comer, abnormal psychology, 6e – chapter 15 1 chapter 15 treatments for schizophrenia and other...

Comer, Abnormal Psychology, 6e – Comer, Abnormal Psychology, 6e – Chapter 15Chapter 15

11

Chapter 15Chapter 15

Treatments for Schizophrenia Treatments for Schizophrenia and Other Severe Mental and Other Severe Mental

DisordersDisorders

Slides & Handouts by Karen Clay Slides & Handouts by Karen Clay Rhines, Ph.D.Rhines, Ph.D.

Seton Hall UniversitySeton Hall University

2Comer, Abnormal Psychology, 6e – Comer, Abnormal Psychology, 6e –


How Is Schizophrenia How Is Schizophrenia Treated?Treated?

Historically, people with schizophrenia Historically, people with schizophrenia were considered beyond help and without were considered beyond help and without hopehope

Though schizophrenia is still hard to treat, Though schizophrenia is still hard to treat, the discovery of antipsychotic drugs has the discovery of antipsychotic drugs has enabled people with the disorder to think enabled people with the disorder to think clearly and profit from psychotherapiesclearly and profit from psychotherapies

Each of the models offers treatments for Each of the models offers treatments for schizophrenia, and all have been influential schizophrenia, and all have been influential at one time or anotherat one time or another



Institutional Care in the Institutional Care in the PastPast

For more than half of the 20For more than half of the 20thth century, century, people with schizophrenia were people with schizophrenia were considered insane and were considered insane and were institutionalized in public mental institutionalized in public mental hospitalshospitals

Because patients failed to respond to Because patients failed to respond to traditional therapies, the primary goals traditional therapies, the primary goals of the hospitals were to restrain them of the hospitals were to restrain them and give them food, shelter, and clothingand give them food, shelter, and clothing




The move toward institutionalization The move toward institutionalization began in 1793 with the practice of began in 1793 with the practice of “moral treatment” “moral treatment”

Hospitals were created in isolated Hospitals were created in isolated areas to protect patients from the areas to protect patients from the stresses of daily life and to offer stresses of daily life and to offer them a healthful psychological them a healthful psychological environmentenvironment




States throughout the U.S. were States throughout the U.S. were required by law to establish public required by law to establish public mental institutions (state hospitals) for mental institutions (state hospitals) for patients who could not afford private patients who could not afford private carecare Unfortunately, problems with overcrowding, Unfortunately, problems with overcrowding,

understaffing, and poor patient outcomes understaffing, and poor patient outcomes led to loss of individual care and the led to loss of individual care and the creation of “back wards” – human creation of “back wards” – human warehouses filled with hopelessnesswarehouses filled with hopelessness




Many patients not only failed to improve Many patients not only failed to improve under these conditions but developed under these conditions but developed additional symptoms, apparently as a result additional symptoms, apparently as a result of institutionalization itselfof institutionalization itself The most common pattern of decline was called The most common pattern of decline was called

the social breakdown syndrome, which involved: the social breakdown syndrome, which involved: Extreme withdrawal, anger, and physical Extreme withdrawal, anger, and physical

aggressivenessaggressiveness

Loss of interest in personal appearance and Loss of interest in personal appearance and functioningfunctioning



Institutional Care Institutional Care Takes a Turn for the Takes a Turn for the

BetterBetter In the 1950s, clinicians developed two In the 1950s, clinicians developed two

institutional approaches that brought some institutional approaches that brought some hope to chronic patients:hope to chronic patients: Milieu therapyMilieu therapy

Based on humanistic principlesBased on humanistic principles

Token economiesToken economies Based on behavioral principlesBased on behavioral principles

These approaches particularly helped These approaches particularly helped improve the personal care and self-image improve the personal care and self-image of patients, problem areas that were of patients, problem areas that were worsened by institutionalizationworsened by institutionalization




BetterBetter Milieu therapyMilieu therapy

The guiding principle is that institutions can help The guiding principle is that institutions can help patients make clinical progress by creating a patients make clinical progress by creating a social climate (“milieu”) that promotes productive social climate (“milieu”) that promotes productive activity, self-respect, and individual responsibilityactivity, self-respect, and individual responsibility

Milieu programs have been set up in institutions Milieu programs have been set up in institutions throughout the Western world with moderate throughout the Western world with moderate successsuccess

