WHAT IS THE CONCEPT OF RECOVERY ?
B ) WHAT ARE THE EVIDENCE BASED STRATEGIES FOR PSYCHOSOCIAL REHABILITATION OF SCHIZOPHRENIA ?
A 2 A ) DEFINITION
1 Essentially, recovery is a complex and dynamic process encompassing all the positive benefits to physical, mental and social health that can happen when people with an addiction to alcohol or drugs, or their family members, get the help they need.
2 Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness and quality of life.”
3 If called for a single person - personal recovery is defined within this framework as " Being able to create and live a meaningful and contributing life in a community of choice with or without the presence of mental health issue
4 During acute phases - safety should be the concern followed by deeper engagement in later phase
3 GUIDING PRINCIPLES OF RECOVERY
A ) Recovery is self-directed and empowering.
B ) Recovery involves a personal recognition of the need for change and transformation.
C ) Recovery is holistic.
D ) Recovery has cultural dimensions.
E ) Recovery exists on a continuum of improved health and wellness.
F ) Recovery is supported by peers and allies.
G ) Recovery emerges from hope and gratitude.
H ) Recovery involves a process of healing and self-redefinition.
I ) Recovery involves addressing discrimination and transcending shame and stigma.
J ) Recovery involves (re)joining and (re)building a life in the community.
K ) Recovery is a reality. It can, will, and does happen.
CONCEPTUAL MODELS OF RECOVERY PROCESSES
A ) Anderson , Oades and Caputi model
1 - There are 4 processes involved in personal recovery
I - Finding and Maintaining Hope
II - Reestablishment of positive identity
III - Building a meaningful life
IV - Taking responsibility and control
B ) Glover model ( 2012 )
Recovery is possible through a set of 5 processes such as -
I - From passive to active sense of self
II - From hopelessness and despair to hope
III - From others control to personal control and responsibility
IV - From ailenation to discovery
V - From disconnectedness to connectedness
C ) Le Boutillier , Leamy , Bird , Davidson , Wiliams and Slade ( 2011 )
Similar to above 2
B ) EVIDENCE BASED STRATEGIES FOR PSYCHOSOCIAL REHABILITATION OF SCHIZOPHRENIA
INTRODUCTION
1 - Schizophrenia is a kind of chronic mental disease characterized by high relapse rate and disability rate
2 - The relapse rate of schizophrenia ranges from 40% to 90%.
3 - Psychosocial interventions can play a critical role in a comprehensive intervention program, and are probably necessary components if treatment is viewed in the context of the patient’s overall level of functioning, quality of life, and compliance with prescribed treatments.
4 - Progress in treatment should be expected to be slow and marked by periodic disruptions and periods of regression. Consequently, it is important that treatment be long term, extending over months and years.
5 - Treatment should also be guided by concrete, short-term goals that are likely to be achieved (eg, to attend day hospital at least twice a week for 1 month).
6 - While there are a number of illness characteristics that are common to most patients, there are extensive individual differences, as well as differences within the same patient over time. Thus, treatment must be tailored to the needs of each patient and adjusted as the patient changes.
7 - Regardelss of the severity of illness, the patient must be included as a parther in treatment planning and goal setting in order to secure effective cooperation. Treatment should be conducted in collaboration with the patient, not done to the patient.
8 - Effective treatment targets specific skills or problem areas that the patient can agree to work on (eg, social skills, drug use, or vocational skills).
9 - Nonspecific group or individual psychotherapy is not effective.
10 - The illness is marked by significant deficits in memory, attention, and exectuve functioning that have major effects on the treatment process. Treatment must be adapted to these impaiments if patients are to be able to learn and retain what is discussed in sessions. Treatment should inadvertently become a memory or attention test.
TYPES / INCLUSIONS
1 Social skill training -
A ) This treatment approach, which can be provided to patients either individually or in groups, involves systematically teaching patients specific behaviors that are critical for success in social interactions.
B ) Developed over 25 years ago, it is probably the most widely studied psychological treatment method for individuals with schizophrenia, and there is an extensive literature documenting its efficacy.
2 Family psychoeducation -
A ) The most important development in psychosocial treatment over the last two decades has been the emphasis on the positive effects of family participation in the treatment process
B ) The different approaches to working with families share a number of common elements referred to as psychoeducation: a collaborative, respectful relationship with the family, the provision of information about schizophrenia and its treatment, and teaching family members less stressful and more constructive strategies for communication and solving problems.
3 - Cognitive therapy -
A ) Antipsychotic medications are primarily effective for reducing positive symptoms, but even the new-generation medications are not highly effective for all patients.
B ) Recently, there has been increased interest in teaching patients coping strategies for controlling residual symptoms.
C )A number of laboratories in the United Kingdom have reported very promising findings for interventions that employ cognitive behavior therapy techniques (eg, self-talk, rational analysis) to reduce distress associated with both hallucinations and delusions ( v imp )
4 - Cognitive rehabilitation -
A ) As indicated above, schizophrenia is marked by neurocognitive impairments that have a significant impact on community functioning and are only partially ameliorated bymedication.
B ) Consequently, considerable effort has been devoted to development of cognitive rehabilitation programs to increase memory capacity, attention, and high level problem-solving skills.
C ) Most of these techniques employ repetitive practice on neurocognitive tasks using computers.
RECENT EVIDENCE BASED GUIDELINES ( ACCORDING TO NICE ( UK ) AND PORT )
COMBINATION STRATEGIES
AS mentioned above 4 processes or parameter such as -
(a) the simultaneous delivery of two practices (two interventions or an intervention and a program) and
(b) modified practices: interventions changed in order become integrated with another intervention or within a program
Eg -
1 - Cognitive Behavior Therapy (CBT) and Social Skills Training
The group included modules that were repeated over time, enabling the participants to go over the content more than once and allowing new participants to enter the group at any given moment.
2 - CBT and Family Psychoeducation
The merged intervention has the advantage of covering essential elements of family psychoeducation for psychosis, including updated information on recovery, and also offers concrete CBT tools that can be useful for the person with a mental illness as well for their family members.
3 - Social Skills Training and Supported Employment Programs
the goal is to develop spontaneous behaviors and therefore involves multiple role-plays and repetitive behaviors.
4 - Cognitive Remediation and Supported Employment
The computerized program aims at improving attention, concentration, psychomotor speed, learning and memory as well as executive functions.
5 - CBT and supported rehabilitation