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Understanding SchizophreniaA Handbook for People Diagnosed with Schizophrenia This booklet is a collaboration between the Queensland Centre for Mental Health Learning and the Mental Health Clinical Collaborative
Information in this handbook was obtained from international research and papers and the various brochures and booklets compiled by the different mental health services and hospitals throughout Queensland
Pictures and images were downloaded from photo.com and www.uq.edu.au/news/images/mediaAll program materials have been designed in collaboration between the QueenslandCentre for Mental Health Learning (QCMHL) and the Mental Health ClinicalCollaborative. If you have any feedback or enquiries about this material pleasecontact QCMHL on 3271 8622 or email [email protected] orhttp://www.health.qld.gov.au/qcmhl © Copyright State of Queensland (QueenslandHealth) July 2007
Front Cover: The star symbol is drawn from the Queensland Health Document:Sharing Responsibility for Recovery. The symbol was designed to reinforce the fivecommon elements identified as necessary in supporting each individual during theirrecovery journey. Details of these recovery elements are included in this handbook
2 Foreword by Dr Aaron GrovesThe handbook has been developed in consultation with consumers, serviceproviders and carers through a partnership with the Mental Health ClinicalCollaborative and the Queensland Centre for Mental Health Learning
The intention in compiling this resource was to provide an educational andpersonalised document for consumers and clinicians in adult inpatient mental healthsettings. It takes a recovery approach and contains a range of resource materials,good practice approaches, and worksheets that can be adapted to meet theindividual needs of consumers
This handbook has been designed for consumers to use independently or incollaboration with a health care professional to promote a shared understanding ofthe consumer’s experience. The modular approach of the booklet is designed toallow the individual to move through the information at a pace suited to their ownneeds as well as provide a resource that extends beyond the inpatient facility
I believe that this handbook is a valuable resource
Aaron GrovesDirector of Mental HealthMental Health BranchQueensland Health 3 PrefaceThis handbook was prepared for use in an inpatient setting withadults. It is designed so that consumers can use it individually,but it would be most beneficial if completed together withmental health clinicians prior to discharge and most probably,in an ongoing way after discharge in the community. It isrecommended that if consumers have any questions whenreading this handbook, that doctors or other members of thetreating team are consulted for assistance
Please note that throughout this handbook, worksheets havebeen inserted for reference and to act as an example of howyou might complete them. These are examples only and weacknowledge that every case is different and thereforeworksheet completion will be very individual
4 Table of ContentsOverview and Objectives of Handbook Page 6Module One - Basic Information Page 7 Part A - What is schizophrenia? Page 7 Part B - What causes schizophrenia? Page 9 Part C - Symptoms of schizophrenia Page 11Module Two - Recovery Page 17 Part A - What Helps and Hinders? Page 17 (Includes resource section) Part B - Medication Information Page 27 Part C - Coping Strategies for Symptoms Page 34 Part D - Preparing Your Wellness and Page 38 Recovery Plan and Individual Care Plan Part E – Outcomes Tracking Page 55 Part F - Can I be forced to accept treatment if I do not want it? Page 56References Page 59Worksheets Page 60Appendix A - Individual Care Plan Page 68 5 Overview and Objectives of HandbookOne of the main factors that can help in recovery from schizophrenia isto have accurate information and education about illness and recovery
Some of the other factors that assist are support from family, friends,community groups and professionals, adequate treatment, medication,counselling and a healthy lifestyle
Whether you find yourself in a mental health inpatient facility for the firsttime or after repeated admissions, the experience can be very daunting,as you are likely to be experiencing symptoms that can make you feelscared, confused or distressed
The purpose of this handbook is to instil hope and provide someguidance on ‘where to go from here’. As such, while the initial sectionswill provide a brief overview of the definition and cause of schizophrenia,the main focus of the workbook will be on recovery
Worksheets are included throughout, so that you can personalise yourexperience and have a record to help you communicate with yourtreatment team and other people important to your recovery. By the endof this workbook, you should have a basic understanding of whatschizophrenia is, how you experience schizophrenia and your plan forrecovery
