BYU IS PSYCH 342 Lesson 15

tardive dyskinesia

extra pyramidal effects of first generation antipsychotic drugs involving involuntary movements that some patients have after they have taken antipsychotic drugs for an extended time (i.e. involuntary writhing or ticlike movements of the tongue, mouth, face, or whole body; involuntary chewing, sucking, and lip smacking; jerky movements of the arms, legs, or entire body)

state hospitals

public mental hospitals in the United States, run by the individual states

what are the limitations of token economies?

- Ethical and legal concerns about basic human rights - whether operant conditioning procedures change a patient's psychotic thoughts and perceptions or simply improve the patient's ability to imitate normal behavior - it has often been difficult for patients to make a satisfactory transition from hospital token economy programs to community living; some patients who find that the real world doesn't reward them so concretely abandoned their newly acquired behaviors

consequences of inadequate community treatment for Schizophrenia

- Some received no treatment - some spend a short time in a state hospital or semi hospital and are then discharged prematurely, often without adequate follow-up treatment - many returned to their families and received medication and perhaps emotional and financial support, but little else in the way of treatment - some enter an alternative institutions such as a nursing home or rest home, where they receive only custodial care and medication - some end up in foster homes, boarding houses, care homes, or similar facilities - 34% of people with schizophrenia and other severe disorders live in totally unsupervised settings - a number of people with schizophrenia spend their days wandering through neighborhood streets - a great number of people with schizophrenia and other severe disorders have become homeless - people with severe mental disorders are in prisons and jails, often because their disorders have led them to break the law

partial hospitalization

- day centers -semihospital/residential crisis center

family therapy for schizophrenia

- people with schizophrenia who feel positive toward their relatives do better in treatment - in family therapy, relatives about more realistic expectations and become more tolerant, less guilt ridden, and more willing to try new patterns of communication - family therapy helps reduce tensions within the family and helps relapse rates and hospital re emissions go down

parkinsonian and related symptoms

- the most common extrapyramidal effects of first generation drugs are parkinsonian symptoms (i.e. muscle tremors, muscle rigidity, shaking, moving slowly, shuffling feet, little facial expression) - some people also experience symptoms such as movements of the face, neck, tongue, and back, and a number experience significant restlessness and discomfort in their limbs

hallucination reinterpretation and acceptance

- treatment is designed to help change how people view and react to their hallucinations - therapists believe that people can be guided to interpret their hallucinatory experiences in a more accurate way, they will not suffer the fear and confusion produced by their delusional misinterpretations - Cognitive behavioral techniques often help people with schizophrenia feel more control over their hallucinations and reduce their delusional ideas, but they do not eliminate the hallucinations

antipsychotic drugs

drugs that help correct grossly confused or distorted thinking

short-term hospitalization

Hospitalization in a mental hospital or a General Hospital psychiatric unit that only lasts a few weeks *after patients improve, they are released for aftercare

community mental health centers

a treatment facility that provides medication, psychotherapy, and emergency care for psychological problems and coordinates treatment in the community

cognitive remediation

a treatment that focuses on the cognitive impairments that often characterize people with schizophrenia, particularly their difficulties inattention, planning, and memory

how effective are token economy programs?

Researchers have found that token economies do help reduce psychotic and related behaviors

Token economy program

a behavior focused program in which a person's desirable behaviors are reinforced systematically by the awarding of tokens that can be exchanged for goods or privileges; patients are rewarded when they behave acceptably and are not rewarded when they behave unacceptably

case managers

a community therapists who offers and coordinates a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patients rights

Milieu therapy

a humanistic approach to institutional treatment based on the premise that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity pioneered by Maxwell Jones the daily schedule of patients was designed to resemble life outside the hospital

Agranulocytosis

a life threatening drop in white blood cells; this condition is sometimes produced by the 2nd generation antipsychotic drug clozapine

aftercare

a program of post hospitalization care and treatment in the community

day centers

a program that offers hospital like treatment during the day only (all day programs in which patients return to their homes for the night); also known as a day hospital

halfway houses

a residence for people with schizophrenia or other severe problems, often staffed by paraprofessionals; also known as a group home or crisis house for people who do not require hospitalization but are unable to live alone or with their families

neuroleptic malignant syndrome

a severe, potentially fatal reaction consisting of muscle rigidity, fever, altered consciousness, and improper functioning of the autonomic nervous system

sheltered workshop

a supervised workplace for people who are not yet ready for competitive jobs

5. Of all people with schizophrenia and other severe mental disorders, ________% do not receive any form of treatment. a. 40 to 60 b. 10 to 20 c. 25 to 35 d. 2 to 5

