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Assessment and Interventions for Schizophrenia
Schizophrenia is a serious mental illness that affects around 24 million people across the world (Lim, Barrio, Hernandez, Barragan, & Brekke, 2017). It is one of the most debilitating mental illnesses because of the significant social and occupational impairments (Beecher, 2009). Schizophrenia is characterized by cognitive impairments that greatly limit functions (Eack, 2012). Individuals with the disease have poor verbal memory, low IQ, poor mental speed, and perform poorly on fluency tasks (Xiao, Bartel, & Brekke, 2017). Schizophrenia is a hereditary disease, and it typically onsets by the age of 30 (Tikovsky, 2017). Recent research supports success in cognitive-behavioral therapies and psychotherapies (Hamm, Buck, Vohs, Westerlund, & Lysather, 2016). Because of their expertise in psychosocial intervention, social workers have a special ability to aid in treating individuals with schizophrenia (Eack, 2012).
According to the Diagnostic Statistical Manual (DSM-V) (2013), the diagnostic criteria for schizophrenia includes psychotic symptoms that are present for a noteworthy amount of time. Psychotic symptoms include delusions, hallucinations, disorganized speech, disorganized behavior, and other negative symptoms(DSM-V, 2013). The time of onset for schizophrenia is typically late adolescence to early adulthood, and this is a time of very important development (Eack, 2012).
Schizophrenia is unique compared to other psychiatric disorders because of its lasting symptoms with psychosocial impairments between episodes (Lim et. Al., 2017). When compared to people with mood disorders and schizoaffective disorders, people with schizophrenia performed the worst in the domains of processing, working memory, visual learning, reasoning, problem solving, and social cognition (Xiao et. Al., 2017). Low scores in social cognition is important in recognizing schizophrenia from other illnesses (Xiao et. Al., 2017). Assessing an individual’s social cognition and neurocognition are important to diagnose schizophrenia (Xiao et. Al., 2017). Because of their cognitive impairments, individuals with schizophrenia can be especially vulnerable to socioeconomic hardships (Lim et. Al., 2017).
Neurocognition is the process involved in thinking and reasoning such as attention, memory, and executive function abilities. Attention is especially important in detecting information that is important, and memory is needed for storing information. The greatest impairments are to verbal memory and attention. Social cognition is the ability to process, interpret, and regulate socioemotional information. Social cognitive impairments include trouble taking perspective, regulation emotions, and recognizing social cues. Impairments of attention and memory effects the ability of a person to hold a job or even carry a conversation. Social disabilities are attributed to a person being unable to understand other perspectives and social cues. Neurocognitive and social cognitive impairments are closely associated with schizophrenia (Eack, 2012).
An accurate family history can be extremely useful when assessing a patient suspected of having schizophrenia. If an individual has immediate family with the disorder, they are ten times more likely to have it (Tikovsky, 2017). The genetic effects of schizophrenia are complicated, but recently it has been discovered that compliment component 4 (C4) plays a role as a pathway for the disorder. C4 is involved in marking synapses in the brain for removal. It is most active in the late teens and early 20s. Overactivity of C4 is associated with a higher risk of schizophrenia (Runnels, 2018). The discovery of the genetic components that play a role in the etiology of schizophrenia is evidence of the hereditary nature of the disease.
Gender of the patient plays a significant part in assessing them for schizophrenia. It affects the onset and the prominence of symptoms (Seeman, 2018). Seeman (2018) describes her female patients with schizophrenia as “well groomed, chatty, friendly, and smart” (p. 9). While she described her male patients as “emotionally distant, apathetic, disheveled, and angry” (p. 9). Women typically encounter the onset of symptoms later in life compared to men, and this allows for the women to have time to complete more education and mature their social skills . While women often worked outside the home and maintained committed relationships, men with schizophrenia are associated with high suicide rates, unemployment, and being dependent on their parents (Seeman, 2018).