6 Module One - Some Basic Information Part A - What is Schizophrenia?What is schizophrenia?Schizophrenia is an illness that affects the brain andleads to difficulties with thoughts, feelings and behaviours
Schizophrenia affects approximately one outof every 100 people
For 75% of people diagnosed withSchizophrenia it starts in adolescence or earlyadulthood
Facts and Myths about Schizophrenia: ¾ Schizophrenia is not caused by bad parenting, childhood trauma, poverty or alcohol ¾ Schizophrenia is not contagious ¾ Although people with schizophrenia sometimes hear “voices” that others can’t hear, this illness does not mean that you have “split” or “multiple” personalities ¾ Schizophrenia is not a person’s fault; it is a chemical brain disorder caused by a combination of biological and genetic factors, and often triggered by environmental stressors ¾ Schizophrenia is not a developmental disability or intellectual disability ¾ Those with a diagnosis of schizophrenia who are undergoing treatment are not more violent or aggressive than those who do not have schizophrenia
7 Schizophrenia can affect anyone regardless of gender, ethnicity, culture, sexuality, class, intelligence or level of education
Schizophrenia symptoms may develop very quickly over several weeks or maydevelop slowly over a few months or years
Some people might have only one period where they experience symptoms andnever experience them again
For others, Schizophrenia symptoms can come and go over a longer period
The good news is that there are many things that you can do to help maintain ameaningful and positive life and minimise the chance and/or impact of a relapse
This booklet will provide a focus on recovery with more information and worksheetsfor you to develop a personal recovery plan
Other mental and physical illnesses that can occur at the sametime as SchizophreniaThe more common mental health issues that can occur at the same time aresubstance abuse, depression and obsessive-compulsive behaviour
Substance abuse can be present before a diagnosis, or some individuals start touse substances in an attempt to control or decrease symptoms. However,substance abuse has been found to have an overall negative effect onrecovery
A range of physical health complaints have also been associated withschizophrenia, such as cardiovascular problems (heart issues), pulmonary problems(e.g., asthma), neurological problems, endocrine problems (glands and/or hormonalproblems) and metabolic problems (such as obesity). There is little agreement inresearch as to how common these conditions are. However, given their potentialseriousness, it is important to always maintain a focus on living a healthy lifestyleand consult your GP about your general health and wellbeing
8 Module One - Some Basic Information Part B - What Causes Schizophrenia?There are many theories to explain the cause of schizophrenia, but the exact causeremains unknown. The main theories look at the role ofgenetics, biochemical factors, illicit drug use and environmentalfactors
Family/Genetic FactorsThere is evidence that genetics play some role in the development of schizophreniaalthough this role is still not clear. Statistics have shown:¾ When one parent has schizophrenia their child has at least a 1 in 10 chance of developing schizophrenia
¾ When both parents have schizophrenia then the risk of their children developing schizophrenia increases up to almost 40%
¾ In the case of identical twins, if one twin has schizophrenia, the second twin has at least a 50% chance of also developing schizophrenia
It is important to note that genetics are only part of the puzzle, because most peoplewho develop schizophrenia have no relatives with the illness
Further, just because a person has schizophrenia does not mean that they will ‘passit on’ to their children
Biochemical Factors Certain substances in the brain may cause a chemical imbalance. For example, the neurotransmitters “dopamine” and “serotonin” have both been linked to schizophrenia
Medications can help to correct imbalances in the chemistry of the brain
Again however, biochemical factors are only a partial explanation as there is notenough evidence to show that a chemical imbalance is the only cause ofschizophrenia
9 Brain Abnormalities Research has found that there can be differences in the structure of people’s brains with particular forms of schizophrenia, such as having enlarged ventricles (Ventricles are the spaces which carry fluid through the brain). However, the relevance of brain abnormalities is still unclear as many people with schizophrenia don’t have enlargedventricles and their brain structure looks normal
Viral TheoriesAnother theory is that babies whose mother had a virus in the latter stages ofpregnancy are at higher risk of developing schizophrenia. There is no strongevidence to support this theory however
Use of certain drugsAll sorts of recreational drugs can make the illness worse by increasing symptoms
Marijuana, Amphetamines (‘Speed’, ‘Ecstasy’) and Hallucinogens (‘Acid, ‘LSD’, and‘Magic Mushrooms’) are particularly likely to cause an increase in symptoms
