Schizophrenia

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?

Case Study

Schizophrenia – the First Family Interview

Use open-ended questions to gather each members’ concerns

Ask how this illness has affected interaction with the family

Ask each person about his/her understanding of this illness

Ask how each perceives his/her role in management of this issue

Ask 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

Schizophrenia – What it is/is not

Schizophrenia is A brain disease, with concrete and specific symptoms due to

physical and biochemical changes in the brain An illness that strikes young people in their prime – age of

onset is usually between 16 and 25 Highly treatable with medication, although there is no cure More common than most people think (1% worldwide)

Schizophrenia is not A split personality Caused by childhood trauma, bad parenting, or poverty The result of any action or personal failure by the individual

Schizophrenia – medical management

Positive Symptoms hallucinations delusions disorganized speech and

behavior

Negative Symptomsflat affectpoverty of speechan inability to pursue and persist in goal directed activitiesinability to enjoy anything, apathy

Drug Therapy Two major classes of antipsychotic

medications

Conventional antipsychoticshelp reduce positive symptoms

“Atypical” antipsychoticsNewer drugs that can help reduce both positive and negative symptoms with fewer side effects

Schizophrenia –Family Psychoeducation

Benefits to the patient of family therapy: Family support has been shown to reduce psychotic

relapse Family support creates a safe setting in which the

patient can share his feeling about his illness Family involvement demonstrates caring and trust

and can help decrease stress in the patient Family involvement enlists the family as an ally in

promoting and bringing about therapeutic progress

Schizophrenia –Family Psychoeducation

Benefits of Family therapy to the family caregivers: Continual learning about the disorder, treatments, and

meds Strategies for handling day to day problems due to

symptoms Strategies for helping the patient accept treatment Help in recognizing signs and symptoms of relapse Provides a safe place to share hopes, fears, and

expectations of one another Introductions to local and national support groups

Schizophrenia Recovery Services

Area where assistance may be neededDaily ActivitiesHealthFamily LifeMedication SupportHousing Assistance

Schizophrenia Recovery Services Assistance Areas

EntitlementFinancial ManagementSubstance Abuse TreatmentCounselingHow Do Families Benefit?

Schizophrenia – Resources

Schizophrenics Anonymous – Southfield, Brighton, Clinton

National Organization for Mental Illness

National Mental Health Information Center (part of SAMHSA Substance Abuse Mental Health Service Administration).

Clinton Valley Center Citizens Advisory Council

Assertive Community Treatment Association – Brighton Michigan

Michigan Vocational Rehabilitation

Muesser, Kim and Gingerich, Susan (2006) “Complete Family guide to Schizophrenia.”

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.

Schizophrenia Sounds/Sights

Enjoy a simulation of a schizophrenic as he tries to refill a lost prescription.

Review true life stories from

Michigan schizophrenics

who regularly attend

Schizophrenics Anonymous meetings.

Not all hallucinations need to be frightening