BHECN webinar series
The Schizophrenia Spectrum: Part 2-Practice
October 2017Will Spaulding, Ph.D.Professor of Psychology, UNL
About This Series: Core Topics for Behavioral Health Providers
Presenter Topic Date
Dr. Will Spaulding Schizophrenia- Part 1 and Part 2 October 19th
Dr. Mario Scalora Forensic Issues and Civil Commitment
November 9th
Dr. Dennis McChargue Addiction TBDDr. Amanda Duffy Randall & Liam Heerten-Rodriguez
Basics of Sexual Health TBD
Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez
Working with Sexual Challenges TBD
Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez
Older Adult Sexualities TBD
Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez
LGBQ Sexualities TBD
Dr. Amanda Duffy Randall & Liam Heerten-Rodriguez
Working with Trans Clients throughout the Lifespan
TBD
• BHECN's webinar series designed to educate behavioral health trainees about practical topics in behavioral health
• Expert presenters provide a mixture of principles and case based application• All webinars are free of charge• Topics include:
The Behavioral Health Education Center of Nebraska (BHECN), pronounced “beacon”, was established in 2009 by a legislative bill to address the shortage of behavioral health professionals in rural and underserved areas of the state. unmc.edu/bhecn
MISSION: BHECN is dedicated to improving access to behavioral health care across the state of Nebraska by developing a skilled and passionate workforce.
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Click the link to view a recording of today's webinar and information on future webinarshttps://www.unmc.edu/bhecn/education/online-training/core-topics-webinars.html
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Conflict of Interest Statement
The presenter has one conflict of interest to acknowledge: He thinks you should buy his book:
The Schizophrenia Spectrum:Part 2: Practice
The Schizophrenia Spectrum Part 2: Practice
The Schizophrenia Spectrum Part 2: Practice
The biosystemic paradigm: Levels of functioning & impairmentLevel of functioning Abnormality or problem
social environmental Conflicts with family over autonomy and support, legal problems, limited access to social roles other than “mental patient”
behavioral (instrumental and self-regulation skills)
Deficits in interpersonal, occupational and living skills, mood and emotion self-regulation
social cognition Deficits in person perception, emotion recognition, theory of mind, efficient recognition of social situations
neurocognitive Variable impairments in attention, memory, concept formation, executive functioning
neurophysiological Compromised neural networksAbnormal neurotransmitter metabolismStructural receptor abnormalities
The Schizophrenia Spectrum Part 2: Practice
The biosystemic paradigm: Levels of treatment
Level of functioning
Abnormality or problem Treatment approach
neurocognitive Variable impairments in attention, memory, concept formation, executive functioning
Neuropsychological therapy;Structured milieu;Contingency management (behavioral programs)
neurophysiological Compromised neural networksAbnormal neurotransmittermetabolismStructural receptor abnormalities
Antipsychotic medicationMood stabilizing medicationECT
The Schizophrenia Spectrum Part 2: Practice
The biosystemic paradigm: Levels of treatment
Level of functioning
Abnormality or problem Treatment approach
socioenvironmental Family conflictLegal problemsNo access to normal social roles
Behavioral family therapyTherapeutic jurisprudenceCommunity resource development
Instrumental skills Living skill deficits, interpersonal skill deficits
Independent living skills training; social skills training
Self-regulation skills Emotional & psychophysiologicaldysregulation
Cognitive behavioral therapy specialized for psychosis
Social cognition Social perception and problem-solving deficits
Social-cognitive therapy specialized for psychosis
The Schizophrenia Spectrum Part 2: Practice
Treatment and the episodic course of the illnessSe
verit
y
Time
“reactive” course
“process” course
The Schizophrenia Spectrum Part 2: Practice
Treatment and the episodic course of the illnessSe
verit
y
Time
“reactive” course
“process” course
“acute” episodes
The Schizophrenia Spectrum Part 2: Practice
Treatment and the episodic course of the illnessSe
verit
y
Time
“reactive” course
“process” course
“baseline” functioning
The Schizophrenia Spectrum Part 2: Practice
Treatment and the episodic course of the illness
The Schizophrenia Spectrum Part 2: Practice
Treatment and the episodic course of the illness
The Schizophrenia Spectrum Part 2: Practice
Treatment and the episodic course of the illness
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
Person Role
Person recovering The “patient;” provides basic recovery goals, collaborates in all aspects of treatment and rehab planning
Substitute decision-maker
The “guardian;” legally appointed person responsible for making choices the “patient” is unable to make
Supervising practitioner
The “navigator;” provides comprehensive assessment, chief strategist, legally responsible for overall plan
Team coordinator The “case manager;” organizes the team and monitors all aspects of the plan
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
Team member Role
Medication manager The “prescriber;” Collects and analyzes information on medication response, assesses changing needs and maintains optimal psychopharmacological regimen
Therapist Provides psychotherapy and skill training in group, family and individual formats
Skill coach Provides in vivo skill training and coaching in home, work and leisure settings
Peer support person A non-professional person with lived experience, provides social support, help with activities of daily living, social networking
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
Collaborator Role
Primary healthcare provider Consult on non-psychiatric health problems, role of primary care in recovery
Neuropsychologist Consult on nature of cognitive impairments, role in recovery, and treatment options
Neuropsychiatrist Consult on psychopharmacology complications, neurological problems
Administrative social work consultant Assessment and planning for benefits, entitlements, disability status
Family members Collaboration on role of immediate and extended family in rehab and recovery
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
Problem Intervention Primaryprovider
CNS dysregulation Psychiatric medication S. Jones, APRN
Post-acute neuro-cognitive impairment
Integrated Psychological Therapy and individual cognition-focused component for CBTp
B. Allen, Ph.D.A. Smith, M.A.
Emotional regulation skill deficit
Individual mindfulness-focused component in CBTp
A. Smith, M.A.
Independent living skills deficit
Residential rehab program living skills training & coaching
J. Doe, LMHP
The Schizophrenia Spectrum Part 2: Practice
Rehabilitation and recovery
Problem Intervention Primaryprovider
Interpersonal skills deficit Social skills training group at community service center
A. Smith, MA
Occupational skills deficit 1) Occupational skills group2) Supported employment program
K. King, OTRS. Gros, LMHP
Family conflict Behavioral family therapy S. Mann, MFT
Unstable housing/financial situation
Benefits assessment and planning R. Swift, MSW
The Schizophrenia Spectrum Part 2: Practice
The bible of psychiatric rehabilitation –American Psychiatric Publications, 2008.
Case composites and discussion
The Schizophrenia Spectrum Part 2: Practice
End of Part 2
Case composites and discussion
Case A: 25 year old male• Perinatal complications• Parental hx of ADHD, EtOH• Dx’d ADHD @ age 6• Dx’d ODD @ age 10• Socially isolated adolescence• High school dropout• Institutionalized by age 17• No hx of adult functioning• Insidious onset of psychosis• Continuous episodes• Undifferentiated presentation• Poor medication response• Semi-independent functioning
with extraordinary support
Case B: 25 year old male• Normal birth & neonatal health• Family hx of depression• Normal childhood & pubescence• Emotional instability & heavy
cannabis use by age 16• Psychotic onset in college• Paranoid/affective presentation• Moderate medication benefit
but poor adherence• College dropout• Intense family conflict• Chronic unemployment, drift
into homelessness• Semi-functional “mental
patient” social role & life style
BHECN webinar series
The Schizophrenia Spectrum: Part 2-Practice
Questions?
Click the link to view a recording of today's webinar and information on future webinarshttps://www.unmc.edu/bhecn/education/online-training/core-topics-webinars.html
Recording available