Week 7: Diagnosing Psychosis: Schizophrenia Spectrum
Schizophrenia, which appears in individuals in their young-adult years, is one of the most disabling conditions that an individual can develop. Unlike many other DSM-5 disorders, the genetic underpinnings of schizophrenia have been studied for a long time. Symptoms of the illness appear similarly across races and cultures, although cultures vary widely in how they handle the illness.
No matter in what culture an individual is raised, it is universal that the onset profoundly changes the life course of the individual and their family members. Phases of the illness vary, in a cycle, but delays in treatment are often associated with increased difficulty in functioning. The medical model is a key element of stabilizing schizophrenia, but psychosocial interventions are increasingly critical if families and patients are to avoid the high rates of suicide, despair, isolation, unemployment, and homelessness that can result. Early and ongoing psychosocial and cognitive treatments can stabilize lives.
This week you analyze examples of individuals living with schizophrenia. You also present to the class your own differential diagnostic process for your collaboration case.
Learning Objectives
Students will:
- Analyze a case study focused on a schizophrenia disorder utilizing steps of differential diagnosis
- Recommend a measurement instrument to validate diagnosis
- Analyze client experiences with schizophrenia
- Apply measures to aid diagnosing psychosis in a social work case study
- Create an individualized treatment plan for a schizophrenia diagnosis in a social work case study
Learning Resources
Required Readings
Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Chapter 5, “Coping with Uncertainty” (pp. 43–56)
Chapter 13, “Diagnosing Psychosis” (pp. 185–215)
American Psychiatric Association. (2013p). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm02
American Psychiatric Association. (2013b). Assessment measures. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.AssessmentMeasures
Required Media
TED Conferences, LLC (Producer). (2012). A tale of mental illness—from the inside [Video file]. Retrieved from https://www.ted.com/talks/elyn_saks_seeing_mental_illness
TEDx Talks. (2017, March 27). I am not a monster: Schizophrenia | Cecilia McGough | TEDxPSU [Video file]. Retrieved from https://youtu.be/xbagFzcyNiM
Osmosis. (2016, March 8). Schizophrenia: Causes, symptoms, diagnosis, treatment & pathology [Video file]. Retrieved from https://youtu.be/PURvJV2SMso
Article Choices for Assignment
Select at least 2 articles from the following list for the Assignment.
Atadokht, A., Ebrahimzadeh, S., & Mikaeeli, N. (2019). The effectiveness of humor skills training on positive and negative symptoms of chronic schizophrenia spectrum. Journal of Holistic Nursing and Midwifery, 29(1), 15-21.
Breitborde, N. J. K., Moe, A. M., Ered, A., Ellman, L. M., & Bell, E. K. (2017). Optimizing psychosocial interventions in first-episode psychosis: Current perspectives and future directions. Psychology Research and Behavior Management, 10, 119–127. doi:10.2147/PRBM.S111593
Cohen, A. N., Hamilton, A. B., Saks, E. R., Glover, D. L., Glynn, S. M., Brekke, J. S., & Marder, S. R. (2017). How occupationally high-achieving individuals with a diagnosis of schizophrenia manage their symptoms. Psychiatric Services, 68(4), 324–329. doi:10.1176/appi.ps.201600031
Hernandez, M., Barrio, C., & Yamada, A.-M. (2013). Hope and burden among Latino families of adults with schizophrenia. Family Process, 52(4), 697–708. doi:10.1111/famp.12042
Kung, W. (2016). Tangible needs and external stressors faced by Chinese American families with a member having schizophrenia. Social Work Research, 40(1), 53–63. doi:10.1093/swr/svv047
Mueser, K. T., Penn, D. L., Addington, J., Brunette, M. F., Gingerich, S., Glynn, S. M., … Kane, J. M. (2015). The NAVIGATE program for first-episode psychosis: Rationale, overview, and description of psychosocial components. Psychiatric Services, 66(7), 680–690. doi:10.1176/appi.ps.201400413
Velthorst, E., Fett, A.-K. J., Reichenberg, A., Perlman, G., van Os, J., Bronet, E. J., & Kotov, R. (2017). The 20-year longitudinal trajectories of social functioning in individuals with psychotic disorders. American Journal of Psychiatry, 174(11), 1075–1085. doi:10.1176/appi.ajp.2016.15111419
Walsh, J., Hochbrueckner, R., Corcoran, J., & Spence, R. (2016). The lived experience of schizophrenia: A systematic review and meta-synthesis. Social Work in Mental Health, 14(6), 607–624. doi:10.1080/15332985.2015.1100153
White, C., & Unruh, A. (2013). Unheard voices: Mothers of adult children with schizophrenia speak up. Canadian Journal of Community Mental Health, 32(3), 109–120. doi:10.7870/cjcmh-2013-025
Optional Resources
American Psychiatric Association. (2018). Online assessment measures. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures
Optional Media
Singer, J. B. (Producer). (2008, November 17). Episode 45—Schizophrenia and social work: Interview with Shaun Eack [Audio podcast]. Retrieved from http://socialworkpodcast.blogspot.com/2008/11/schizophrenia-and-social-work-interview.html
Discussion: Video Report of Your Case Consultation: Presenting and Validating Diagnosis
In this Discussion, you first present to your peers the case collaboration begun in Week 4. Note: You make this presentation individually—you do not present with your partner. Your colleagues then review your diagnosis for validity, recommending an evidence-based tool to use in your case.