Research has shown that patients with schizophrenia in Research has shown that patients with schizophrenia in milieu programs often leave the hospital at higher rates milieu programs often leave the hospital at higher rates than patients receiving custodial carethan patients receiving custodial care




BetterBetter The token economyThe token economy

Based on operant conditioning principles, token Based on operant conditioning principles, token economies are used in institutions to change the economies are used in institutions to change the behavior of patients with schizophreniabehavior of patients with schizophrenia

Patients are rewarded when they behave in Patients are rewarded when they behave in socially acceptable ways and are not rewarded socially acceptable ways and are not rewarded when they behave unacceptablywhen they behave unacceptably

Immediate rewards are tokens that can later be Immediate rewards are tokens that can later be exchanged for food, cigarettes, privileges, and other exchanged for food, cigarettes, privileges, and other desirable objectsdesirable objects

Acceptable behaviors likely to be targeted include care Acceptable behaviors likely to be targeted include care for oneself and one’s possessions, going to a work for oneself and one’s possessions, going to a work program, and showing self-controlprogram, and showing self-control





Researchers have found that token economies Researchers have found that token economies help change psychotic and related behaviorhelp change psychotic and related behavior

However, questions have been raised about However, questions have been raised about such programs:such programs:

Many research studies have been uncontrolled; Many research studies have been uncontrolled; instead of patients being randomly assigned to instead of patients being randomly assigned to groups, a whole ward will participate in the programgroups, a whole ward will participate in the program

Are such programs ethical and legal? Aren’t all Are such programs ethical and legal? Aren’t all humans entitled to basic rights, some of which are humans entitled to basic rights, some of which are compromised in a strict token economy system?compromised in a strict token economy system?





Questions have been raised about such Questions have been raised about such programs:programs: Are such programs truly effective? For Are such programs truly effective? For

example, patients may change overt example, patients may change overt behaviors but not underlying psychotic behaviors but not underlying psychotic beliefsbeliefs

Transitioning from a token economy system Transitioning from a token economy system to community living may be difficult for to community living may be difficult for patientspatients




BetterBetter Milieu therapy and token economies Milieu therapy and token economies

have helped improve the gloomy have helped improve the gloomy outlook for patients with outlook for patients with schizophrenia schizophrenia They are still used in many mental They are still used in many mental

hospitals, usually along with medicationhospitals, usually along with medication

This approach has also been applied to This approach has also been applied to other clinical problemsother clinical problems



Antipsychotic DrugsAntipsychotic Drugs

While milieu therapy and token While milieu therapy and token economies helped improve economies helped improve treatment outcomes, it was the treatment outcomes, it was the discovery of antipsychotic drugs in discovery of antipsychotic drugs in the 1950s that revolutionized the 1950s that revolutionized treatment for those with treatment for those with schizophreniaschizophrenia




The discovery of antipsychotic medications The discovery of antipsychotic medications dates back to the 1940s, when researchers dates back to the 1940s, when researchers developed antihistamine drugs for allergiesdeveloped antihistamine drugs for allergies

It was discovered that one group of It was discovered that one group of antihistamines, phenothiazines, could be used antihistamines, phenothiazines, could be used to calm patients about to undergo surgeryto calm patients about to undergo surgery Psychiatrists tested one of the drugs, Psychiatrists tested one of the drugs,

chlorpromazine, on six patients with psychosis and chlorpromazine, on six patients with psychosis and observed a sharp reduction in their symptomsobserved a sharp reduction in their symptoms

In 1954, chlorpromazine (under the trade name In 1954, chlorpromazine (under the trade name Thorazine) was approved for sale in the U.S. as an Thorazine) was approved for sale in the U.S. as an antipsychotic drugantipsychotic drug




Since the discovery of the phenothiazines, Since the discovery of the phenothiazines, other kinds of psychotic drugs have been other kinds of psychotic drugs have been developeddeveloped Those developed throughout the 1960s, 1970s, Those developed throughout the 1960s, 1970s,

and 1980s are now referred to as “conventional” and 1980s are now referred to as “conventional” antipsychotic drugsantipsychotic drugs

These drugs are also known as neuroleptic drugs These drugs are also known as neuroleptic drugs because they often produce undesired movement because they often produce undesired movement effects similar to symptoms of neurological diseaseseffects similar to symptoms of neurological diseases

Drugs developed in recent years are known as Drugs developed in recent years are known as “atypical” or “second-generation” antipsychotics“atypical” or “second-generation” antipsychotics



How Effective Are How Effective Are Antipsychotic Drugs?Antipsychotic Drugs?

