{"id":4195,"date":"2018-09-18T17:16:53","date_gmt":"2018-09-18T21:16:53","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4195"},"modified":"2018-09-18T17:27:42","modified_gmt":"2018-09-18T21:27:42","slug":"schizophrenia-2","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/abnormal-psychology\/schizophrenia-2\/","title":{"rendered":"Schizophrenia"},"content":{"rendered":"<ul>\n<li>= A disorder characterized by disordered thinking, in which ideas are not logically related; faulty perceptions and attention; a lack of emotional expressiveness; and disturbances in behaviour, such as a disheveled appearance<\/li>\n<li>Withdraw from other people and everyday reality, experience delusions and hallucinations<\/li>\n<li>Substance use rates are high, suicide rates are high *12x more likely to die of suicide<\/li>\n<li>Mortality rates are as high, or higher than people who smoke<\/li>\n<li>1% life prevalence, affects men more than women<\/li>\n<li>Diagnosed more frequently among some groups: African Americans *may reflect diagnostic bias<\/li>\n<li>Sometimes begins in childhood, usually appears in late adolescence\/early adulthood *earlier in men than women o Late onset (30s) = more severe<\/li>\n<li>3 domains of symptoms: positive, negative, and disorganization DSM-5 Criteria:<\/li>\n<li>1) Two or more of the following symptoms for at least 1 month: one symptom should be either 1, 2, or 3 o Delusions, 2. Hallucinations, 3. Disorganized speech, 4. Disorganized\/catatonic behaviour,<\/li>\n<\/ul>\n<ol start=\"5\">\n<li>Negative symptoms (diminished motivation or emotional expression)<\/li>\n<\/ol>\n<ul>\n<li>2) Functioning in work, relationships of self-care has declined since onset<\/li>\n<li>3) Signs of disorder for at least 6 months; o Or, if during a prodromal or residual phase, negative symptoms or 2+ symptoms 1-4 in less severe form <strong>Positive Symptoms<\/strong><\/li>\n<li>= Comprise excesses and distortions, and include hallucinations and delusions<\/li>\n<li>Acute episodes are characterized by positive symptoms \uf0b7 <strong>Delusions<\/strong>:<\/li>\n<\/ul>\n<p>o = Beliefs contrary to reality and firmly held in spite of disconfirming evidence o Precursory delusions (\u201cCIA planted a listening device in my head\u201d)\u00a0 *found in 65% o Forms:<\/p>\n<ul>\n<li><strong>Thought insertion<\/strong> = belief that thoughts that are not his\/her own have been placed in his\/her mind by an external source<\/li>\n<li><strong>Thought broadcasting<\/strong> = belief that thoughts are broadcasted or transmitted, so that others know what one is thinking<\/li>\n<li>Belief that an external force controls one\u2019s feelings or behaviours<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Grandiose delusions<\/strong> = an exaggerated sense of one\u2019s own importance, power, knowledge or identity<\/li>\n<li><strong>Ideas of reference<\/strong> = incorporating unimportant events within a delusional framework and reading personal significance into the trivial activities of others \uf0b7 Hallucinations and other disturbances of perception:<\/li>\n<\/ul>\n<p>o <strong>Hallucinations<\/strong> = sensory experiences in the absence of any relevant stimulation from the environment<\/p>\n<p>\uf0a7 Most dramatic distortions of perception o More often auditory than visual (74% have auditory hallucinations) o Hear one\u2019s own thoughts spoken by another voice o Hear voices arguing or commenting on one\u2019s behaviour *increased activity in Broca\u2019s area o Hallucinations believed to come from a known person are experienced more positively o Possible explanation: misattribute their own voice as someone else\u2019s<\/p>\n<p>o Greater activity in Broca\u2019s area (frontal cortex) during auditory hallucinations *supports ability to produce speech<\/p>\n<p>\uf0a7 And in Wernicke\u2019s area (temporal cortex) *supports ability to understand speech **hearing voices <strong>Negative Symptoms<\/strong><\/p>\n<ul>\n<li>= Consist of behavioural deficits in motivation, pleasure, social closeness, and emotion expression<\/li>\n<li>Tend to endure beyond an acute episode<\/li>\n<li>Have profound effects on the lives of people with schizophrenia<\/li>\n<li>Presence of negative symptoms is a strong predictor of a poor quality of life<\/li>\n<li>Represent 2 domains: 1) experience: motivation, emotion, sociality &amp; pleasure, 2) expression (outward expression of