Schizophrenia Do you hear what I hear?

How does it present? A chronic, severe, an disabling brain disorder Hear voices Paranoia People are reading their mind Controlling their thoughts Plotting to harm them

What causes schizophrenia? Genes and environment 1% of population has schizophrenia Occurs in 10% with a 1st degree relative One or more genes…? Imbalance of chemicals of the brain Don’t know all gene combinations that cause it Fluid filled ventricles and less gray matter (consistency) 1st degree relative = mom, dad, brother, sister. If a twin has schizophrenia, the other is 40-65% likely to get it. Risk goes up if a cousin or 2nd degree relative is diagnosed.

Schizophrenia Part 1 Homeless Had a family Had a career Had friends Doesn’t want “help” Does he “need” it…? https://youtu.be/rCbf-pKtkhU

Jade

Effectiveness of Occupational Goal Intervention (OGI) Focused on executive function (EF) Remedial or process-oriented Direct cognitive retraining Targets underlying mechanisms that may be causing issue Use assets for success EF are considered essential elements in non-routine situations and in performance of complicated or new tasks that require coordination among subporcesses to achieve a specific goal.

Method 18 participants Diagnosed w/ schizophrenia from DSM IV Ages 22-38 Excluded if any other neurological issues Excluded for addiction or severe cognitive impairment Randomly assigned to 1 of 3 groups Occupational Goal Intervention (OGI) Frontal/ Executive Program (FEP) Activity Training Approach (ATA) control group

Effective Measures/ Evaluations Standard Progressive Matrices (Raven’s test) Wisconsin Card Sorting Test (WCST) The Wechsler Adult Intelligence Scale (WAIS – III) Behavioral Assessment of the Dysexecutive Syndrome (BADS) Executive Functions Performance Test (EFPT) Routine Task Inventory – Expanded (RTI – E) Activity Card Sort (ACS) Reintegration to Normal Living Index (RNL)

Intervention Occupational Goals Intervention (OGI) Strategy learning using ADL’s and IADL’s Individual choice Food prep, $ management, reading writing and comp. lit. Frontal/ Executive Program (FEP) 3 modules: cog. Shift, working mem., planning deficits Paper and pencil w/ some construction activities Activity Training Approach (ATA) Activity specific routines Taught specific tasks with habituation the goal Computer literacy specifically for information seeking.

Procedure Tested at three points in program 18 sessions each 2-3 sessions/ wk at 1-1.5 hour/ session 6-8 weeks with a follow up 6 months later

Results All groups improved EF measures Highest were among the OGI group Followed by FEP group, then ATA (control) Using remedial or strategy learning approach is profitable OGI improved performance in daily functions Both the OGI and FEP groups had greater improvements that the control group All achievements were sustained 6 months later OGI – the importance of transferring and generalizing from treatment to real life is strongly acknowledged by researchers and clinicians in rehab and OT. Contribution to OT is the inclusion of wide range of activity and participation outcome versus other studies focusing on social skills, meal prep, work, etc.

Kristen

References National Institute of Mental Health (HIM). taken from: http://www.nimh.nih.gov/health/topics/schizophrenia/index.s html Katz, N., Keren, N. (2011). Effectivness of occupational goal intervention for clients with schizophrenia. American Journal of Occupational Therapy, 65, 287 -296. doi: 10.5014/ajot.2011.001347