provided successful in improving cognition and processing speed and there was some evidence to
suggest that it has also had a positive effect on some functional outcomes
Other recent studies have shown that a s patients ability to recognize facial affect in others
working memory and attention can all be improved though cognitive training.
Zakzanis; has demonstrated the utility of scaffolding in the remediation of cognitive deficits.
Scaffaloded instruction is a concept derived from Vygotskys cognitive develop research.
Vygotsky proposed that everyone has a zone of current develop and that the complexity of tasks
must be tailored to account for indiv current skill level and level of potential develop.
The scaffolding model of instruction require instructors to select tasks that reflect the patients
current capabilities so that eventually they are able to solve problems for themselves
The ultimate goal is to develop general problem solving skills and processes that patients can
generalize to new situations
Found that the delivery of scaffolded instruction to patients with s relative to direct instruction
significantly increased the # of categories created during the Wisconsin card sorting test and that
cognitive improvements were still evident one month later
The scaffolded group also had relatively higher levels of positive affect and self esteem. Thus
scalffodling may lead to improvements in self regulation and self conceptualizations
Evaluation of psychological treatments
CBT results in a reduction of the positive symp while family therapy and education contribute to
lower rates of relapse and re-hospitalization
Integrated psychological therapy (IPT) combines neurocgitive remediation with training in social
cognition, social skills and problem solving
Favoured IPT over attention placebo and standard care control groups only on outcomes that
included symp, psychosocial functioning and neurocogintion
Case mgt/assertive community treatment
After deinstitutionalization began in the 1960s
Out of this program a new mental health speciality the case manager was created
Canada adopted the strategy
Initially case managers were basically brokers of services. They were able to get patients into
context with providers of whatever services the patients required.
The assertive community treatment mode and the intensive case mgt model both entail a
multidisciplinary team that provides community services ranging from medications, treatment for
substance abuse, help in dealing with the kinds of stressor patients face regularly, psychotherapy,
vocational training and assistance in obtaining housing and employment
It wasn’t until the 1990s that intensive case mgt programs and programs more or less similar to the
current ACT model cuz appearing in psychiatric and general hospitals in Canada’s
The great Vancouver mental health service agency is considered one of the best of its kind in north
America. The agency serves about 5,000 ppl with serious mental disorders each yr many of them
suffering from s
It provides housing, special programs for older patients, and community response teams that can
act very quickly in crisis situations involving their clients.
The latter approach is proving to be effective in Ontario
Community based teams of doctors/nurses and social worker called PACT(Program for assertive
community treatment) have been set up to ease the pressure caused by the closing of provincial
psychiatric hospitals and to reduce the # of ppl with s and other serious psychiatric disorders who
end up in emergent wards
The mental health teams are available 24 hours a day and even make house calls to mentally ill ppl
in their homes and work
Ontario is the only province to implement the ACT on a wide scale. By 2002-03 Canada had 61
There are a # of programs in Quebec patterned after the ACT model
Indications are that more intensive treatment is more effective than less intensive methods in
reducing time spent in the hospital, improving housing stability and ameliorating symp However more intensive case mgt has not shown positive effects on other domains such as time
spent in jail or social functioning
Concluded that inner city populations might benefit from such specific programs
General trends in treatment
Etiology of s was the child’s psychological enviro esp the family.
Thinking is now that bio factors predispose a person to develop s and that stressors principally of a
psychological nature trigger the illness in a predisposed indiv and interfere with the personas
adaptation to community living.
Best approach is to emphasise psycholical intervention and pharmacological
Families and patients are given realistic and scientifically sound info about s. they learn that it is a
disability that can be controlled bi its probably life long. Medication is necessary to maintain
control and allow patients to perform daily activities. What is not necessary is the guilt of the
family members who may have been led to believed that something in the pa