These drugs can also play a part in the onset of a first episode of schizophrenia
EnvironmentStressful events, although not really a cause ofschizophrenia, can lead to a decline of mentalhealth and trigger symptoms. Again, astriggers are not always identified before symptomspresent, stress alone can not be seen as a sole causeof schizophrenia
10 Module One - Some Basic Information Part C - Symptoms of SchizophreniaSymptoms mean “signs”, “warning signs” or indications that something is wrong
What does this mean to you?Schizophrenia affects different people in different ways. Not everybody willexperience the same symptoms, nor are these symptoms always experienced to thesame degree
Symptoms of schizophrenia can also come and go at different times. These periodsare often referred to as “relapses” or “acute episodes”. This is when peopleexperience symptoms like hallucinations, delusions and confusing thoughts. Thesesymptoms are called “positive symptoms” although they are not positive in terms ofbeing wanted. “Positive symptoms” usually improve with decreased stimuli, calminteractions and antipsychotic medication
There are other types of symptoms such as a loss of interest, loss of energy, loss ofemotional warmth or loss of humour. These are called “negative symptoms”. Someof the newer medications and some non-medical strategies can help with thesesymptoms
It is sometimes difficult when symptoms are being experienced, to tell what is realfrom what you are experiencing at that time. Below are some examples of thesymptoms of schizophrenia. Often it is easier to identify your symptoms once youare more well, or others can help you with this during your recovery
“Positive symptoms”: problems with your thinking: ¾ Your thoughts and therefore conversation may become jumbled, disjointed, slow or fast
¾ You may feel as though your thoughts have an impact on other people or events
¾ You may feel as if thoughts are being “put into” or “taken out of” your head
¾ You may feel as though others know what you are thinking ¾ You may find your thoughts suddenly blocked
¾ One particular thought may become “fixed” in your mind, and you can’t shake it off (this can be a delusional thought, but not necessarily so)
11 DelusionsA delusion is a fixed false belief held by a person, that remains even though there isobvious evidence to the contrary
There are many different types of delusions. Some examples are: ¾ Thinking that other people want to hurt you or are out to get you
¾ Thinking that you are related to someone of great importance (e.g. royalty), are a special person or religious figure (such as God)
¾ Thinking you have special abilities or powers
¾ Thinking that the TV, radio or newspaper has a special message for you or is specifically aimed at you ¾ Thinking that you are being controlled by someone else ¾ Thinking that other people can read your mind, or that you can read other people’s mind
HallucinationsHallucinations are false perceptions or sensations. These can be: ¾ Hearing ¾ Seeing ¾ Tasting ¾ Smelling or ¾ Feeling ………….something that is not really there
The most common type of hallucinations are auditory, or hearing something that others can’t hear. For many people this means hearing voices which seem to come from inside their head or from their environment
These can seem very real, as though there is someone beside you or in the next room talking
For most people, hallucinations are quite distressing, but in some cases they can be pleasant. They can also be very distracting and make it difficult to concentrate
The intention in compiling this resource was to provide an educational and personalised document for consumers and clinicians in adult inpatient mental health settings. It takes a recovery approach and contains a range of resource materials, good practice approaches, and worksheets that can be adapted to meet the individual needs of consumers.
The handbook has been primarily developed, therefore, as a guide for families when early signs indicate that a relative may have schizophrenia, and as a resource for these families when a diagnosis of schizophrenia has been determined. To this end, it has been put together with help from many families with relatives who have schizophrenia.
The purpose of this handbook is to provide you with information on the World Trade Center (WTC) Health Program (the Program). Disclaimer: This handbook is not a legal document. The purpose of this handbook is to provide general Program information in a way that is easy for you to use and understand.
Previous versions of the Member Handbook are available upon request by emailing [email protected] The purpose of this handbook is to provide you with information on the World Trade Center (WTC) Health Program (the Program). Disclaimer: This handbook is not a legal document.
To certify a medically associated health condition, your CCE or NPN doctor must explain how the health condition results from either treatment or progression of the underlying certified WTC-related health condition.