Such tools help confirm the details and validity of a diagnosis. Measures also help clinicians notice other patterns in a disorder that might otherwise be missed. By confirming an accurate diagnosis through a measurement instrument, a social worker ensures that the appropriate evidence-based treatment is used.
By Day 2
Post the following two pieces:
- Use the Kaltura Media uploader to upload a 3- to 5-minute video in which you:
- Briefly summarize your case, highlighting the diagnostic symptoms seen in the case.
- Describe your decision-making process for identifying the key problems in the case and the differential eliminations for your case.
- Identify the diagnosis chosen by you and your partner for the client in the case. Explain the diagnosis by providing the supporting DSM-5 criteria with specific examples of how your client met those criteria.
Include a transcript and/or edit closed captioning on your video to ensure your presentation is accessible to colleagues of differing abilities.
- Post a fully coded DSM-5 diagnosis. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention).
By Day 6
Watch your peers’ videos and respond to at least two colleagues who had a different case in the following ways:
- Provide an informal observation designed to improve, clarify, or question an aspect of the presentation.
- Explain a measurement instrument that would be useful in tracking ongoing progress for your colleague’s case, clarifying or uncovering further associated symptoms or validating the diagnosis.
Note: You are required to create a thread for your initial Discussion post before you will be able to view other colleagues’ postings in this forum. If you have not yet visited the weekly resources and assignments, you should visit that area now to access the complete set of directions and guidelines for this discussion.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 7 Discussion Rubric
Post by Day 2 and Respond by Day 6
To participate in this Discussion:
Week 7 Discussion
Assignment: Schizophrenia Over Time: Experiences Living With the Illness
Experiences of schizophrenia are not homogeneous; there is wide variety in onset, course of illness, and combinations of symptoms. Social workers need to be able to understand the different manifestations and pathways of the illness to plan interventions. Social work services play a key role in stabilizing crises, supporting family coping, and influencing overall quality of life and outcomes of individuals with schizophrenia. In this Assignment, you practice applying this necessary individualization.
To prepare: In the Learning Resources, focus on the associated features, development, and course of the illnesses in the schizophrenia spectrum. Also focus on descriptions of the disorder and the way it develops for different individuals.
Choose two articles from the list in the Learning Resources that apply to treatment support and interventions for the schizophrenia spectrum and other psychotic disorders chapter in the DSM 5. Choose either Saks or McGough to focus on for this assignment.
By Day 7
Submit a 3- to 4-page paper, supported by at least 4 scholarly resources (not including DSM-5), in which you address the following:
- Describe Saks’s or McGough’s experiences with schizophrenia. Identify onset, associated features (specifically referencing the positive and negative symptoms), development, and course.
- Explain how you would use the Clinician Rated Dimensions of Psychosis Symptom Severity measure and the WHODAS to help confirm your diagnosis.
- Explain how you would plan treatment and individualize it for Saks or McGough. Support your response with references to scholarly resources. In your explanation, consider the following questions:
- What are the long-term challenges for someone living with the illness?
- What social, family, vocational, and medical supports are needed for long-term stabilization?
- Briefly explain how race/ethnicity, gender, sexual orientation, socioeconomic status, religion, or other identity characteristics may influence an individual’s experience with schizophrenia.
