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PSYC 3140
Joel Goldberg

ABNORMAL PSYCHOLOGY LECTURE: MARCH 5TH, 2013 TOPIC: SCHIZOPHRENIA ➔ Handout given named “Diagnosis of Common Attention Impairments” and “Coping with Cognitive Impairments” th ➔ Final Exam April 15 2 hours Rexall Centre (cumulative) ➔ Demonstration ◦ Wisconsin Card Sorting Test ▪ Presented are cards with different shapes and colours ▪ Cards keep changing and you have to match the cards with the ones that were there originally ▪ What does this test demand and evaluate? • First it was based on matching the shape, then the colour, and then the number of shapes → measuring whether the person can understand and realize the sudden changes in concept. (example: match the triangles with triangles, match the yellow circle with the yellow star, match the 4 circles with the 4 triangles). • Response inhibition • Mental Flexibility – identify perseveration errors (when you are mentally stuck) → if you show mental rigidity by not changing with the concepts (inflexible) ➔ Approaches to Cognitive Rehabilitation ◦ Adjustment to Loss – example, student who cannot see the blackboard from far is asked to move closer to the board (did not change actual vision) ◦ Strategy Building – check eyes and give them eye glasses (coping aid) ◦ Train the Brain – you put a patch over the strong eye which gives a chance for the weak eye muscle to exercise and build strength → restoring function (training) → least evidence for this approach ▪ Refer to handout “Coping with Cognitive Impairments” for examples to adjustment to loss approaches ➔ Case Study: Rose nd ◦ Diagnosed with schizo, treated with 2 generation anti-psychotic medication, psychotic symptoms in remission ◦ Underwent neuropsychological testing ◦ Found to have strengths in mental arithmetic and working memory, normal verbal skills, average intellect ◦ Participated in IPS (Individual Placement and Supports) vocational program – subsidize wages – three month supports ◦ Job placement: variety store ▪ Match person with career → good at math so they matched her with a career as a cashier • She did not do well at all at this job → they needed more info • If it was just cashier demands she would have been fine but because she had to do other duties like dry cleaning and stocking shelves she struggled → had trouble with mental flexibility (going from one duty to another) • Intervention – tell employer that she has to stay as a cashier and then slowly introduce the other duties into her routine • They have trouble adjusting to changes in their routine ➔ Three Brief Videos – Schizophrenia (example of adjustment to loss) ➔ Created by David Dartsch ➔ HPSTalent Show – HPS Idol (Health __________ Schizophrenia Talent Show) ◦ Took cartoonist course and learned to make films with clay figures – did not want to perform with the others but he did play these 3 video clips ◦ 1 one – social apprehensions shown ▪ A drawn out figure dancing ▪ Then tomatoes are thrown at the figure and people are booing ▪ The figure dances faster ▪ People continue to boo ▪ The figure dances faster again ▪ The figure is sweating and confused and then starts flapping its arms flying around, an egg appears and the crowd cheers ◦ 2 one – he was treated with 2 generation medication (advantage of not having side effects with motor functions but they have a different side effect which is a terrible weight gain. People become pathologically obese. So they try to get them involved in different exercises. ▪ This figure runs away from tough guys with bats ▪ A random comes down by parachute ▪ You see construction workers, a dog, the figure is running throughout the neighborhood ▪ The figure runs home and a guy comes and delivers him a treadmill so he can start to exercise ◦ 3 one – psychological testing – he wants them to be sensitive to him ▪ Gorilla figure beating its chest, eating a banana ▪ A guy figure complaining the gorilla is a slob ▪ The gorilla starts to beat up the guy ▪ the gorilla plays music while he makes the human dance ▪ The guy takes his face off and call for the marines ▪ The gorilla beats up all the marines as they try to fight him ▪ They start shooting at the gorilla who tries to run and throwing bombs at him ▪ The bombs are thrown back at the marines and they run away ▪ Then the gorilla views a survey test that says things like do you always feel under attack etc ▪ The therapist looks disappointed and the gorilla gets mad and is thrown into anger management therapy ▪ He is being diagnosed as violent and yet the context is that he feels threatened and he responds defensively and is sent to treatment but he feels like it is jail and that he has been betrayed and that no one is showing empathy ▪ Example: it is easy for an average person to walk down the street but this individual always feel threatened walking down the street even by pregnant ladies ▪ This is how he spoke to people because cartoons were his strength ➔ Strategy Building example ◦ If someone has the skills they do not need the support but in this case they do not have the skills so they need the support ▪ Example: living in an apartment alone (they know how to cook but not on their own – cannot apply) ▪ Collective Kitchen Supportive Meal program – plan meals, do shopping, then next week you cook 8-10 meals ▪ There is an organizer (peer leader) there to help – different work stations ▪ Some could only chop vegetables others could do more ▪ They put the food in containers and take it home so all they have to do is put it in a non fancy microwave – food and microwaves donated (push 1 number and then hit start – very simple) ▪ Trouble generalizing skills – problem ▪ Room is paid for, food is paid for. Other aspects needed – they can only spend up to $120.00 a month ▪ Therapy room – desk, white board • Strategy building approach and how a case worker deals with this • Client Planing for Change – Personal Criteria such as: affordable rent, close to bus stop etc and whether a group home, the YMCA and subsidized housing has these aspects • Need to develop personal criteria first, then get a real estate agent to help to look at the best approaches (need to look at what you can afford along with all the other personal criteria – example: close to friends, far away from mother-in-law etc) • Researching Alternative Environments – process set out on a worksheet • Helps with goal planning ◦ Case workers working with people with schizo ◦ They all have different needs ◦ Every worker has between 30-50 cases, people come less frequently ◦ Not as intensive in terms of care ◦ Other places: case workers with have 10 clients and see them a few times a day and sometimes drive around to see them (this is all a type of support) ▪ Validated approach – successful ▪ Helping people remain in the community ▪ More expensive ▪ Personal Strengths Approach – less medical care, more peer type of support while Rehabilitation Model – skills training ▪ Impairment Schizophrenia – helping them back in the community (just like helping the student with an eye impairment) ➔ Case Workers/Managers ◦ Helping individuals to plan, organize, to manage depends on them to be flexible (motivation) ◦ Case worker is like surrogate dorso - lateral pre - frontal cortex ➔ Train the Brain example ◦ Techniques of Skills Training ▪ Instruction ▪ Demonstration ▪ Role Playing ▪ Corrective Feedback ▪ Generalization • Tennis – explain how to serve, show how to serve, serve together, critical feedback, and generalizing • Social skills – we take for granted ◦ Schizo – too close and abrupt in a convo ◦ These skills can develop from earlier child play – misinterpreting social ques ◦ Social skill training – give instructions, break down starting a convo in different steps, demonstrate how to start a convo, role playing the convo, feedback, generalization (start convo in waiting area for example) ◦ Want to take the skills and apply it in the real world – generalization – the frontal system of our brain is responsible for generalization ◦ Applying what you learned in the real world ➔ Cognitive Rehabilitation ◦ Attention Process Training – developed by Professor Katie Matear ◦ Refer to handout “Diagnosis of Common Attention Impairments” ◦ Treatment – you can do with someone who is unconscious (injection, intravenous etc) ◦ Rehabilitation – the person has to want to change ◦ Someone in a coma – not alter ◦ Sustained Attention – listening to the Professor f
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