emotion)<\/li>\n<li><strong>Avolition <\/strong>= A lack of motivation and a seeming absence of interest in or an inability to persist in what are usually routine activities, including work or school, hobbies, or social activities o Spend much of their lifetime sitting around doing nothing o Less motivated by goals about autonomy, gaining new knowledge or skills, or praise by others o Equally motivated by goals that have to do with relatedness to others and with avoiding a negative outcome<\/li>\n<li><strong>Asociality <\/strong>= Severe impairments in social relationships o Few friends, poor social skills, very little interest in being with other people o May not desire close relationships with family\/friends\/romantic partners<\/li>\n<li><strong>Anhedonia <\/strong>= A loss of interest in or a reported lessening of the experience of pleasure o <strong>Consummatory pleasure<\/strong> = the amount of pleasure experienced in the moment or in the presence of something pleasurable\n<ul>\n<li><strong>Anticipatory pleasure<\/strong> = the amount of expected or anticipated pleasure from future events or activities<\/li>\n<li>Deficit in anticipatory pleasure, not in consummatory<\/li>\n<\/ul>\n<\/li>\n<li><strong>Blunted affect<\/strong> = A lack of outward expression of emotion o Stare vacantly, face muscles motionless, eyes lifeless, toneless voice o Found in 66%<\/li>\n<\/ul>\n<p>o Only refers to outward expression of emotion, not to inner experience (not impoverished)<\/p>\n<ul>\n<li><strong>Alogia <\/strong>= A significant reduction in the amount of speech o Do not talk much<\/li>\n<\/ul>\n<p><strong>Disorganized Symptoms<\/strong><\/p>\n<ul>\n<li>Include disorganized speech and disorganized behaviour<\/li>\n<\/ul>\n<p>Disorganized Speech (formal thought disorder)<\/p>\n<ul>\n<li><strong>Disorganized speech<\/strong> = problems in organizing ideas and in speaking so that a listener can understand o <strong>Incoherence<\/strong> = inability to organize ideas<\/li>\n<li><strong>Loose associations<\/strong>\/<strong>derailment<\/strong> = the person may be more successful in communicating with a listener but has difficulty sticking to one topic<\/li>\n<li>Disorganized speech is associated with problems in executive functioning: problem solving, planning, and making associations between thinking and feeling<\/li>\n<li>Also related to the ability to perceive semantic information<\/li>\n<\/ul>\n<p>Disorganized Behaviour<\/p>\n<ul>\n<li><strong>Disorganized behaviour<\/strong> = may go into inexplicable bouts of agitation, dress in unusual clothing, act in a silly manner, hoard food, or collect garbage<\/li>\n<li>Lose the ability to organize behaviour and make it conform to community standard \uf0b7 Difficulty performing tasks of everyday living<\/li>\n<\/ul>\n<p>Movement Symptoms<\/p>\n<ul>\n<li><strong>Catatonia<\/strong> = gesture repeatedly, using peculiar and sometimes complex sequences of finger, hand, and arm movements, which often seem to be purposeful *excitable flailing of the limbs o Seldom seen today<\/li>\n<\/ul>\n<p>o Similarity with encephalitis lethargica<\/p>\n<ul>\n<li>Unusual increase in overall activity, much excitement, flailing of the limbs, great expenditure of energy similar to mania<\/li>\n<li><strong>(Catatonic) Immobility<\/strong> = adopt unusual postures and maintain them for very long periods of time \uf0b7 <strong>Waxy flexibility<\/strong> = limbs can be manipulated &amp; posed by another person<\/li>\n<\/ul>\n<p><strong>Schizophrenia and the DSM-5<\/strong><\/p>\n<ul>\n<li>Symptoms must last at least 6 months, must include 1 month of an acute episode, or <strong>active phase<\/strong> = presence of at least 2 symptoms: delusions, hallucinations, disorganized speech, disorganized behaviour, and negative symptoms<\/li>\n<li>Remaining time for diagnosis can occur before or after active phase<\/li>\n<li>Removal of subtypes of schizophrenia (paranoid, disorganized, catatonic, undifferentiated) *poor reliability, questionable usefulness, poor predictive validity<\/li>\n<li>Addition of severity ratings for each of the 5 symptoms<\/li>\n<li>Part of category: Schizophrenia spectrum and other psychotic disorders o <strong>Schizophreniform disorder <\/strong>= same symptoms of schizophrenia, last only 1-6 months\n<ul>\n<li>Must include hallucinations, delusions, or disorganized speech o <strong>Brief psychotic disorder<\/strong> = lasts from 1 day to 1 month, often