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CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders
BOX 15–5 Topics for Patient and Family Education Related to Schizophrenia NATURE OF THE ILLNESS
6. Relaxation techniques 7. Social skills training 8. Daily living skills training
1. What to expect as the illness progresses 2. Symptoms associated with the illness 3. Ways for family to respond to behaviors associated with the illness MANAGEMENT OF THE ILLNESS 1. Connection of exacerbation of symptoms to times of stress 2. Appropriate medication management 3. Side effects of medications
SUPPORT SERVICES 1. Financial assistance 2. Housing 3. Legal assistance 4. Caregiver support groups 5. Respite care 6. Home health care 7. Residential treatment options
4. Importance of not stopping medications 5. When to contact health-care provider
do not respond to medication and remain severely ill for much of their lives. Men typically have poorer outcomes than women do; women respond better to treatment with antipsychotic medications. Although the paradigm of thirds provides a general guideline for understanding the variable course and progno- sis in schizophrenia, Jablensky (2017) notes that with each successive decade there has been a trend toward a less deteriorating course in schizophrenia, which may be attributed to both treatment advances and changes in attitudes about this illness. Psychological Treatments Individual Psychotherapy Individual recovery-oriented psychotherapy and cog- nitive therapies are evidence-based interventions in the treatment of the client with schizophrenia, but they should be adjuncts to a multifaceted team approach. The primary focus in all cases must reflect efforts to decrease anxiety and increase trust. Establishing a relationship is often particularly difficult because the individual with schizophrenia is desperately lonely yet defends against closeness and trust. The individual is likely to respond to attempts at closeness with suspiciousness, anxiety, aggression, or regression. Successful intervention may be achieved with honesty, simple directness, and a manner that respects the client’s privacy and human dignity. Exag- gerated warmth and professions of friendship are likely to be met with confusion and suspicion. Once a therapeutic interpersonal relationship has been established, reality orientation is maintained through exploration of the client’s behavior in rela- tionships. Education is provided to help the client
identify sources of real or perceived danger and ways of reacting appropriately. Methods for improving interpersonal communication, emotional expres- sion, and frustration tolerance are attempted. Group Therapy Group therapy for individuals with schizophrenia has been shown to be effective, particularly with out- patients and when combined with drug treatment. Boland and Verduin (2022) stated: Group therapy for persons with schizophrenia gen- erally focuses on real-life plans, problems, and rela- tionships. Some investigators doubt that dynamic interpretation and insight therapy are valuable for typical patients with schizophrenia. But group ther- apy is effective in reducing social isolation, increas- ing the sense of cohesiveness, and improving reality testing for patients with schizophrenia. (p. 355) Group therapy in inpatient settings is less productive. Inpatient treatment usually occurs when symptom- atology and social disorganization are at their most intense. At this time, having the least stimuli possi- ble is most beneficial for the patient. Because group therapy can be intensive and highly stimulating, it may be counterproductive early in treatment. Group therapy for schizophrenia has been most useful over the long-term course of the illness. The social interaction, sense of cohesiveness, identifica- tion, and reality testing achieved within the group setting have proven to be highly therapeutic pro- cesses for individuals with this illness. Groups that offer a supportive environment appear to be more helpful than those that follow a more confronta- tional approach.
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