Research has repeatedly shown that Research has repeatedly shown that antipsychotic drugs reduce schizophrenia antipsychotic drugs reduce schizophrenia symptoms in the majority of patientssymptoms in the majority of patients In direct comparisons, drugs appear to be In direct comparisons, drugs appear to be

more effective than any other approach used more effective than any other approach used alonealone

In most cases, the drugs produce the In most cases, the drugs produce the maximum level of improvement within the maximum level of improvement within the first six months of treatmentfirst six months of treatment Symptoms may return if patients stop taking Symptoms may return if patients stop taking

the drugs too soonthe drugs too soon




Antipsychotic drugs, particularly the Antipsychotic drugs, particularly the conventional ones, reduce the positive conventional ones, reduce the positive symptoms of schizophrenia more completely, or symptoms of schizophrenia more completely, or at least more quickly, than the negative at least more quickly, than the negative symptomssymptoms Correspondingly, people who display largely positive Correspondingly, people who display largely positive

symptoms generally have better rates of recovery symptoms generally have better rates of recovery than those with primarily negative symptomsthan those with primarily negative symptoms

Since men with the disorder tend to have more Since men with the disorder tend to have more negative symptoms than women, they require higher negative symptoms than women, they require higher doses and respond less readily to the antipsychotic doses and respond less readily to the antipsychotic drugsdrugs




Although the use of such drugs is Although the use of such drugs is now widely accepted, patients often now widely accepted, patients often dislike the powerful effects of the dislike the powerful effects of the drugs, and some refuse to take themdrugs, and some refuse to take them



The Unwanted Effects of The Unwanted Effects of Conventional Conventional

Antipsychotic DrugsAntipsychotic Drugs In addition to reducing psychotic In addition to reducing psychotic

symptoms, conventional antipsychotic symptoms, conventional antipsychotic drugs sometimes produce disturbing drugs sometimes produce disturbing movement problemsmovement problems These are called “extrapyramidal effects” These are called “extrapyramidal effects”

because they appear to be caused by the drugs’ because they appear to be caused by the drugs’ impact on the extrapyramidal areas of the brainimpact on the extrapyramidal areas of the brain

These effects are so common that they are These effects are so common that they are listed as a separate category of disorders listed as a separate category of disorders – – medication-induced movement disorders medication-induced movement disorders – – in in the DSM-IV-TRthe DSM-IV-TR




Antipsychotic DrugsAntipsychotic Drugs The most common of these effects The most common of these effects

produce Parkinsonian symptoms, produce Parkinsonian symptoms, reactions that closely resemble the reactions that closely resemble the features of the neurological disorder features of the neurological disorder Parkinson’s disease, including:Parkinson’s disease, including: Muscle tremor and rigidityMuscle tremor and rigidity Dystonia (bizarre movements of the Dystonia (bizarre movements of the

face, neck, tongue, and back)face, neck, tongue, and back) Akathisia (great restlessness, agitation, Akathisia (great restlessness, agitation,

and discomfort in the limbs)and discomfort in the limbs)



The Unwanted Effects of The Unwanted Effects of Conventional Antipsychotic Conventional Antipsychotic

DrugsDrugs The Parkinsonian and related symptoms The Parkinsonian and related symptoms

seem to be the result of medication-seem to be the result of medication-induced reductions of dopamine activity induced reductions of dopamine activity in the substantia nigra, a part of the brain in the substantia nigra, a part of the brain that coordinates movement and posturethat coordinates movement and posture

In most cases, the symptoms can be In most cases, the symptoms can be reversed if an anti-Parkinsonian drug is reversed if an anti-Parkinsonian drug is taken along with the antipsychotictaken along with the antipsychotic Sometimes medication use must be halted Sometimes medication use must be halted

altogetheraltogether




Antipsychotic DrugsAntipsychotic Drugs In as many as 1% of patients, particularly In as many as 1% of patients, particularly

elderly ones, conventional antipsychotic drugs elderly ones, conventional antipsychotic drugs produce neuroleptic malignant syndrome produce neuroleptic malignant syndrome –– a a severe, potentially fatal reaction severe, potentially fatal reaction Symptoms include muscle rigidity, fever, altered Symptoms include muscle rigidity, fever, altered

consciousness, and improper functioning of the consciousness, and improper functioning of the autonomic nervous systemautonomic nervous system