There are disagreements on how schizophrenia should be defined (Tikovsky, 2017), and it is possible that practitioners have been lumping different disorders with similar symptoms under the disorder of schizophrenia (Runnels, 2018). There are criticisms of the validity and reliability of the methods of gathering information from clients. The causation of schizophrenia is still not certain, and it causes it to be challenging for practitioners to fully comprehend the effects of genetic and environmental factors (Tikovsky, 2017).
Social Work Interventions
The severity of schizophrenia makes the population living with it extremely vulnerable (Beecher, 2009). Social workers specialize in working with vulnerable populations, and social workers have pioneered the development of psychosocial interventions that have proven to be effective in treating schizophrenia (Eack, 2012). Social workers have a broad knowledge base that aids in equipping them to treat schizophrenic patients. The emphasis on person in situation perspective, biopsychosocial knowledge, and treatment modalities such as cognitive-behavioral therapy, ecological approach, and strength perspectives give social workers unique tools to treat schizophrenia (Beecher, 2009).
The treatment of schizophrenia is most often centered around the medical model (Beecher, 2009). The etiological medical model operates on the basis that mental illnesses are disorders of the brain that should be treated with medication and/or physical treatment. The practice oriented medical model seeks to identify the root of the problem and then treating to heal or repair the issue (Beecher, 2009).
Psychosocial interventions are extremely important to improving an individual’s functioning when the individual has schizophrenia (Eack, 2012). The growth of treatments available are helped by the growing belief that recovery is possible for individuals with schizophrenia (Hamm et. Al., 2016). Psychosocial interventions are most often provided by social workers because of their role in developing, evaluating, and using psychosocial interventions. Community treatment, family psychoeducation, and strength-based therapies are all methods social workers use to aid treatment of schizophrenia. These interventions combined with the appropriate medication are associated with success in recovery (Eack, 2012). The collection of social workers and other disciplines has resulted in psychosocial interventions to improve cognitive functioning. The psychosocial interventions are constructed to improve cognition by using aimed cognitive exercises and training (Eack, 2012).
It is important to address an individual with schizophrenia from an interpersonal stance. It is necessary for the practitioner to have a sensitive and responsive approach to the process occurring in that moment. The position from which a therapist speaks more important thatn what is actually said. The practitioner must believe that it is possible for the most psychotic patients to be understood. People with severe mental disorders find ways to make sense of what is happening to them. Practitioners must also accept that it is possible for an individual with a severe mental disorder to want to recover. The therapist should adopt the role of a consultant to the patient to aid them in their recovery (Hamm et. Al., 2016). Interventions that allow for individuals to make decisions about their treatment can nurture recovery. Intrinsic motivations encourage better engagement in interventions and make it more likely the individual is successful in recovery (Lim et. Al., 2017).
Outcome oriented recovery stresses the decrease of symptoms and a return to premorbid functioning. Process-oriented recovery focuses on coping with and managing symptoms. The mental health community does not agree on which method is better for schizophrenia (Lim et. Al., 2017). Lim, Barrio, Hernandez, Barragon, and Brekke’s study found that more than one in 20 participants accomplished a year of recovery. This goes against the stereotype that individuals with schizophrenia generally do not recover (Lim et. Al., 2017).
Positive family relationships when entering rehabilitation is associated with success in recovery (Lim et. Al., 2017). Family members are often the most likely to be hurt by a delusional or hallucination individual. Ensuring the patient is not a risk to others is important to treatment (Seeman, 2018). Providing psychoeducation to the family of individuals with schizophrenia is effective in lowering the likelihood of relapse (Lim et. Al., 2017).
Cognitive remediation has proven to be an effective approach to psychosocial interventions for treating schizophrenia (Eack, 2012). Cognitive remediation approaches include a variety of exercises such as completing sudoku puzzles and computer programs designed to target precise domains of cognition. There are diverse methods of approaches available to practitioners, but they all share common principles. Almost all approaches include strategic techniques designed to optimize cognitive performance along with drill and practice techniques that improve performance through repetition. While evidence supports improvements in neurocognition using cognitive remediation approaches, there are less studies on how it improves social cognition. The belief is that if cognitive functioning can be improved, recovery is possible. There is evidence that supports using cognitive remediation in community and social work settings. Social workers will have a large impact on providing cognitive remediation to underserved individuals (Eack, 2012).