brought on by extreme stress<\/li>\n<li>Symptoms MUST include hallucinations, delusions, or disorganized speech o <strong>Schizoaffective disorder<\/strong> = comprised of a mixture of symptoms of schizophrenia and mood disorders<\/li>\n<li>Either depressive or manic episode required (mood symptoms present for majority of duration)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>o <strong>Delusional disorder<\/strong> = troubled by delusions (persecution\/jealousy, grandiose, erotomania, somatic delusions)<\/p>\n<ul>\n<li>New category to \u201cConditions for Further Study\u201d \uf0e0 attenuated psychosis syndrome <strong>Etiology<\/strong><\/li>\n<\/ul>\n<p>Genetic Factors<\/p>\n<ul>\n<li><strong>Genetically heterogeneous<\/strong> \uf0e0 genetic factors may vary from case to case, not likely caused by 1 gene<\/li>\n<li>People with schizophrenia in their family histories have more negative symptoms that no family history o Negative symptoms may have stronger genetic component<\/li>\n<li>Incidence of schizophrenia highest if both biological parents were diagnosed (27.3%), (7% if one parent)<\/li>\n<li>Risk for MZ twins is 44.3%, 12,08% for DZ<\/li>\n<li>Even with adopted children whose biological parent had schizophrenia, there is still a heightened risk for developing<\/li>\n<li><strong>Familial high-risk study<\/strong> = begins with 1 or 2 biological parents with schizophrenia, follow their offspring longitudinally to identify how many develop schizophrenia<\/li>\n<li>6x more likely to develop by age 40 if have a parent with schizophrenia<\/li>\n<li>Predisposition is not transmitted by a single gene<\/li>\n<li>Multiple common genes associated with schizophrenia and bipolar<\/li>\n<li>1) <strong>DTNBP1<\/strong> &amp; <strong>NGR1<\/strong> \u2013 associated w\/schizophrenia, 2) <strong>COMT<\/strong> &amp; <strong>BDNF<\/strong> \u2013 associated w\/cognitive deficits associated w\/schizophrenia o DTNBP1 codes for a protein \u2018dysbindin\u2019 \u2013 impacts dopamine and glutamate NTM systems o COMT associated with cognitive control processes relying on the <strong>prefrontal cortex<\/strong> o BDNF \u2013 linked to cognitive functioning in people with and without schizophrenia<\/li>\n<\/ul>\n<p>(polymorphism Val66Met) o ***These genes do not appear in GWAS<\/p>\n<ul>\n<li>SNPs associated with schizophrenia are also associated with bipolar disorder<\/li>\n<li>Genome-wide scans: identification of several gene mutations<\/li>\n<\/ul>\n<p>The Role of Neurotransmitters \uf0b7 Dopamine theory:<\/p>\n<ul>\n<li>Drugs effective in treating schizophrenia reduce dopamine activity (antipsychotic drugs) o Side effects resembling symptoms of Parkinson\u2019s disease *caused by low dopamine in particular area of brain<\/li>\n<li>Antipsychotic drugs block postsynaptic dopamine receptor <strong>D2<\/strong>, in the <strong>mesolimbic pathway<\/strong> o Amphetamines amplify dopamine activity, can produce state closely resembling schizophrenia<\/li>\n<li>Only related to positive and disorganized symptoms of schizophrenia<\/li>\n<li>Dopamine neurons in prefrontal cortex (<strong>mesocortical pathway<\/strong>) may be underactive &amp; fail to inhibit dopamine neurons in subcortical brain areas **negative symptoms<\/li>\n<\/ul>\n<p>\uf0a7 Antipsychotics do not have major effect on dopamine neurons in prefrontal cortex o Take several weeks for antipsychotics to lessen positive symptoms, although receptors are rapidly blocked<\/p>\n<p>o To be effective, must reduce DA to below normal levels<\/p>\n<ul>\n<li>New drugs related to serotonin, block <strong>D2<\/strong> receptors, also block serotonin receptor <strong>5HT2<\/strong><\/li>\n<li>GABA transmission in prefrontal cortex is disrupted in those with schizophrenia<\/li>\n<li>Glutamate may also play a role *low levels in cerebrospinal fluid ***medication targeting glutamate shows promise o Also low levels of enzyme needed to produce glutamate<\/li>\n<li>Elevated AA homocysteine \u2013 interacts with NMDA receptor in pregnant women whose child develops schizophrenia<\/li>\n<li>PCP drug can induce positive and negative symptoms in people without schizophrenia<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Brain Structure &amp; Function \uf0b7 Enlarged ventricles: o 4 ventricles (spaces filled with cerebrospinal fluid) o Larger ventricles implies a loss of brain cells o Origin of enlarged ventricles may not be