BHECN webinar series The Schizophrenia Spectrum: Part 2 ...€¦ · BHECN webinar series The Schizophrenia Spectrum: Part 2-Practice October 2017 Will Spaulding, Ph.D. Professor of

BHECN webinar series

The Schizophrenia Spectrum: Part 2-Practice

October 2017Will Spaulding, Ph.D.Professor of Psychology, UNL

About This Series: Core Topics for Behavioral Health Providers

Presenter Topic Date

Dr. Will Spaulding Schizophrenia- Part 1 and Part 2 October 19th

Dr. Mario Scalora Forensic Issues and Civil Commitment

November 9th

Dr. Dennis McChargue Addiction TBDDr. Amanda Duffy Randall & Liam Heerten-Rodriguez

Basics of Sexual Health TBD

Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez

Working with Sexual Challenges TBD


Older Adult Sexualities TBD


LGBQ Sexualities TBD


Working with Trans Clients throughout the Lifespan

TBD

• BHECN's webinar series designed to educate behavioral health trainees about practical topics in behavioral health

• Expert presenters provide a mixture of principles and case based application• All webinars are free of charge• Topics include:

The Behavioral Health Education Center of Nebraska (BHECN), pronounced “beacon”, was established in 2009 by a legislative bill to address the shortage of behavioral health professionals in rural and underserved areas of the state. unmc.edu/bhecn

MISSION: BHECN is dedicated to improving access to behavioral health care across the state of Nebraska by developing a skilled and passionate workforce.

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https://unmc.edu/bhecn/

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Conflict of Interest Statement

The presenter has one conflict of interest to acknowledge: He thinks you should buy his book:

The Schizophrenia Spectrum:Part 2: Practice

The Schizophrenia Spectrum Part 2: Practice


The biosystemic paradigm: Levels of functioning & impairmentLevel of functioning Abnormality or problem

social environmental Conflicts with family over autonomy and support, legal problems, limited access to social roles other than “mental patient”

behavioral (instrumental and self-regulation skills)

Deficits in interpersonal, occupational and living skills, mood and emotion self-regulation

social cognition Deficits in person perception, emotion recognition, theory of mind, efficient recognition of social situations

neurocognitive Variable impairments in attention, memory, concept formation, executive functioning

neurophysiological Compromised neural networksAbnormal neurotransmitter metabolismStructural receptor abnormalities


The biosystemic paradigm: Levels of treatment

Level of functioning

Abnormality or problem Treatment approach

neurocognitive Variable impairments in attention, memory, concept formation, executive functioning

Neuropsychological therapy;Structured milieu;Contingency management (behavioral programs)

neurophysiological Compromised neural networksAbnormal neurotransmittermetabolismStructural receptor abnormalities

Antipsychotic medicationMood stabilizing medicationECT


The biosystemic paradigm: Levels of treatment

Level of functioning

Abnormality or problem Treatment approach

socioenvironmental Family conflictLegal problemsNo access to normal social roles

Behavioral family therapyTherapeutic jurisprudenceCommunity resource development

Instrumental skills Living skill deficits, interpersonal skill deficits

Independent living skills training; social skills training

Self-regulation skills Emotional & psychophysiologicaldysregulation

Cognitive behavioral therapy specialized for psychosis

Social cognition Social perception and problem-solving deficits

Social-cognitive therapy specialized for psychosis


Treatment and the episodic course of the illnessSe

verit

y

Time

“reactive” course

“process” course



verit

y

Time



“acute” episodes



verit

y

Time



“baseline” functioning


Treatment and the episodic course of the illness






Rehabilitation and recovery











Person Role

Person recovering The “patient;” provides basic recovery goals, collaborates in all aspects of treatment and rehab planning

Substitute decision-maker

The “guardian;” legally appointed person responsible for making choices the “patient” is unable to make

Supervising practitioner

The “navigator;” provides comprehensive assessment, chief strategist, legally responsible for overall plan

Team coordinator The “case manager;” organizes the team and monitors all aspects of the plan



Team member Role

Medication manager The “prescriber;” Collects and analyzes information on medication response, assesses changing needs and maintains optimal psychopharmacological regimen

Therapist Provides psychotherapy and skill training in group, family and individual formats

Skill coach Provides in vivo skill training and coaching in home, work and leisure settings

Peer support person A non-professional person with lived experience, provides social support, help with activities of daily living, social networking



Collaborator Role

Primary healthcare provider Consult on non-psychiatric health problems, role of primary care in recovery

Neuropsychologist Consult on nature of cognitive impairments, role in recovery, and treatment options

Neuropsychiatrist Consult on psychopharmacology complications, neurological problems

Administrative social work consultant Assessment and planning for benefits, entitlements, disability status

Family members Collaboration on role of immediate and extended family in rehab and recovery



Problem Intervention Primaryprovider

CNS dysregulation Psychiatric medication S. Jones, APRN

Post-acute neuro-cognitive impairment

Integrated Psychological Therapy and individual cognition-focused component for CBTp

B. Allen, Ph.D.A. Smith, M.A.

Emotional regulation skill deficit

Individual mindfulness-focused component in CBTp

A. Smith, M.A.

Independent living skills deficit

Residential rehab program living skills training & coaching

J. Doe, LMHP



Problem Intervention Primaryprovider

Interpersonal skills deficit Social skills training group at community service center

A. Smith, MA

Occupational skills deficit 1) Occupational skills group2) Supported employment program

K. King, OTRS. Gros, LMHP

Family conflict Behavioral family therapy S. Mann, MFT

Unstable housing/financial situation

Benefits assessment and planning R. Swift, MSW


The bible of psychiatric rehabilitation –American Psychiatric Publications, 2008.

Case composites and discussion


End of Part 2

Case composites and discussion

Case A: 25 year old male• Perinatal complications• Parental hx of ADHD, EtOH• Dx’d ADHD @ age 6• Dx’d ODD @ age 10• Socially isolated adolescence• High school dropout• Institutionalized by age 17• No hx of adult functioning• Insidious onset of psychosis• Continuous episodes• Undifferentiated presentation• Poor medication response• Semi-independent functioning

with extraordinary support

Case B: 25 year old male• Normal birth & neonatal health• Family hx of depression• Normal childhood & pubescence• Emotional instability & heavy

cannabis use by age 16• Psychotic onset in college• Paranoid/affective presentation• Moderate medication benefit

but poor adherence• College dropout• Intense family conflict• Chronic unemployment, drift

into homelessness• Semi-functional “mental

patient” social role & life style

BHECN webinar series

The Schizophrenia Spectrum: Part 2-Practice

Questions?

Click the link to view a recording of today's webinar and information on future webinarshttps://www.unmc.edu/bhecn/education/online-training/core-topics-webinars.html

Recording available

https://www.unmc.edu/bhecn/education/online-training/core-topics-webinars.html

Documents

BHECN webinar series The Schizophrenia Spectrum: Part 2 ...€¦ · BHECN webinar series The Schizophrenia Spectrum: Part 2-Practice October 2017 Will Spaulding, Ph.D. Professor of