Often individuals who develop schizophrenia have had a schizoid or schizotypal character for some time. They are often quiet, passive, and introverted individuals. only 10-20% have what could be considered “good” outcome -remission rates are low – 10-50%
Some factors that are indicative of a better course prognostically are: -another distinction - not made in DSM, is that individuals with more positive symptoms are “type 1” and have a better response to treatment. Those with more negative are type II and have a poorer response
Genetics and neurological abnormalities are by and large the most accepted models in terms of causality The Stress-vulnerability model posits that schizo is caused by underlying psychobiological vulnerability, determined early in life by genetic and early environmental effects. Onset and the course of illness are determined by dynamic interplay of biological and psychosocial factors.
All of these drugs work on the dopamine system, which is irregularly excessive in schizo – the atypicals also work on other neurotransmitters – mainly seratonin Atypicals are the newer drugs with fewer side effects – better tolerated Clozapine is probably the most effective, particularly with negetive symptoms. However there is a risk of life-threatening decrease in white blood cells.
You may have a patient that is still on the older class of antipsychotics – what they used before the atypicals/ These drugs are more apt to cause extrapyramidal symptoms involving nerves and muscles, tremors, and may also elevate risk of heart failure and therefore are used less and less. However, they have less risk of weight gain than the newer atypicals.
Here are Some specific examples of CBT techniques you can use 1 st , attempt to ID the hallucination, or delusions function or relationship to real life – often it is metaphorical to some extent So if a patient states “they are poisoning me with drugs” you may need to use psychoeducation to explain the side effects he perceives as “poison” If the patient is experiencing “thought broadcasting” you can ask about the evidence for this belief and suggest an alternative or rational explanation. A good strategy is having them keep a log of details about he voices, who what where when. The goal is to get them to realize that they are generating the voices themselves. for negative symptoms, you’ll want to do what you would with a severely depressed patient – attempt to set daily goals for a structure or schedule. Also remember to use rewards for small steps and keeping the schedule.
A note regarding all therapies is that an integrative approach tends to work best – integration between medication, CBT, psychoeducation, and family therapy works better than any approach used alone. A few studies I found comparing the different psychosocial approaches did support CBT as the most beneficial in terms of relapse and re-hospitalization, so those strategies, getting the patient to challenge distortions and even hallucinations, can be extremely beneficial.
Finally, it is important to remember that a diagnosis of schizophrenia is often comorbid with another problem that you’ll have to treat.
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