Module Two SCHIZOPHRENIA

1. Module TwoSCHIZOPHRENIA • Lesson 1: What is schizophrenia and who it is manifested • Lesson 2: How the patient himself experiences Schizophrenia • Lesson 3: What are the causes of Schizophrenia • Lesson 4: Ways of treatment for Schizophrenia • Lesson 5: Schizophrenia and Family • Lesson 6: Other psychotic disorders

2. Lesson 1 WHAT IS SCHIZOPHRENIA AND HOW IT IS MANIFESTED

3. Step 1: Introduction The subject of Schizophrenia preoccupy the society and attracts the Media. Unfortunately what is said or written is often inaccurate and create false impressions, which, in their turn, block the more efficient treatment of this serious problem.

4. Step 2 • The person that suffers from Schizophrenia has not got “split mind” or “dual personality” • He is not “dotty”, “nutty”, “cracked” or “loony” etc. these terms are not used in Psychiatry. • He is no a criminal or violent. • His disease is not a punishment for his or his parents sins. • This did not occur because of his improper sexual behavior • The fact that there is no treatment is mistaken.

5. Step 2 (continued) Schizophrenia is: • A serious mental disorder • It belongs to psychotic disorders. • Influences the way in which the person think, feels and behaves. • It is usually manifested to young persons but sometimes can also be manifested to middles-aged, or even elderly. • From this disorder suffer about one every hundred persons.

6. Step 3:Slide projection Slide 2.1.1: Symptoms of Schizophrenia • POSITIVE SYMPTOMS Aberrant ideas (hallucinations) Delusions Disorganized speech Abnormal behavior • NEGATIVE SYMPTOMS Reduction of emotions Poor content of though and speech Lack of desire and pleasure

7. Step 3 (continued) Slide 2.1.2: different types of Schizophrenia • Paranoid • Catatonic • Disorganized • Undifferentiated • Residual

8. Step 4 Slide 2.1.4: Factors that influence negatively the progress of Schizophrenia? • Insidious outbreak • Onset in early age • Isolation before the manifestation of the disorder • Male gender • Απουσία εκλυτικών γεγονότων • Absence of emotional elements • Long duration of acute phase

9. Step 4 (continued) • Important functionality decrease • Many residuary elements • Coexistence of neurological diseases • Existence of family history • retreat from reality(?) • Substance use

10. Step 5:Questions and Comments

11. Lesson 2 HOW THE PATIENT HIMSELF EXPERIENCE SCHIZOPHRENIA

12. Step 1: Introduction It is really important to try to understand how exactly thinks and feels a person who is under the effect of hallucinating disorders and auditory delusions and why his behavior is disordered.

13. Step 2: Slide Projection Slide 2.2.1: Fields of human functionality that might be influenced from Schizophrenia Biological: • Sleep • Nutrition • Mobility • Function of intestines and cysts • Physical health

14. Step 2 (continued) Psychological: • Perception of other people, objects and the environment. • Mood and emotional reactions • The idea of himself, ability of self-examination and self esteem • Concentration, thinking and learning • Adaptability

15. Step 2 (continued) Social: • Communication with other people (verbal or not verbal) • Personal relationships • Manifestation of sexuality • Employment • Entertainment

16. Step 3: Questions and comments

17. Lesson 3 CAUSES OF SCHIZOPHRENIA

18. Step 1: Introduction In reality, we do not know yet the causes of Schizophrenia. Scientists have studied many different factors who could possibly explain the reason why people manifest Schizophrenia. At present we have not found a concrete causal factor. But as it appears there are plenty factors that contribute in combination with each other to its manifestation.

19. Step 2:Slide Projection Slide 2.3.1: Causal factors of Schizophrenia ·Genetic ·Neurochemical ·Neurodevelopmental ·Environmental

20. Step 3: Slide Projection Slide 2.3.1:Possibility of manifestation of Schizophrenia to relatives Monozygotic twins (identical twins) 45% (100% similar genetic material) • Immediate family connection - parents, siblings, children - 10% (50% similar genetic material) • Non immediate family connection – uncle, nephew - 3% (25% similar genetic material) Probability of the manifestation of the disease to the general population is estimated to 1%.

21. Step 4: Questions and Comments (10΄)

22. Lesson 4 WHICH IS THE THERAPEUTICAL TREATMENT OF SCHIZOPHRENIA

23. Factors affecting treatment: • Symptoms • Problems that occur from the duration of the disease • Biological consequences to the person • Psychological consequences • Social difficulties

24. Step 2: Slide projection and Discussion Slide 2.4.1: Therapeutical interventions used in Schizophrenia • Antipsychotic medication • Trust relation with the therapeutical group • Complete continuous assistance • Intervention in the family • Intervention in the environment • Supporting therapy

25. Step 2 (continued) • Group therapy • Learning of social skills • Cognitive therapy • Professional education • Work rehabilitation • Home ensuring • Entertainment

26. Step 3 Legends spread regarding antipsychotic medication : • The psychiatric medication is all the same, notorious and we should avoid taking it • Psychiatric medication is drugs that one can be addicted to. • They might be useful for a patient, but they should stop the medication as soon as the symptoms subside.

27. Step 3 (continued) • The medication must always be taken in respect with the doctor’s instructions. • Stopping them for no reason increases the possibilities of relapse. • Relapses might be also shown while the patient is under the medication but are usually more gentle.