As soon as the syndrome is recognized, drug As soon as the syndrome is recognized, drug use is discontinued and each symptom is use is discontinued and each symptom is treated medicallytreated medically Individuals may also be given dopamine-enhancing Individuals may also be given dopamine-enhancing

drugsdrugs



Unwanted Effects of Unwanted Effects of Conventional Conventional

Antipsychotic DrugsAntipsychotic Drugs A more difficult side effect of A more difficult side effect of

conventional antipsychotic drugs conventional antipsychotic drugs appears up to one year after starting the appears up to one year after starting the medicationmedication This reaction, called tardive dyskinesia, This reaction, called tardive dyskinesia,

involves involuntary movements, usually of involves involuntary movements, usually of the mouth, lips, tongue, legs, or bodythe mouth, lips, tongue, legs, or body It affects more than 10% of those taking the It affects more than 10% of those taking the

drugsdrugs

It can be IRREVERSIBLE!It can be IRREVERSIBLE!



Unwanted Effects of Unwanted Effects of Conventional Conventional

Antipsychotic DrugsAntipsychotic Drugs Since learning of the unwanted side Since learning of the unwanted side

effects of conventional antipsychotic effects of conventional antipsychotic drugs, clinicians have become more drugs, clinicians have become more careful in their prescription practices:careful in their prescription practices: They try to prescribe the lowest effective They try to prescribe the lowest effective

dosedose

They gradually reduce or stop medication They gradually reduce or stop medication weeks or months after the patient begins weeks or months after the patient begins functioning normallyfunctioning normally



New Antipsychotic DrugsNew Antipsychotic Drugs

In recent years, new antipsychotic In recent years, new antipsychotic drugs have been developeddrugs have been developed Examples: Clozaril, Risperdal, Zyprexa, Examples: Clozaril, Risperdal, Zyprexa,

Seroquel, Geodon, and AbilifySeroquel, Geodon, and Abilify



New Antipsychotic DrugsNew Antipsychotic Drugs

These new drugs are called “atypical” These new drugs are called “atypical” because their biological operation differs because their biological operation differs from that of conventional antipsychoticsfrom that of conventional antipsychotics They appear more effective than conventional They appear more effective than conventional

drugs, especially for negative symptomsdrugs, especially for negative symptoms

They cause few extrapyramidal side effectsThey cause few extrapyramidal side effects

They do, however, carry a risk of They do, however, carry a risk of agranulocytosis, a potentially fatal drop in agranulocytosis, a potentially fatal drop in white blood cellswhite blood cells



PsychotherapyPsychotherapy

Before the discovery of antipsychotic Before the discovery of antipsychotic drugs, psychotherapy was not an drugs, psychotherapy was not an option for people with schizophreniaoption for people with schizophrenia Most were simply too far removed from Most were simply too far removed from

reality to profit from psychotherapyreality to profit from psychotherapy




Today, psychotherapy can be very Today, psychotherapy can be very helpful when used in combination with helpful when used in combination with medicationmedication The most helpful forms of psychotherapy The most helpful forms of psychotherapy

include insight therapy and two broader include insight therapy and two broader sociocultural therapies: family therapy and sociocultural therapies: family therapy and social therapysocial therapy

These approaches are often combined and These approaches are often combined and tailored to the needs of the individual tailored to the needs of the individual patientpatient




Insight therapyInsight therapy A variety of insight therapies have been A variety of insight therapies have been

used to treat schizophreniaused to treat schizophrenia

Studies suggest that the orientation of Studies suggest that the orientation of the therapist is less important than their the therapist is less important than their experience with schizophreniaexperience with schizophrenia In addition, the most successful therapists are In addition, the most successful therapists are

those who take an active role, set limits, those who take an active role, set limits, express opinions, and challenge the patients’ express opinions, and challenge the patients’ statementsstatements




Family therapyFamily therapy Around 25% of persons recovering from Around 25% of persons recovering from

schizophrenia live with family membersschizophrenia live with family members This creates significant family stressThis creates significant family stress Those who live with relatives who display high levels Those who live with relatives who display high levels

of expressed emotion are at greater risk for relapse of expressed emotion are at greater risk for relapse than those who live with more positive or supportive than those who live with more positive or supportive familiesfamilies