genetic<\/p>\n<ul>\n<li>Correlated with impaired performance on neuropsychological tests, poor functioning prior to the onset of the disorder and poor response to medication treatment<\/li>\n<li>Not specific to schizophrenia (bipolar, other psychotic features) \uf0b7 Prefrontal cortex:<\/li>\n<li>Plays a role in speech, decision making, emotion and goal directed behaviour **all disrupted in schizophrenia<\/li>\n<li>Reduction in grey matter and volume of prefrontal cortex = reduced connectivity o Perform more poorly on neuropsychological tests on working memory\n<ul>\n<li>Some declines occur before onset (late 30s) o Lower glucose metabolism in prefrontal cortex when performing neuropsychological tests<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>(PET scan) o Less blood flow to these areas during fMRI o Failure to show frontal activation related to severity of negative symptoms o Loss of dendritic spines, not loss of neurons *disrupts neuron communication = <strong>disconnection syndrome<\/strong><\/p>\n<ul>\n<li>Could lead to behavioural and speech disorganization symptoms \uf0b7 Temporal cortex:<\/li>\n<\/ul>\n<ul>\n<li>Abnormalities in temporal gyrus, hippocampus, amygdala, anterior cingulate<\/li>\n<li>Reduction in cortical grey matter, reduced volume in basal ganglia, hippocampus and limbic structures<\/li>\n<li>Reduced hippocampus volume may reflected combination of genetic and environmental factors\n<ul>\n<li>Closely relates to HPA axis and chronic stress (reduction in volume)<\/li>\n<li>More reactive to stress in schizophrenia, rather than experiencing more Connectivity in the Brain \uf0b7 3 types of connectivity:<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>o <strong>Structural<\/strong>\/<strong>anatomical connectivity<\/strong> = how different structures of the brain are connected via white matter<\/p>\n<ul>\n<li>Less white matter connectivity in schizophrenia in frontal and temporal lobes o <strong>Functional connectivity<\/strong> = connectivity between brain regions based on correlations between blood oxygen level dependent signal measured with fMRI<\/li>\n<li>Particularly reduced connectivity in frontal cortex o <strong>Effective connectivity<\/strong> = combines both types of connectivity, shows correlations between<\/li>\n<\/ul>\n<p>BOLD activations in different regions and the direction &amp; timing of activations<\/p>\n<ul>\n<li>Less connectivity in between brain networks, including frontoparietal and default-mode networks o Correlated with poor performance on cognitive tests<\/li>\n<\/ul>\n<p>o Might be part of genetic diathesis<\/p>\n<p>Environmental Factors Influencing the Developing Brain<\/p>\n<ul>\n<li>Possible damage during gestation<\/li>\n<li>High rates of delivery complications in those with schizophrenia o Reduced oxygen supply to brain, resulting in loss of cortical grey matter Maternal infections during pregnancy<\/li>\n<li>Exposure to prenatal influenza (especially in 2<sup>nd<\/sup> trimester)<\/li>\n<li>Stress linked to release of cortisol, cortisol related to increased dopamine activity in mesolimbic pathway<\/li>\n<li>Development of symptoms in adolescence related to loss of synapses due to excessive pruning<\/li>\n<li>Cannabis use in adolescence studied as a risk factor *associated with worsening of symptoms among those diagnosed o Greater risk of developing symptoms with cannabis use<\/li>\n<\/ul>\n<p>Psychological Factors<\/p>\n<ul>\n<li>Very reactive to stressors \uf0b7 Socioeconomic Status:\n<ul>\n<li>Found at all levels of SES o Highest rates in lowest SES group<\/li>\n<li><strong>Sociogenic hypothesis<\/strong> = stress associated with poverty such as low education, limited opportunities and stigma from others of high status contributes to development of schizophrenia<\/li>\n<li><strong>Social selection hypothesis<\/strong> = during the course of developing illness, people with schizophrenia drift into poor neighborhoods because their illness impairs their earning power, cannot afford to live elsewhere **research supports \uf0b7 Family-Related Factors:<\/li>\n<li>Mother-son relationship (<strong>schizophrenogenic mother<\/strong>)<\/li>\n<li>Vague communication between family members, high levels of family conflict o Expression of hostility towards schizophrenic family member\n<ul>\n<li>Critical comments, hostility, emotional overinvolevment = <strong>expression emotion<\/strong> (EE)<\/li>\n<li>Linked to relapse rates