a. 40 to 60

2. The ________ requires that people with mental disorders receive treatment in their communities rather than being transported to institutions far from home. a. Community Mental Health Act b. Deinstitutionalization Act of 1963 c. Mental Health Insurance Parity Act d. Civil Rights Act

a. Community Mental Health Act

16. A comprehensive award-winning mental health treatment program linked in the lesson on schizophrenia treatments is ________, which emphasized work and practical life skills. a. Fountain House b. Fostering Unity c. Hope International d. Polis Community Residences

a. Fountain House

10. A patient is taking an antipsychotic medication to treat schizophrenia. Which is not a known side effect of this drug? a. Huntington's-type symptoms b. neuroleptic malignant syndrome c. tardive dyskinesia d. Parkinsonian-type symptoms

a. Huntington's-type symptoms

9. A video overview of antipsychotic medications indicated that the type and amount of medication prescribed varies based on trials during the acute phase, with an attention to several side effects, listed using the acronym ________. a. SHE WAS ME b. STAY WARM c. REAL NOW d. TRUE THAT

a. SHE WAS ME

2. In a video embedded in the lesson on treatments for schizophrenia, why did professor Elyn Saks say that she did not reveal her mental illness to others until late in life, and what was one of her primary suggestions to other people? a. Stigma against mental illness kept her from telling anyone; there are people with schizophrenia, not schizophrenics. b. A crime against her caused her to reevaluate life and be bolder; incarcerate the people with mental illness who exhibit dangerous behaviors so that other people with mental illness remain safe. c. She only developed the symptoms later in life; she suggested that those with schizophrenia receive psychoanalysis. d. She only took medications later in life; medications are not as necessary as people believe.

a. Stigma against mental illness kept her from telling anyone; there are people with schizophrenia, not schizophrenics.

14. The first medication approved for sale in the United States as an antipsychotic was ________. a. Thorazine b. Haldol c. Risperdal d. Zyprexa

a. Thorazine

19. According to a video embedded in the lesson on treatments for schizophrenia, medications to treat the symptoms of schizophrenia commonly target which chemical in the brain? a. dopamine b. acetylcholine c. adrenaline d. norepinephrine

a. dopamine

6. Antipsychotic drugs reduce psychotic symptoms, at least in part, because they block excessive activity of neurotransmitters at the brain's ________ receptors. a. dopamine D2 b. serotonin c. GABA d. dopamine D9

a. dopamine D2

8. In a video embedded in the lesson on treatments for schizophrenia, Elyn Saks described three factors that had resulted in her being able to manage psychotic symptoms and live a successful life. Which one of these was not specifically mentioned as a positive factor by Professor Saks? a. inpatient restraints and empathy from other inpatients b. supportive workplace c. medication and five days a week psychoanalytic psychotherapy d. supportive friends and family

a. inpatient restraints and empathy from other inpatients

1. In one study of patients who had been receiving antipsychotic medication for at least five years, ________ percent of them relapsed within a year when they were switched to a placebo. a. 40 b. 75 c. 60 d. 27

b. 75

5. According to a video on antipsychotic medications, individuals with a psychotic disorder who do not take medications are ________ likely to relapse. a. 45% b. 75% c. 95% d. 25%

b. 75%

11. ________ are treatment facilities that provide medication, psychotherapy, and emergency care for psychological problems and that coordinate treatment in the community. a. Aftercare programs b. Community mental health centers c. Halfway houses d. Day hospitals

b. Community mental health centers

10. The move toward institutionalization of the mentally ill in hospitals rather than asylums began in ________. a. the United States b. France c. Belgium d. Germany

b. France

1. The discovery of ________ revolutionized treatment for schizophrenia. a. milieu therapy b. antipsychotic drugs c. leucotomy d. token economies

b. antipsychotic drugs

20. The lesson on treatments for schizophrenia covered all of the following concepts except ________. a. habilitation services and the benefits of treatments involving work b. music and art therapy as a way to promote emotional expression c. vignettes based on suitcases of patients at a large hospital in Willard, New York d. mercy bookings by police e. All of these were covered in the lesson.