Family therapy attempts to address such Family therapy attempts to address such issues, create more realistic expectations, and issues, create more realistic expectations, and provide psychoeducation about the disorderprovide psychoeducation about the disorder

Families may also turn to family support Families may also turn to family support groups and family psychoeducation programsgroups and family psychoeducation programs



Social TherapySocial Therapy

Many clinicians believe that the treatment Many clinicians believe that the treatment of people with schizophrenia should of people with schizophrenia should include techniques that address social and include techniques that address social and personal difficulties in the clients’ livespersonal difficulties in the clients’ lives These include: practical advice, problem These include: practical advice, problem

solving, decision making, social skills training, solving, decision making, social skills training, medication management, employment medication management, employment counseling, financial assistance, and housingcounseling, financial assistance, and housing

Research finds that this approach reduces Research finds that this approach reduces rehospitalizationrehospitalization



The Community The Community ApproachApproach

The community approach is the broadest The community approach is the broadest approach for the treatment of schizophreniaapproach for the treatment of schizophrenia In 1963, Congress passed the Community Mental In 1963, Congress passed the Community Mental

Health Act, which said that patients should be able Health Act, which said that patients should be able to receive care within their own communities, to receive care within their own communities, rather than being transported to institutions far rather than being transported to institutions far from homefrom home

This led to massive deinstitutionalization of patients with This led to massive deinstitutionalization of patients with schizophreniaschizophrenia

Unfortunately, community care was (and is) inadequate Unfortunately, community care was (and is) inadequate for their carefor their care

The result is a “revolving door” syndromeThe result is a “revolving door” syndrome



What Are the Features of What Are the Features of

Effective Community Effective Community Care?Care? People recovering from schizophrenia and People recovering from schizophrenia and

other severe disorders need medication, other severe disorders need medication, psychotherapy, help in handling daily psychotherapy, help in handling daily pressures and responsibilities, guidance pressures and responsibilities, guidance in making decisions, training in social in making decisions, training in social skills, residential supervision, and skills, residential supervision, and vocational counselingvocational counseling This combination of services sometimes is This combination of services sometimes is

called assertive community treatmentcalled assertive community treatment

Other key features are…Other key features are…




Effective Community Effective Community Care?Care? Coordinated servicesCoordinated services

Community mental health centers provide Community mental health centers provide medications, psychotherapy, and inpatient medications, psychotherapy, and inpatient emergency careemergency care

Coordination of services is especially important for Coordination of services is especially important for mentally ill chemical abusers (MICAs)mentally ill chemical abusers (MICAs)

Short-term hospitalizationShort-term hospitalization If treatment on an outpatient basis is unsuccessful, If treatment on an outpatient basis is unsuccessful,

patients may be transferred to short-term hospital patients may be transferred to short-term hospital programsprograms

After being hospitalized for up to a few weeks, After being hospitalized for up to a few weeks, patients are released to aftercare programs for patients are released to aftercare programs for follow-up in the communityfollow-up in the community




Effective Community Effective Community Care?Care? Partial hospitalizationPartial hospitalization

If patients’ needs fall between full If patients’ needs fall between full hospitalization and outpatient care, day hospitalization and outpatient care, day center programs may be effectivecenter programs may be effective

These programs provide daily These programs provide daily supervised activities and programs to supervised activities and programs to improve social skillsimprove social skills




Effective Community Effective Community Care?Care? Supervised residencesSupervised residences

Halfway houses provide shelter and supervision Halfway houses provide shelter and supervision for those patients who are unable to live alone for those patients who are unable to live alone or with their families but who do not require or with their families but who do not require hospitalizationhospitalization

Staff are usually paraprofessionalsStaff are usually paraprofessionals

Houses are run with a milieu therapy philosophyHouses are run with a milieu therapy philosophy

These programs help those with schizophrenia These programs help those with schizophrenia adjust to community life and avoid adjust to community life and avoid rehospitalizationrehospitalization




Effective Community Effective Community Care?Care? Occupational trainingOccupational training

Many people recovering from Many people recovering from schizophrenia receive occupational schizophrenia receive occupational training in a sheltered workshop – a training in a sheltered workshop – a supervised workplace for employees supervised workplace for employees who are not ready for competitive or who are not ready for competitive or complicated jobscomplicated jobs



How Has Community How Has Community Treatment Failed?Treatment Failed?