o Negative symptoms most likely to elicit critical comments<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>o Expression of unusual thoughts by schizophrenia linked to higher critical comments, and higher critical comments lead to increased unusual thoughts *bidirectional<\/p>\n<p>Developmental Factors<\/p>\n<ul>\n<li><strong>Retrospective studies<\/strong> = begin with a group of adults with schizophrenia (or other diagnosis) and follow back to childhood to unearth records and tests from their early years o Lower IQs as children, more often delinquent and withdrawn o Boys rated by teachers as disagreeable, girls as passive\n<ul>\n<li>Poorer motor skills, more expression of negative emotions as children *coding home videos \uf0b7 Prospective studies:<\/li>\n<li>Look at identifying childhood characteristics associated with development of schizophrenia in early adulthood<\/li>\n<li>Lower IQ scores as children predicted onset of schizophrenia in young adulthood (beginning at age 7)<\/li>\n<li><strong>Clinical high-risk study<\/strong> = identifies people with early, attenuated signs of schizophrenia, most often milder forms of hallucinations, delusions, or disorganization that causes impairment<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Treatment<\/strong><\/p>\n<ul>\n<li>Most often includes combination of short-term hospitalization, medication and psychosocial treatment<\/li>\n<li>Some schizophrenics lack insight into their impairments and refuse any treatment<\/li>\n<li>Gender (female) and age (older) are predictors of better insight during first episode of illness Medications<\/li>\n<li><strong>Antipsychotic drugs<\/strong> = used to treat symptoms of schizophrenia (aka neuroleptics \uf0e0 produce side effects similar to symptoms of a neurological disease) \uf0b7 First generation antipsychotics:\n<ul>\n<li>Reduce positive and disorganized symptoms (also reduce agitation &amp; violent behaviour), little or not effect on negative symptoms<\/li>\n<li>Block dopamine D2 receptors<\/li>\n<li>30% do not respond favourably to first generation, 50% quit after 1 year, 75% quit before 2 years because of side effects<\/li>\n<li>Side effects: sedation, dizziness, blurred vision, restlessness, sexual dysfunction, dystonia<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>(rigidity), dyskinesia (abnormal muscle motion), akasthesia (inability to remain still)\u00a0 o <strong>Extrapyramidal side effects<\/strong> = resemble the symptoms of Parkinson\u2019s disease (tremors, shuffle, drooling)<\/p>\n<ul>\n<li><strong>Tardive dyskinesia<\/strong> = mouth muscles involuntarily make sucking, lip-smacking and chinwagging motions<\/li>\n<\/ul>\n<p>\uf0a7 Mainly in older people with schizophrenia who had been treated with 1<sup>st<\/sup> generation drugs<\/p>\n<ul>\n<li><strong>Neuroleptic malignant syndrome<\/strong> = (1% of cases) sometimes fatal, severe muscular rigidity develops, accompanied by fever \uf0b7 Second generation antipsychotics:<\/li>\n<li>Approval of clozapine \u2013 therapeutic gains in those who didn\u2019t respond well to 1<sup>st<\/sup> generation medication, produce fewer side effects, less relapse and treatment noncompliance *impacts serotonin receptors<\/li>\n<\/ul>\n<p>\uf0a7 Side effects: impair immune system functioning, agranulocytosis (lower amount of<\/p>\n<p>WBC), seizures, dizziness, fatigue, drooling, weight gain *fewer motor side effects<\/p>\n<ul>\n<li>Olanzapine and risperidone \u2013 produce fewer side effects<\/li>\n<li>Equally as effective in reducing positive and disorganized symptoms, slightly more effective in reducing negative symptoms and improving cognitive deficits<\/li>\n<li>Less treatment noncompliance o No differences in relapse *reduces relapse? o Can also produce extrapyramidal side effects o Less often given to African-Americans<\/li>\n<\/ul>\n<ul>\n<li>Medical review: 2<sup>nd<\/sup> generation not more effective, did not produce fewer unpleasant side effects, nearly \u00be stopped taking before study ended o Can lead to serious side effects: pancreatitis, weight gain, diabetes<\/li>\n<\/ul>\n<p>Psychological Treatments<\/p>\n<ul>\n<li>Psychosocial treatments are recommended alongside medication (Patient Outcome Research Team<\/li>\n<\/ul>\n<p>\u201cPORT\u201d recommendation) o Skills training, CBT, family-based treatment<\/p>\n<ul>\n<li><strong>Social skills training<\/strong> = designed to teach people with