28. Step 3 (continued) The patients usually want to stop their medication due to one of the following reasons: • Because they cannot suffer the side effects. • Because its reminds them of their disease, • Perhaps because the symptoms have not totally subside even though they are on medication, • or because they cannot drink alcohol, as their doctor have recommended.

29. Step 4: Slide projection Slide 2.4.2: Common antipsychotic drugs Conventional • Chlorpromazine(Largactil) • Thiriodazine (Melleril) • Triflupromazine (Stelazine) • Haloperidol (Aloperidin) • Loxapine (Loxapac) unconventional • Clozapine (Leponex) • risperidone (Risperdal) • Olanzapine(Zyprexa) • Quetiapine (Seroquel)

30. Step 4 (continued) Slide 2.4.3: Side effects of antipsychotic drugs • Parkinsonism. • Anxiety • low blood pressure • restlessness • muscle stiffness • milk secretion • sexual dysfunction • dry mouth, or constipation or blurred vision • Photosensitivity • Malignant sybdrom • weight gain

31. Step 5: Questions and comments (10΄)

32. Lesson5 FAMILY AND SCHIZOPHRENIA

33. Step 1: Can the family cause Schizophrenia? • In the past many theories were brought up that put responsibility to the family for the onset of schizophrenia. (Lidz: “schism and skew”, Bateson: “double bind”) • Today it is commonly acceptable that the family do not cause Schizophrenia, but contrary can have a major role to the efficiency of the treatment.

34. Step 2: Theory presentation The meaning of Expressed Emotion (EE): • The progress of Schizophrenia might be affected by a way the family expresses its emotions towards the patient.

35. Step 2 (continued) • Three factors are closely associated with the relapses of the disease. These are the following: negative comments towards the patient aggressive behavior towards him. • In families where these factors appear in a excessive way, are called family with high Expressed Emotion and the danger of relapsing the disease, if they have a schizophrenic member, are extremely high.

36. Step 2 (continued) • This theory has been proved by research studies in which were used special evaluation research tools for the communication of the family and the relationship of their members. • The high emotional expression of the family influences negatively the evolution of other mental disorders not only Schizophrenia’s. It is a factor that increases stress and consequently aggravates the situation of the patient.

37. Step 3: theory presentation (10΄) The charge of the family • Even though the interest of Psychiatry is mainly focused on the family’s influence to the disease, the last years it is accepted that the families of schizophrenic persons are also under great pressure, which has negative effects to all the members of the family, included the schizophrenic person.

38. Step 3 (continued) • The families of the persons that manifest schizophrenia at first cannot understand it and later refuse to accept it. They usually wonder if it was their fault or if another member of the family might manifest the disease and want to know which will be its evolution. • They need help and information from specialists. • The family charge is more important when the symptoms of the patient are more intense (frequent).

39. Step 4: Theory Presentation • Most of the psychiatric services that are treating schizophrenic persons dispose nowadays a program of therapeutic treatment that includes the relatives. • There are also specialized programs of Family Therapy for decreasing the tension in the family environment and supporting the family. • An important factor to these is training the family in schizophrenia and ameliorating the communication between its members.

40. Step 5: Questions and comments (10΄)

41. Lesson6 OTHER PSYCHOTIC DISORDERS

42. Step 1: Slide projection Other psychotic disorders: • Schizophreniform Disorder • Schizoeffective Disorder • Delusional Disorder • Brief Psychotic Disorder. • Psychotic Disorder Not Otherwise Specified Επινεμόμενη Διαταραχή • Psychotic Disorder Due to a General Medical Condition • Substance-Induced Psychotic Disorder. (alcohol or other substance)

43. Step 2: Theory Presentation Schizophreniform Disorder • Clinical case (view) alike to schizophrenia, without including necessarily social and functional loss. • Duration less than 6 months (or it is schizophrenia). So, it might also be temporary diagnosis at the onset of schizophrenia. • 2/3 of the people with this diagnosis, later on will be diagnosed as schizophrenic, while 1/3 recovers. • The therapy is the same with the treatment of an schizophrenic episode.

44. Step 2 (continued) Schizoeffective disorder • Coexistence for a period of time of symptoms of schizophrenia and Depression and manifestation of schizophrenic symptoms periodically, while depression symptoms last longer. • Quite inaccurate diagnosis, but it is important that it is better in relation to schizophrenia’s (but worse in relation to depression’s) • Common to women • Treatment regarding to the symptoms (antipsychotic drugs, antidepressants and other psychosocial interventions)

45. Step 2 (continued) Delusional Disorder • Existence of aberrant ideas (hallucinations), but not delusions. • Aberrant but not bizarre ideas. • Mainly ideas of persecution, grandeur, somatic, jealousy or erotomania (sex-mania). • Usually manifested at middle-age or later. • No sufficient response to antipsychotic medication. Developing a trust relation with the therapist and after a series of gentle treatment (handling) it is the best treatment.

46. Step 2 (continued) Brief Psychotic Disorder • It is called a psychotic episode with symptoms alike to schizophrenia’s that is manifested abruptly and lasts less than a month. • It is a rare disorder mainly manifested to adolescents and very young persons. • The treatment includes antipsychotic medication and supporting psychotherapy.

47. Step 2 (continued) Psychotic Disorder Not Otherwise Specified • It is a fairly rare situation in which a person (usually relative) that lives close to the schizophrenic person manifests similar aberrant ideas. • Usually manifested to women. • As a therapy, it is recommended the elimination from the psychotic person, so the aberrant ideas subside.

48. Step 3: Questions and comments(10΄)