There is no doubt that effective community There is no doubt that effective community programs can help people with programs can help people with schizophrenia recoverschizophrenia recover

However, fewer than half of all people who However, fewer than half of all people who need them receive appropriate community need them receive appropriate community mental health servicesmental health services In any given year, 40% to 60% of all people with In any given year, 40% to 60% of all people with

schizophrenia receive no treatment at allschizophrenia receive no treatment at all Two factors are primarily responsible:Two factors are primarily responsible:

Poor coordination of servicesPoor coordination of services Shortage of servicesShortage of services




Poor coordination of servicesPoor coordination of services Mental health agencies in a community often Mental health agencies in a community often

fail to communicate with one anotherfail to communicate with one another

To combat this problem, a growing number of To combat this problem, a growing number of community therapists have become case community therapists have become case managers for people with schizophreniamanagers for people with schizophrenia

Case managers offer therapy and advice, teach Case managers offer therapy and advice, teach problem-solving and social skills, and ensure problem-solving and social skills, and ensure compliance with medications compliance with medications

Case managers also try to coordinate available Case managers also try to coordinate available community services for their clientscommunity services for their clients




Shortage of servicesShortage of services The number of community programs available to The number of community programs available to

people with schizophrenia is woefully inadequatepeople with schizophrenia is woefully inadequate The centers that do exist generally fail to The centers that do exist generally fail to

provide adequate services for people with severe provide adequate services for people with severe disordersdisorders

This shortage is due to:This shortage is due to: A lack of mental health professionals who wish to work A lack of mental health professionals who wish to work

with severely disturbed patientswith severely disturbed patients Objections to such programs by neighborhood residentsObjections to such programs by neighborhood residents Funding shortages (primary reason)Funding shortages (primary reason)



What Are the Consequences What Are the Consequences of Inadequate Community of Inadequate Community

Treatment?Treatment? When community treatment fails, When community treatment fails,

many people with schizophrenia many people with schizophrenia receive no treatment at allreceive no treatment at all Some return to their families and Some return to their families and

receive medication and perhaps receive medication and perhaps emotional and financial support, but emotional and financial support, but little else in the way of treatmentlittle else in the way of treatment




Treatment?Treatment? About 8% of patients enter an alternative care About 8% of patients enter an alternative care

facility (such as a nursing home), where they facility (such as a nursing home), where they receive custodial care and medicationreceive custodial care and medication

About 18% are placed in privately run About 18% are placed in privately run residences (such as foster homes or residences (such as foster homes or boardinghouses) where supervision is provided boardinghouses) where supervision is provided by untrained individualsby untrained individuals

As many as 31% of patients are placed in single-As many as 31% of patients are placed in single-room occupancy hotels, generally in rundown room occupancy hotels, generally in rundown environments, where they survive on environments, where they survive on government disability paymentsgovernment disability payments




Treatment?Treatment? Finally, a great number of people Finally, a great number of people

with schizophrenia become homelesswith schizophrenia become homeless Approximately one-third of the Approximately one-third of the

homeless people in America have a homeless people in America have a severe mental disorder, commonly severe mental disorder, commonly schizophreniaschizophrenia



The Promise of The Promise of Community TreatmentCommunity Treatment

Despite these very serious problems, Despite these very serious problems, proper community care has shown great proper community care has shown great potential for assisting in the recovery potential for assisting in the recovery from schizophreniafrom schizophrenia Task forces have been created to find more Task forces have been created to find more

effective ways for all levels of government to effective ways for all levels of government to meet the needs of people with such disordersmeet the needs of people with such disorders

Another important advancement has been the Another important advancement has been the formation of national interest groups, formation of national interest groups, including the National Alliance for the including the National Alliance for the Mentally Ill (NAMI)Mentally Ill (NAMI)



The Promise of The Promise of Community TreatmentCommunity Treatment

Today community care is a major Today community care is a major feature of treatment for people feature of treatment for people recovering from schizophrenia in recovering from schizophrenia in countries around the worldcountries around the world

Both in the U.S. and abroad, varied Both in the U.S. and abroad, varied and welland well coordinated community coordinated community treatment is seen as an important part treatment is seen as an important part of the solution to the problem of of the solution to the problem of schizophreniaschizophrenia

comer, abnormal psychology, 6e – chapter 15 1 chapter 15 treatments for schizophrenia and other...

Documents

e chapter

abnormal psychology

institutional care

public mental hospitals

hopelessness slide

clothing slide

loss of individual care

private care states