lost prescription.Review true life stories fromMichigan schizophrenicswho regularly attendSchizophrenics Anonymous meetings.