: Social Skills Training and Family Management modalities in addition to medications!
Treatment themes
: Most effective treatments contain practical problem solving, low stress socialization, positive reinforcement, specific goals, and a therapeutic relationship with outreach and accessibility
Treatment modalities
Multidimensional Interactive Model
Basis: Symptoms (but not disease itself) result from stressors impinging on enduring biopsychological vulnerabilities
Stressors may be physical or social (e.g. drugs, alcohol, criticism, major life events)
Effects of stress modulated by protective factors: (personal resources, social/environmental supports)
Psychosocial Interventions
(i.e. talking to the patient) - Why do it?
30 - 40% of medication-compliant patients will still relapse within a year
"Negative Symptoms" not very responsive to medications
Even more effective (newer) medications can’t teach life and coping skills!
(Theoretical Orientation: e.g. behavioral, cognitive, psychodynamic..)
All treatments have therapeutic Goals and Objectives (e.g. emotional insight, family problem solving, skill development…)
Individual Therapy
Psychodynamic Approaches (psychoanalysis, i.e. Freud)
Psychodynamic therapies offer little benefit in Schizophrenia and are inferior to reality-adaptive supportive therapy.
Also, Emotional Intensity associated with psychoanalysis may be harmful for some persons with Schizophrenia
Therapeutic Alliance
- highly predictive of good outcome
Benefits
:
facilitates engagement and continuation
promotes acceptance of medications
permits "active ingredients" to work
integral to success of case management
better information to plan treatment
engages patient as collaborator
humanizes the helping relationship
Strengthened by the therapist who is supportive, active, and consistent
Case Management - Therapy of support management
Requires Skills in assessment and treatment delivery
Involves: Brokering and advocacy (financial, health, housing, social, other service needs)
Group Therapies
- most effective in aftercare/ outpatient phase of treatment
Social Skills Training
Highly-structured treatment with explicit goals including: Agendas planned in advance, Procedures from a manual, and Homework and in vivo ("real life") assignments.
Works best with combined social skills trainer/ case manager
Findings
:
wide variety of skills can be learned
less generalization if complex social skills
encouragement improves generalization
little or no help in florid psychosis
patients report reduced social anxiety
durability varies (retention rare for treatment < 3 months)
Family Therapy
Basis: "expressed emotion" - too much emotional intensity expressed by family members are counterproductive
Goal
: Interventions aim to lower "emotional temperature"
How
: Use of education and behavioral techniques
Results
: Superior outcomes compared to traditional therapies alone (meds and case management)
Sources of therapeutic effect: a) reduction of stress (EE) b) building coping skills
Milieu Therapy
- complete 24hr/7day structural therapy, many models exist
Community Treatment Team
Psychiatrist: diagnostician, prescriber, primary care provider
Psych nurse
: medical management
Case manager
: primary support, community outreach, brokering and advocacy, variably involved in treatment
Counselor
: individual, group, family
Occupational/vocational therapist
:
Community psych
: views the individual as part of a larger population by providing services to populations compared to specific individuals. Involves considering the Impact on the community, how to allocate scarce resources, awareness of social, cultural, organizational, and political issues