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Seven Myths of Schizophrenia. At least 7 myths perpetuated about schizophrenia and other psychotic disorders discourage clinicians and case managers in promoting recovery10 long-term studies show that consumers with severe and persistent mental illness can and do significantly improve over time
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1. Empirical Correction of 7 Myths about Schizophrenia: Lessons from Vermont Betty Dahlquist, MSW, CPRP
California Association of Social Rehabilitation Agencies (CASRA)
2. Seven Myths of Schizophrenia
At least 7 myths perpetuated about schizophrenia and other psychotic disorders discourage clinicians and case managers in promoting recovery
10 long-term studies show that consumers with severe and persistent mental illness can and do significantly improve over time
Rehabilitation begins Day 1 of treatment
Supportive psychotherapy is crucial for integrating the experience of illness and enhancing adult development
There is no research evidence that consumers must stay on medications all of their lives
People with serious mental illness can perform at all levels of work.
3. 7 Myths about Schizophrenia
They have been around for 100 years.
Handed down from generation to generation of trainees across all the caring professions
Have led to pessimism about outcome
Significantly reduced opportunities for improvement
Why we used to believe these myths
What is the reality for each
Treatment strategies
4. 7 Myths about Schizophrenia
Myth 1: Once a schizophrenic, always a schizophrenic
Myth 2: A schizophrenic is a schizophrenic
Myth 3: Rehabilitation only after stabilization
Myth 4: Why bother with psychotherapy?
Myth 5: Patients must be on medication on their lives
Myth 6: People with schizophrenia cannot do anything except low-level jobs
Myth 7: Families are the Etiological Agents
5. Myth #1: “Once a schizophrenic, always a schizophrenic”
Background
Kraeplin - Good vs. Bad Outcome
E. Bleuler - “non restitutio ad integrum”
Cohen & Cohen - “the clinician’s illusion”
Reality
Wide heterogeneity
Confluence of evidence across the world
Impact of time changes everything
Predictors lose power
Set up programs “as if”
6. Results from Long-term studies
The longer a cohort was followed, the more pronounced the picture of increasing heterogeneity and improvement in functioning
Have consistently found that half to two thirds of patients significantly improved or recovered
Universal criteria for recovery are:
No current signs and symptoms of any mental illness
No current medications
Working
Relating well to family and friends
Integrated into the community
Acting in such a way as to not being able to detect having ever been hospitalized for any kind of psychiatric problems.
7. Myth #2: “A schizophrenic is a schizophrenic”
Reality: A rose is not a rose is not a rose
Evidence Against Myth #2
A group of schizophrenias (E. Bleuler)
substantial individual heterogeneity
Many genetic/environmental models (E.G. Kendler)
Suggested Rx Strategies
Comprehensive assessments
Re-evaluate often
See the person behind the disorder
Collaboration
8. Myth #3: Rehabilitation only after Stabilization
The Vermont-Maine Story
269 patients from the back wards deinstitutionalized in the 1950’s
A major follow-up study in the early 1980’s
Average of 32 years after first admission (22-62 years)
97% found 30 years later
68% achieved significant improvement or recovery
DSMIII diagnosis did not predict poor long-term outcomes as expected
Rehabilitation, being out of the hospital combined with biological correction mechanism
9. Rehabilitation is Treatment
Managing one’s symptoms
Managing a budget
Acquiring a job
Acquiring a desirable housing situation
Conducting social conversations
Anything that raises self-esteem, lowers symptoms and improves functioning deserves to be called and reimbursed as “treatment”
10. Myth #4: Why bother with psychotherapy?
Reality: Supportive psychotherapy is crucial for integrating the experience of psychosis & enhancing continuing adult development
Evidence:
Surveys of consumers
Family interventions reduce relapse rates
Suggested Rx
Realistic and practical
Complementary to medication
Working through trauma and grief
Getting on with adult development
11. Suggested Rx Strategies continued
Strategies continued
Longitudinal picture = halts and advances
Acquisition of skills
Biological and Environmental re-calibrations
True collaboration -Walking the path together
What Vermont subjects said made the most difference in their struggles towards recovery
“Someone believed in me”
“Someone told me I had a chance to get better”
My own persistence
Translates to hope and hope connects with natural self-healing
12. Myth #5: Patients Must be on Medications all their Lives
Background:
May be generated by MD’s in power struggles to promote compliance
or MD believes in myth #1 or its corollary: “once a broken brain, always a broken brain”
Reality: It My be only a small percentage of folks who will need medications indefinitely
No supporting data (25-50% completely off)
American compliance rates (40-50%)
Denial of illness problems
Disorientation
Lack of knowledge
Side effects
No environmental engineering
13. Myth #5 continued.
Suggested Rx strategies:
Strong patient-physician collaboration
Targeted psycho-education and skill building strategies
Built-in re-assessment strategies
Standardized side effects monitoring techniques
Training in non-pharmacological techniques to cope with symptoms
14. Myth #6: People with Schizophrenia cannot to anything except low-level jobs.
Reality: People with schizophrenia can and do perform at every level of work
Symptoms do not predict work performance
Diagnosis does not predict work performance
Ability to function in a hospital or school does not predict ability in work environment
Best predictor are ratings of a person’s work adjustment skills in work settings
Best demographic is a person’s prior employment history.
Ability to get along socially with others is another predictor of work performance.
“Employment is nature’s best physician and is essential to human happiness” (Galen, 172 AD)
15. Myth #7: Families are the Etiological Agents
Reality: Families, as collaborators, can provide critical information to lower a relative’s vulnerability to episodes
Evidence Against Myth #7
Not causes of schizophrenia
Most families not high ‘expressed emotion’ (EE)
Family burden of care
Full of myths and misinformation
Suggested Rx Strategies - Collaboration
Establish a relationship early
Education and emotional support
Triaging 1st v. long-term families
System Collaborators
16. “Schizophrenia does not seem to be a disease of slow progressive deterioration, even in the 2nd and 3rd decade of illness, there is still potential for full or partial recovery”(Huber et.al. 1980
Finally, it is my hope that this presentation has excited and encouraged you to continue this very difficult work we do.