schizophrenia how to successfully manage a wide variety of interpersonal situations o (Discussing medications with psychiatrist, ordering meals in a restaurant, filling out a job application, saying no to drug dealers, reading bus schedules)\n<ul>\n<li>Involves role-playing and other group exercises the practice skills (in therapy and real social situations)<\/li>\n<li>Help achieve fewer relapses, better social functioning, higher quality of life o May also be effective in reducing negative symptoms Family therapies:<\/li>\n<li>Developed to try and decrease expressed emotion within the family (hostility, critical comments and emotionally overinvolved)<\/li>\n<li>1) Education about schizophrenia \u2013 about genetic\/neurobiological factors, cognitive problems associated, symptoms, and signs of relapse<\/li>\n<li>2) Information about antipsychotic medication \u2013 importance of taking, effects and side effects<\/li>\n<li>3) Blame avoidance and reduction \u2013 encourage family members not to blame themselves of their ill relative<\/li>\n<li>4) Communication and problem-solving skills \u2013 express feelings in constructive, empathic, nondemanding manner<\/li>\n<li>5) Social network expansion \u2013 encouraged to expand social contacts o 6) Hope \u2013 hope for improvement, not to return to hospital<\/li>\n<\/ul>\n<\/li>\n<li>CBT:\n<ul>\n<li>Encouraged to test out delusional beliefs<\/li>\n<li>Helped to attach nonpsychotic meaning to paranoid symptoms to reduce intensity and aversive nature<\/li>\n<li>Helps reduce negative symptoms *recognize &amp; challenge expectations associated w\/negative symptoms<\/li>\n<\/ul>\n<\/li>\n<li>Cognitive Remediation Therapies:\n<ul>\n<li>Improvement in basic cognitive processes hold promise for improving social and emotional lives of schizophrenics<\/li>\n<li>Try to normalize attention and memory<\/li>\n<li><strong>Cognitive remediation training<\/strong>\/<strong>cognitive enhancement therapy<\/strong> (CET) = seek to enhance basic cognitive functions such as verbal learning ability<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>\uf0a7 Effective in reducing symptoms and improving cognitive abilities, linked to good functional outcomes<\/p>\n<ul>\n<li>Can include computer-based training in memory, problem solving and attention o <strong>Enriched supportive therapy<\/strong> (EST) = includes supportive and educational elements \uf0b7 Psychoeducation:<\/li>\n<li>Educate patients about their illness, symptoms, time course, triggers, treatment strategies o Reduces relapse and rehospitalization<\/li>\n<\/ul>\n<ul>\n<li>Case Management:\n<ul>\n<li>Case managers \u2013 familiar with the mental health system, able to connect people with schizophrenia to whatever services they required<\/li>\n<li>Often provided direct clinical services<\/li>\n<li>Multidisciplinary team that provides services in the community (medication, treatment for substance abuse, help in dealing with stressors, psychotherapy, vocational training, assistance in obtaining housing and employment<\/li>\n<li>Has not shown improvement in social functioning \uf0b7 Residential Treatment:<\/li>\n<li>\u201cHalfway houses\u201d \u2013 alternative for those who do not need to be in the hospital but are not well enough to live on their own or with family<\/li>\n<li>Protected living units<\/li>\n<li>Vocational rehabilitation \u2013 learn skills to help secure employment and return to the community<\/li>\n<li>Staff may include psychiatrists\/clinical psychologists o Often include group meetings<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>= A disorder characterized by disordered thinking, in which ideas are not logically related; faulty perceptions and attention; a lack of emotional expressiveness; and disturbances in behaviour, such as&hellip; <a class=\"continue\" href=\"https:\/\/www.amyork.ca\/academic\/zz\/abnormal-psychology\/schizophrenia-2\/\">Continue Reading<span> Schizophrenia<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[104],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4195"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4195"}],"version-history":[{"count":0,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4195\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4195"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4195"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4195"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}