Psychotic Disorders and Skill Training

Basic information Schizophrenia and Other Psychotic Disorders Thought Disorders is another term Prevalence: about.5-1.5%; COD=about 47% of people with schizophrenia In King County: individuals are defined as “high utilizers”

Sx associated with psychotic d/o Positive vs. negative sx Hallucinations Delusions Disorganized speech Thought process Behavior disturbance Affect disturbance Avolition

Disorders Schizophrenia Schizophreniform Schizoaffective Delusional Disorder Brief Psychotic Disorder Shared Psychotic Disorder Psychotic Disorder due to medical condition Psychotic Disorder NOS

Key Treatment Issues Engagement Screening and Assessment High risk conditions –Medical risks –Psychological risks –Social risks

Medical Risks Need for detox Polysubstance abuse Health conditions –Underlying chronic conditions –Acute health issues resulting from decompensation, homelessness, etc.

Psychological Risks Suicidality Danger to others Grave disability Decompensation Cognitive difficulties = impaired judgment, poor decision making, difficulty concentrating or following through

Social Risks Basic needs: Food, shelter, clothing, money, etc. Victimization due to heightened vulnerability Social support: family, friends, faith, 12 step, etc.

Treatment Strategies Crisis stabilization Therapeutic coercion: What is it? Why use it? Case management –Financial, health, vocational, educational, legal, medication management, etc. Groups –Client should be stable first –Modified 12 step groups –Skills training

Matching strategy to readiness for change 1.Establish a therapeutic alliance- precontemplation Meet the cx where she/he is Provide basic resources Be supportive & nonconfrontational 2.Evaluate costs and benefits-contemplation 3.Individualize the goals-planning/determination 4.Build a recovery lifestyle-action/maintenance 5.Cope with crisis-relapse

Article discussion Family Support 1.Discuss the difficulties families of people with COD face. 2.What are the benefits for cxs when they have family support? Family Intervention Program 1.Describe the 5 stages of FIDD. 2.Identify and discuss what families need. Both What are one or two skills family members could learn that would improve the situation?

Skills Training Model Substance Abuse Management Model What is something you have learned to do recently? How did you learn to do it? Three stages- Basic training Skills training Practice

Step 1: Basic Training 1.Psychoeducational approach 2.Information, ideas, concepts 3.Knowledge base from which to build skills 4.Examples of concepts: –Damage control –Emergency card –High risk situations –Warning signs –Healthy pleasures and habits

Step 2: Skills training 1.Focus is on skill development 2.Multistep process –Introduce the goal –Have participants state their understanding of the goal –Review relevant terms/concepts –Develop the steps required to complete the goal –Watch a video or live demonstration of the skill –Explain how to role play –Have participants role play –Give corrective feedback –Role play again with a more challenging situation

Step 3: Practice Clients discuss their use Identify common problems, difficulties, successes Set up role plays, incorporating client’s actual experience Give feedback and facilitate discussion Plan homework for coming week

Skills relevant to psychotic d/o & s-r disorder 1.Quitting after a slip 2.Reporting a slip 3.Refusing drugs offered by a dealer 4.Refusing drugs offered by a friend or family member 5.Getting an appointment with a busy person 6.Getting a support person 7.Reporting sx and side effects to a doctor 8.Inviting someone to do something healthy 9.Negotiating with a rep. payee

Quiz 3 review Mood disorders – recognize episodes and disorders Cognitive-behavioral therapy – event to behavior sequence model, abc’s Suicide risk and responses Anxiety disorders – recognize them PTSD – Key issues, treatment strategies & tools Psychotic disorders – recognize them –Terms: positive & negative symptoms, hallucinations, delusions, decompensation, avolition –Therapeutic coercion –Case management Family role –Issues faced –Family intervention program

Case Study Discussion 1.Discuss signs and sx of mental disorder and substance related disorder. 2.Discuss medical, psychological and social risks. 3.What further information would be helpful?