riesgo de exclusión social
OE 3: Apoyar el desarrollo de actividades culturales en el municipio
schizophrenia. Minimizing the impact of this serious illness depends primarily on early diagnosis, appropriate treatment and support. Schizophrenia differs from several other mental illnesses in the intensity of care that it requires.
A comprehensive treatment program includes:17
• Antipsychotic medication, which forms the cornerstone of treatment for schizophrenia; • Psychoeducation: Education of the
individual about his/her illness and treatment;
• Family interventions: Family education and support;
• Peer support, self-help and recovery: Support groups and rehabilitation to improve the activities of daily living;
• Social skills training
• Vocational Interventions: Vocational and recreational support;
• Cognitive-behavioural interventions • Treatment of co-morbid symptoms and • Integrated addictions program
Most of these services occur in the community. Without them, an individual with schizophrenia faces almost insurmountable challenges to recover and lead a productive, high quality life. The course of schizophrenia varies with each individual. In most cases, however, it involves recurrent episodes of symptoms. While
medications can relieve many of the symptoms, most people with schizophrenia continue to suffer some symptoms throughout their lives. Appropriate treatment early in the course of the disease, and adherence to continued and adequate treatment, are essential in order to
During periods of remission (whether spontaneous or the result of treatment) the individual may function well. Newer medications have substantially reduced the prevalence of severe neurological side effects associated with older drugs. Unfortunately, some medications have other side-effects, such as weight gain, which may discourage the individual from continuing to take the medication or may contribute to other physical problems.
Optimizing the functional status and well-being of individuals with schizophrenia requires a wide range of services, including hospital, community, social, employment and housing services. Ideally, multidisciplinary community treatment teams provide these services. Liaison by care providers with police, courts, shelters, prisons and other services likely to come into contact with people with schizophrenia is essential. Linking with not-for-profit, family, and consumer advocacy and support organizations is also critical.
Social skills training strives to improve social functioning by working with individuals with schizophrenia to resolve problems with
employment, leisure, relationships and activities of daily life.
Occasionally, timely admission to hospital to control symptoms may prevent the development of more severe problems. Where this is not possible on a voluntary basis, all provinces provide for involuntary hospitalization. A majority of provinces also allow for compulsory treatment in the community in cases where the person meets strict criteria in order to reduce relapses and provide treatment in the least restrictive
"Without compulsory admission and psychiatric treatment, people who cannot accept voluntary treatment are abandoned to the consequences of their untreated illness. Untreated these illnesses have a
high fatality rate (10-17 per cent)19 and
higher lifetime disability rates than many
physical illnesses.20 These illnesses can
cause great personal suffering including despair to the point that people, for no reason apparent to others, kill themselves to escape the torment of feelings of worthlessness or because a voice
(hallucination) commands them to."21
Schizophrenia may affect personal insight to the degree that individuals are unable to recognize how seriously ill they are and voluntarily seek help—or even accept help when it is offered. Families may find themselves in the difficult position of recognizing that their family member with schizophrenia needs treatment before he or she does. They face the challenge of engaging the health care system without the individual’s cooperation.
Mental health laws have been put in place to address the situation where the untreated mental illness is likely to cause significant harm to the person or others. These laws are only effective if there is effective service available to treat the individual in these situations.
Mental health laws are specific to each province and territory. They revolve around the following
societal values:22
• The need to provide protection and
assistance to those who, through no fault of their own, cannot assist themselves; • The need to protect other members of
society from the conduct of those whose brain illness diminishes their self-control; and • The need for individuals to be as unfettered
by legal intrusions as possible in a civilized democratic society.
The balance accorded to each societal value changes over time. In the past, greater
emphasis has been on ensuring that people are not kept against their will. This has the potential to leave seriously ill people without treatment. Recent changes to mental health acts are redressing this imbalance.
Innovative practices, such as having an individual write explicit instructions about the treatment they would prefer if they become too ill to decide it at a specific time, assuming that they do not refuse the treatment they need in order to be released, keep the individual rights at the for front of substitute decision-making.
The mental disorder sections of the federal Criminal Code allow a judge to require that a person who is found unfit to stand trial receives compulsory psychiatric treatment. This requires the forensic hospital setting to have adequate resources in order to receive the individual from the prison setting. In cases of conditional discharge or probation, the Criminal Code can encourage but not force treatment.
Endnotes
1 Canadian Psychiatric Association. Canadian clinical practice guidelines for the treatment of
schizophrenia. Can J Psychiatry. 2005;50(11):Supp1.
2 Hafner H, an der Heiden W. Epidemiology of schizophrenia. Can J Psychiatry. 1997;42:139–51.
3 Keks N, Mazumdar P, Shields R. New developments in schizophrenia. Aust Fam Physician.
2000;29:129-31,135–6.
4 http://www.nimh.nih.gob/publicat/schizoph.cfm
5 Ibid.
6 Ibid.
7 Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL et al. Comorbidity of mental disorders
with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990 Nov 21;264(19):2511–8.
8 Canadian Psychiatric Association. Op cit.
9 Wallace C, Mullen PE, Burgess P. Criminal offending in schizophrenia over a 25-year period marked
by deinstitutionalization and increasing prevalence of comorbid substance use disorders. Am J Psychiatry. 2004;161(4):716–27.
10 Jindal R, Baker GB, Yeragani VK. Cardia risk and schizophrenia. J Psychiatry Neurosci.
2005;30(6):393–5.
11 Radomsky ED, Hass GI, Mann JJ, Sweeny JA. Suicidal behaviour in patients with schizophrenia and
other psychotic disorders. Am J Psychiatry. 1999:156:1590–5.
12 Goeree R, O’Brien BJ, Goering P, Blackhouse G, Agro K, Rhodes A, Watson J. The economic burden
of schizophrenia in Canada. Can J Psychiatry. 1999;44:464–72.
13 Murray CJL, Lopez AD, editors. The global burden of disease. Harvard School of Public Health:
Cambridge, Mass, 1996.
14 Cornblatt BA, Green MF, Walker EF. Schizophrenia: etiology and neurocognition. In: Millon T, Blaneyu
PH, Davis R, editors. Oxford Textbook of Psychopathology. New York: Oxford University Press; 1999. p. 292.
15 Keks N et al. Op cit.
16 Maki P, Veijola J, Jones PB, Murray GK, Koponen H, Tienari P, et al. Predictors of schizophrenia—a
review. British Medical Bulletin. 2005:73 and 74:1–15.
17 Canadian Psychiatric Association. Op cit.
18 Gray JE, Shone MA, Liddle PF. Canadian mental health law and policy. Toronto: Butterworths Canada
Ltd., 2000.
19 Torrey EF. Out of the shadows: confronting America’s mental illness crisis. Toronto: John Wiley; 1997.
p. 8.
20 Bland RC. Psychiatry and the burden of mental illness. Can J Psychiatry. 1998;43:801–10.
21 Gray JE et al. Op cit. p. 3.