Schizophrenia and Related Disorders

8/14/2019 Schizophrenia and Related Disorders

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Schizophrenia and relatedSchizophrenia and related

An occupational therapy

perspective


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IntroductionIntroduction

Schizophrenia is oneof a number ofconditions (oftencalled psychoses)characterised by:

A loss of contact

with reality, usuallyincluding: Delusions

Activity 1

From yourpreparatory reading,

define hallucinationsand delusions giving examples ifpossible

What other thingsmight lead to similarsymptoms to


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Gaining an understanding ofGaining an understanding of


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ExampleExample

The next slide is a sample movie of a part of anew piece of virtual reality softwaredesigned to help healthcare professionalsunderstand what psychotic symptoms arelike

Although the movie is not the full

experience, it may still cause you distress. Ifyou anticipate such difficulties, or find youbecome too distressed durin the movie,


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The Degeneration of the Psychotic Perception ofThe Degeneration of the Psychotic Perception ofthe World:the World:

Pre-morbid artworkPre-morbid artworkSubsequently, hisartwork showedevidence of hisprogressive loss ofcontact with reality.Wain began tosuffer symptoms ofvery late-onsetschizophrenia at age57. He neverrecoveredFocus particularlyon the way cats eyesare seen


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Disordered thinkingDisordered thinking

When we dream, all sorts of strange things canhappen to us, but we still believe that theyre reallyhappening to us. Hearing voices can be like that - awaking dream - but something that is experienced as

real. (Darton & Sharman, 2004)

Unlike anxiety-based disorders, the symptomsascribed to psychotic disorders may appear to beoutside our experience. This quote, however,

suggests that our dreams may provide a means ofunderstanding these symptoms. In pairs, discuss past dreams you can remember:


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HallucinationsHallucinations

What do you do?

Your mobile phone rings. Youanswer it, and a voice says,Careful - theyre all watching

When you respond to the caller,there is silence

You discover that the phone isswitched off

You later find out that the

battery has run out

Discuss in groups:

Why do we tend torationalise ?


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Key FeaturesKey Features

First episode


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First-e isode schizo hreniaFirst-e isode schizo hrenia Three typical phases (Bonder 2004:96):

Prodromal First symptoms appear, but condition may not be recognised (Ballas

2007) Symptoms are non-specific; and do not necessarily lead to full

schizophrenia (White et al 2006:376)

In essence, the prodrome is the period between the most validestimates of the onset of change in the person and the onset ofpsychosis (Yung & McGorry 1996:355)

Active Dominated by positive symptoms Phase for which diagnosis can be (retrospectively) made

Diagnosis cannot be made until minimum criteria have been evident for 1month (ICD-10) or even 6 months (DSM-V)

Residual Active phase has passed; but similar features to prodromal phase

remain ***NB*** Although this is the typical pattern after first episode, some

patients appear to make a full recovery


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The prodromal phase The prodromal phase

In small groups:

Read the case study on page 3 From Mller and Husbys list of prodromal features (page 2),

is there sufficient evidence available for a diagnosis ofschizophrenia here?

How else might this girls presentation be explained?

Look at the graph showing the development of

psychosis over time At which arrow point would you say the prodromal phase

begins?

When would you say that the prodromal phase ends, and theactive hase be ins?


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The active phase a MOHOThe active phase a MOHO

In the first episodeof psychosis, what islikely to be the effect

on a persons: Occupational

competence?

Occupationalidentity?

What are theimplications of thisfor the focus of our


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The active hase effect on volitionThe active hase effect on volition

Personal causation

Delusions such as thought insertion/ withdrawal; thoughtbroadcasting (involuntary); ideas of reference; and passivity arelikely to lead to a sense of loss of control (lowered personalcausation)

In contrast, grandiose delusions may lead to inappropriately high

personal causation

Interests Person may appear to have lost interest in previously valued

occupations, and may appear disinterested in other suggested

activities (anhedonia) However, there may be an obsessional interest in one or two

(sometimes delusionally-based) activities examples?

Values and goals Values may be confused and related to disordered thinking


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The active hase effect onThe active hase effect on

Habits

May lose all sense of daily/weekly schedules - leading to, e.g.,lateness for appointments; disrupted pattern of waking/sleeping;self-neglect (missing meals, forgetting to wash/bathe/changeclothes)

Alternatively, may develop a very fixed, limited routine of

activities, as a coping strategy Possible development of an opportunistic pattern of behaviour

drifting into any activities that are around, but not tending toinitiate many independently

Pre-occupation with one or two activities leading to impoverishedroutines

Roles Perception of roles may change due to delusional beliefs

Disruption to volition and habits is likely to seriously disrupt pre-


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The active hase effect on erformanceThe active hase effect on erformance

Performance capacity Objective capacity not significantly affected during first episode

(likely to still be have the capacity to carry out pre-morbidactivities) usually able to return to full capacity once activesymptoms ha

Subjective capacity, however, may be significantly impaired by abelief that they are being prevented from performing theseactivities (c.f. reduced personal causation)