b. music and art therapy as a way to promote emotional expression

3. Token economy programs relied on the systematic application of ________ techniques. a. cognitive restructuring b. operant conditioning c. classic conditioning d. social modeling

b. operant conditioning

18. The lesson emphasized the benefits of psychosocial treatments that included components of ________. a. psychosurgery and periodic brain scans (wrong) b. outreach by professionals and strong family involvement c. residential centers and inpatient hospitalizations d. milieu therapy and electroconvulsive therapy (ECT)

b. outreach by professionals and strong family involvement

3. Family therapy for the treatment of schizophrenia assumes that all of the following statements are true except ________. a. including the family during therapy sessions facilitates communication among family members b. greater therapeutic benefit can be achieved when one is in a supportive and positive family environment c. family interactions cause people to develop psychotic symptoms d. guidance and training helps families adjust to living with a person who has schizophrenia

c. family interactions cause people to develop psychotic symptoms

12. According to a video embedded in the lesson on schizophrenia treatments, David Rosenhan's experiences in a mental health institution led him to conclude that ________. a. medications were so effective that the staff best spent their time by monitoring patients' symptoms closely to prevent extrapyramidal effects from developing b. society has no need for institutional care c. inpatients can be dehumanized and abandoned, such that mental health professionals need to be constantly reminded that people with mental illness are people the same as everyone else d. psychiatrists in large mental health hospitals manage more cases than a typical physician would ever be able to see in a private practice, such that they experience work overload

c. inpatients can be dehumanized and abandoned, such that mental health professionals need to be constantly reminded that people with mental illness are people the same as everyone else

9. The premise of ________ is that institutions need to promote productive activity, self-respect, and individual responsibility. a. rational-emotional-behavior therapy b. token economy programs c. milieu therapy d. social treatment

c. milieu therapy

15. Generally speaking, persons with schizophrenia who feel ________ toward their relatives do better in treatment. a. detached b. apathetic c. positively d. dependent

c. positively

social therapy for schizophrenia

clinicians offer practical advice, work with clients on problem solving, memory enhancement, decision-making, and social skills and make sure that the clients are taking their medications properly and may even help them find work, financial assistance, appropriate health care, and proper housing

features of effective community care fo Schizophrenia

coordinated services - short term hospitalization - partial hospitalization - supervised residences - occupational training and support

13. What (approximate) percentage of people with schizophrenia are homeless? a. 16 b. 10 c. 20 d. 5

d. 5

4. The use of antipsychotic medication dates back to the 1940s, when ________ drugs were used to calm patients about to undergo surgery. a. anticholinergic b. opioid c. beta blocking d. antihistamine

d. antihistamine

4. According to a video embedded in the lesson on treatments for schizophrenia, social problems associated with schizophrenia were made worse during several decades of the late 1900s because ________. a. police engaged in mercy bookings b. thorazine became available c. psychoanalytic approaches inaccurately conceptualized psychosis as ego separation d. increased access to psychoactive substances resulted in individuals with schizophrenia being imprisoned for substance use without adequate treatments

d. increased access to psychoactive substances resulted in individuals with schizophrenia being imprisoned for substance use without adequate treatments

8. Conventional antipsychotic drugs are referred to as ________ drugs because of their undesirable movement-related side effects. a. neuropsychotic b. controlled c. dangerous d. neuroleptic

d. neuroleptic

7. In most cases, antipsychotic drugs produce the maximum level of improvement within the first ________ of treatment. a. month b. nine months c. week d. six months

d. six months

6. Throughout much of the twentieth century, long-term institutionalized mental patients developed additional symptoms as a result of their institutionalization. The most common pattern of decline was ________. a. schizophrenia b. psychosis c. neuroleptic malignant syndrome d. social breakdown syndrome

d. social breakdown syndrome

7. As a result of institutionalization, many patients developed ________. a. diathesis-stress b. schizophrenia c. severe depression d. social breakdown syndrome

d. social breakdown syndrome

17. The main difference between first-generation and second-generation antipsychotic drugs is ________. a. the way they are manufactured b. whether they are better at treating negative symptoms or positive symptoms of schizophrenia c. how frequently they are prescribed d. whether they produce symptoms that resemble neurological disorders

d. whether they produce symptoms that resemble neurological disorders

unwanted effects of first generation antipsychotic drugs

extrapyramidal effects: unwanted movements, such as severe shaking, bizarre looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by anti psychotic drugs - Parkinsonian and related symptoms - neuroleptic malignant syndrome - tardive dyskinesia

Social breakdown syndrome

extreme withdrawal, anger, physical aggressiveness, and loss of interest in personal appearance and functioning; the most common pattern of decline in Schizophrenia

neuroleptic drugs

first generation antipsychotic drugs , so called because they often produce undesired effects similar to the symptoms of neurological disorders thioridazine (mellaril), fluphenazine (prolixin), Trifluoperazine (Stelazine), haloperidol (haldol)

Semihospital/residential crisis center

houses or other structures in the community that provide 24 hour nursing care for people with severe mental disorders

community Mental Health Act

stipulates that patients with psychological disorders are to receive a range of mental health services in their communities rather than being transported to institutions far from home

deinstitutionalization

the discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs

supported employment

when vocational agencies and counselors help clients find competitive jobs in the community and provide psychological support while the clients are employed