This document discusses schizophrenia and psychosocial factors. It defines schizophrenia as a chronic mental disorder affecting perception, thought, emotion and behavior. It then covers the epidemiology, etiology, predisposing factors, clinical features, and management of schizophrenia. For management, it emphasizes the importance of psychosocial interventions like family intervention, psychoeducation, social skills training, psychotherapy, and supported employment alongside pharmacological treatment to improve symptoms and quality of life.

1. MENTAL ILLNESS,
SCHIZOPHRENIA AND
PSYCHOSOCIAL FACTORS

2. OUTLINE
• INTRODUCTION ON MENTAL ILLNESS
• SCHIZOPHRENIA :
• DEFINITION
• EPIDEMIOLOGY
• AETIOLOGY
• PREDISPOSING AND PRECIPITATING FACTORS
• CLINICAL FEATURES
• MANAGEMENT – Psychosocial interventions

3. MENTAL HEALTH VS MENTAL ILLNESS

5. EXAMPLES OF MENTAL ILLNESS

6. SCHIZOPHRENIA
a chronic, severe mental disorder that alters an individual’s perception, thought,
affect and behaviour
Cognitive
function
(thinking)
Emotion
Behavorial

7. EPIDEMIOLOGY
• 15 – 30 new cases per 100
000 population per year
Incidence
• 1 percent
Lifetime Risk
• Between 15 – 45, peak at age
30, earlier illness in men
Age of Onset

8. AETIOLOGY
• Research has not identified one single factor
• Interaction between genes and a range of environmental factors may cause
schizophrenia
• Imbalance of dopamine neurotransmitter
• Neurodevelopmental and neurodegenerative theories

9. PREDISPOSING AND PRECIPITATING FACTORS
Genetic
• Higher risk with
family history of
psychiatric
disorder
Prenatal factors
• Maternal viral
infection
• Malnutrition
Perinatal Factors
• Obstetric
Complication
• hypoxia
• Infection
• Extreme
prematurity

10. Personality
• Schizotypal
• Schizoid
Environment
(psychosocial
stressors)
• Negative life
events
Substance Use
• Cannabis
• Inhalant

11. CLINICAL FEATURES
Clinical
features
Positive
Symptom
s
Negative
Symptoms
Cognitive
symptoms
Mood and
aggressio
n

12. POSITIVE SYMPTOMS
• Delusion - fixed false belief that is not in keeping with one’s cultural,
education and religious background

13. EXAMPLES OF DELUSIONS
Persecutory
Delusion
Grandiose
Delusion
Delusion of
reference
Nihilistic
Delusion
Bizarre
Delusion
Delusion on
control

16. POSITIVE SYMPTOMS
• Hallucinations - Perception without external stimulus

17. EXAMPLES OF HALLUCINATIONS
Types of
Hallucination
Auditory
Visual
Gustatory
Tactile
Olfactory

20. POSITIVE SYMPTOMS
• Disorganised thought, speech and behaviour
• Examples
 talking to self
 laughing to self
 talking irrelevantly, loosening of association
 dressing inappropriately

21. NEGATIVE SYMPTOMS
Alogia
(poverty of
speech)
Anhedonia Avolution
Affective
flattening

23. MOOD AND BEHAVIOURAL SYMPTOMS
• Depressed mood
• Agitation
• Aggression
• Violence

24. COGNITIVE SYMPTOMS
• Disorganised thinking
• Slow thinking
• Difficulty understanding
• Poor concentration
• Poor memory
• Difficulty expressing thoughts
• Difficulty integrating thoughts, feelings and behaviour

25. MANAGEMENT OF SCHIZOPHRENIA
• Assessment
• Physical examination
• Laboratory investigations, brain imaging
• Pharmacological
• Non pharmacological (Psychosocial intervention)

26. PHARMACOLOGICAL MANAGEMENT
• Antipsychotic medications
• Sedative
• Antidepressants
• Electroconvulsive therapy

27. PSYCHOSOCIAL INTERVENTION
• Is an integral part of managing people with schizophrenia, due to
 High relapse rate even when medication is adhered to
 Persistence of symptoms despite continuous medication
 High rates of discontinuing medication
 No difference in quality of life with current available medications
• Psychosocial and pharmacological treatment better than pharmacological
treatment alone

28. PSYCHOSOCIAL INTERVENTION - OBJECTIVES
• Improve individual’s ability to handle stressful life events
• Increase adherence to medication
• Help with illness self-management
• Promote better communication and coping skills
• Enhance quality of life
• Promote recovery and reintegration

29. TYPES OF PSYCHOSOCIAL INTERVENTIONS
Family
intervention
Psychoeducatio
n
Social Skills
Training
Psychotherapy
Supported
Employment

30. FAMILY INTERVENTION
• Psychoeducation
• Teaching communication skills and problem solving
• Helping family to deal with stress
• Early warning sign recognition
• Crisis management

31. PSYCHOEDUCATION
• Provide information and education regarding illness, treatment and management
strategies
• Educate role of family, ways to maintain wellness and crisis management
• Given to people with schizophrenia and their carers
• Aim to change the behaviour and attitude towards illness

32. PSYCHOTHERAPY
• Cognitive remediation therapy (CRT) - teaching new information processing
strategies, individualising treatment and helping to transfer the improvement in
cognitive function in real life setting
• Cognitive behavioural therapy (CBT) – relates thoughts, behaviour and emotions
with respect to coping with persistent delusions or hallucinations
• Counselling and supportive psychotherapy are psychological intervention which
are facilitative, non-directive and/or relationship focused, with the content of
sessions largely based on clients’ needs

33. SOCIAL SKILLS TRAINING
• Practicing specific skills such as self-care, conversation skills, conflict handling,
making friends, and assertiveness
• Help improve social competence, role functioning and community reintegration

34. SUPPORTED EMPLOYMENT
• Immediate job placement in integrated mainstream work settings
• On-the-job training
• Job placement and support according to individuals’ interests
• Ongoing, continuous on-the-job support
• Collaboration between treatment team and employers/work supervisors

35. CHALLENGES
IDENTIFICATION PLACEMENT FINANCIAL SUPPORT
• No
identification/loss
IC
• Foreigners
• Homeless patients
• Family tracing
• Caregiver burden
• Family rejection
• No family members
• Homeless/Vagabon
ds
• Unemployment
• Basic needs
• Transportation to
hospital
• Monthly
assistance