Performance behaviour Mind, brain and body performance may all be significantly

impacted as a result of symptoms (e.g. difficulties in concentratingdue to hallucinatory experiences) and/or side-effects ofmedication

Participation

Work, play and ADL all significantly impaired during active phase


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The active hase effect on skillsThe active hase effect on skills

Perceptual-motor and process skills Difficulty in accurately perceiving real experiences

Active-phase symptoms may include perceptions of bodily control

Abnormal movements? Symptoms of illness

Side-effects of medication (Parkinsonian)

Communication and interaction skills Disordered speech

Paranoia and delusions

Withdrawal from social situations


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The first episode and beyondThe first episode and beyond

Pre-morbidpresentation

Prodromalphase

Active phaseResidualphase

Full symptomsnot developed

Never fullyrecover (10%

of those

developings m toms

No furtherepisodes (20% of

those developingsymptoms)


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Pr n i f r fir iPro nosis after first e isode

Patients who never recover

will need ongoing supportfrom professional services 50% of patients relapse in less

than 2 years Rises to about 61% by 5 years

In most patients (> 60%),schizophrenia has aprolonged, remitting/relapsing course with variableinter-episode recovery; acuterelapses may occur years afterremission (Frangou &

Kington 2004:24) Each relapse produces

increased levels of residualsymptoms Eventually, changes to brain

structures become a arent


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Living with schizophrenia: sharedLiving with schizophrenia: sharednarrativesnarratives

Overall theme: And

then I lost that life

Five chapters:

1. I remember when Iwas normal

2. Its like your computercrashes

3. Coasting through life4. Try to remake that life

as best you can

Using handout #2(p.467 of this article):

Summarise the key

implications of this studyfor practice

Discuss how you mightidentify what stage in thejourney an individual is

at Brainstorm different

occupations that might


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Quality of life with schizophreniaQuality of life with schizophrenia(Lalibert-Rudman et al, 2000)(Lalibert-Rudman et al, 2000)

Seven major factors:

Activity

Social interaction

Time Being normal

Disclosure

Finances

These factors relate tothree overall themes:

Managing time

Connecting andbelonging

Making choices andmaintaining control

As an OT, how would you structure anintervention to ensure these themes and factors

are suitabl addressed?


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Schizophrenia a long-termSchizophrenia a long-term

Research is increasingly challenging thetraditional, pessimistic view of

schizophrenia as almost always chronicand progressive. (Macrae 2005:151):

Some studies suggest that recovery orsignificant improvement may occur inabout 68% of cases (McGuire 2000)

However, such improvement may take 2-3


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ReferencesReferences Ballas, P (2007). Early detection of schizophrenia:

the prodrome phase. Accessed online at

http://www.healthcentral.com/schizophrenia/c/76/3(15.09.08).

Bonder (2004). Psychopathology and Function.Thorofare, New Jersey: SLACK Inc. Darton K and Sharman J (2004). Understanding

Psychotic Experiences. London: Mind.

Available online at:http://www.rcpsych.ac.uk/mentalhealthinformation/(2.10.06).

Frangou, S and Kington, J (2004). Schizophrenia.Medicine 32(7):21-25.
http://www.healthcentral.com/schizophrenia/c/76/3075/early-phase/http://www.rcpsych.ac.uk/mentalhealthinformation/definitions/diagnosesorconditions.aspxhttp://www.rcpsych.ac.uk/mentalhealthinformation/definitions/diagnosesorconditions.aspxhttp://www.healthcentral.com/schizophrenia/c/76/3075/early-phase/


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ReferencesReferencesGeanellos, R (2005). Adversity as opportunity:living with schizophrenia and developing a resilientself. International Journal of Mental Health Nursing14(1):7-15.Gould, A; DeSouza, S; and Rebeiro-Gruhl, KL

(2005). And then I lost that life: a shared narrative offour young men with schizophrenia. British Journalof Occupational Therapy68(10):467-473.Laliberte-Rudman, D; Yu, B; Scott, E; and

Pajouhandeh, P (2000). Exploration of theperspectives of persons with schizophreniaregarding quality of life.American Journal ofOccupational Therapy 54(2):137-47.


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ReferencesReferencesMacrae A (2005). Schizophrenia. In: E Cara and A Macrae

(Eds). Psychosocial occupational therapy: a clinical practice.Clifton Park, New York: Thomson Delmar Learning.Mller, P & Husby R (2000). The initial prodrome inschizophrenia: searching for naturalistic core dimensions ofexperience and behaviour. Schizophrenia Bulletin26(1):217-

232. Accessed online at

http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/26/1/(05.10.08).

White, T; Anjum, A; and Schulz, SC (2006). The

schizophrenia prodrome.American Journal of Psychiatry163(3):376-380.Yung, AR & McGorry, PD (1996). The prodromal phase offirst-episode psychosis: past and current conceptualizations.Schizophrenia Bulletin22(2):353-370.
http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/26/1/217http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/26/1/217

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Schizophrenia and Related Disorders