Cognitive enhancement therapy is a cognitive remediation approach that is meant to improve neurocognition and social cognition. It starts by targeting basic problems through pairing clients for neurocognitive remediation by implanting the computer-based training into a social context. After a few months, multiple pairs of patients join together in groups. Patients work with a coach to create a plan for their recovery. Social-cognitive groups are important to cognitive enhancement therapy, and psychoeducation, cognitive exercises, and homework are used to target social cognitive functioning in the groups (Each, 2012).
Antipsychotic medications are necessary to any effort to treat schizophrenia. They make it possible for people with schizophrenia to live in the community because they help manage the psychotic symptoms like hallucinations and delusions (Eack, 2012). Antipsychotic medications can be taken orally or injected. Long-lasting injections are more effective in lowering the chances of hospitalization (Runnels, 2018). They can be dangerous if the individual taking them is in a situation where it is important to be aware and alert (Seeman, 2018). Even when antipsychotic medications work to get the psychosis under control, individuals with schizophrenia require other interventions because of their poor social, vocational, and cognitive functioning.
More research is necessary to determine what helps individuals with schizophrenia to be successful in recovery in order for more specific treatment to be developed and enhanced (Lim et. Al, 2017). While social workers are not the primary providers for individuals with schizophrenia (Beecher, 2009), they are uniquely qualified to help the especially vulnerable population. Through their knowledge base, social workers are vital instruments to be utilized in the treatment of schizophrenia.
- Beecher, B. (2009). The Medical Model, Mental Health Practitioners, and Individuals with Schizophrenia and Their Families. Journal of Social Work Practice, 23(1), 9–20. https://doi-org.nsula.idm.oclc.org/10.1080/02650530902723282
- Diagnostic and statistical manual of mental disorders. (2013). Arlington, VA: American Psychiatric Publishing.
- Eack, S. M. (2012). Cognitive remediation: A new generation of psychosocial interventions for people with schizophrenia. Social Work, 57(3), 235–246. https://doi-org.nsula.idm.oclc.org/10.1093/sw/sws008
- Hamm JA, Buck KD, Vohs J, Westerlund RJ, Lysaker PH. Interpersonal stance and dialogue in psychotherapy for schizophrenia: A supervisory approach. Clinical Supervisor. 2016;35(1):42-62. doi:10.1080/07325223.2016.1140102.
- Lim, C., Barrio, C., Hernandez, M., Barragán, A., & Brekke, J. S. (2017). Recovery From Schizophrenia in Community-Based Psychosocial Rehabilitation Settings. Research on Social Work Practice, 27(5), 538–551. https://doi-org.nsula.idm.oclc.org/10.1177/1049731515588597
- Runnels, P. (2018). Recent Advances in the Treatment of Schizophrenia: Increasing Adherence to Improve Outcomes. Journal of Managed Care Medicine, 21(3), 49–52. Retrieved from https://nsula.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131746088&site=ehost-live&scope=site
- Seeman, M. V. (2018). Clinical Implications of Gender Differences in Schizophrenia. Psychiatric Times, 35(11), 9–11. Retrieved from https://nsula.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=132936878&site=ehost-live&scope=site
- Tikovsky, E. (2017). Understanding the Nature and Aetiology of Schizophrenia. Journal of Social & Psychological Sciences, 10(1), 1–14. Retrieved from https://nsula.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=129244750&site=ehost-live&scope=site
- Xiao, R., Bartel, R. L., & Brekke, J. (2017). Comparison of neurocognition and social cognition between schizoaffective disorder, mood disorders, and schizophrenia. Social Work Research, 41(3), 169–179. Retrieved from https://nsula.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=swh&AN=90546&site=ehost-live&scope=site
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