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Psychoeducation use for various conditions including severe and common mental

disorders and substance dependence , in psychoeducation we providing


information regarding the diagnosis. explaining the symptoms of the illness
provides a clear understanding of the illness, and helps the patient and family in
understanding the behaviors that are the result of the symptoms of the client and
thus reduces the blame directed towards the index patient.
It helps build support for the index patient and the counselor can also discover
the level of disability caused as a result of illness and suggest appropriate coping
strategies or ways to solve the problem.
Psychoeducation is usually implemented by a psychologist or anybody who is an
expert in the specific condition the individual is experiencing and who has
experience in psychotherapies such as nurses, social workers, occupational
therapists, psychologists and physicians.

Their aim is
 to improve the course of the family member’s illness,
 reduce relapse rates,
 improve patient and family functioning.

These goals are achieved through educating the family about the illness,
teaching families techniques that will help them cope with symptomatic
behavior, and reinforcing family strengths.
It is a comprehensive program for working with families should includes:

• Educational component that provides information about mental illness and the
mental health system
• Skill component that offers training in communication, conflict resolution,
problem solving, assertiveness, behavioral management, and stress management
• Emotional component that provides opportunities for relief, sharing, and
mobilising resources
• Family process component that focuses on family strategies for coping with
mental illness in the family
• Social component that increases use of informal and formal support network
Patient and family education, ie, psychoeducation, is an evidence-based
psychotherapeutic intervention for patients with mental illness and their families.
It teaches patients and their families about the nature of the illness, its treatment,
coping and management strategies, and skills needed to avoid relapse (Table).
Psychoeducation has been defined as “the education of a person with a psychiatric
disorder in subject areas that serve the goals of treatment and rehabilitation.”1

Nature and Purpose of Program


Introductions of family members and staff Purpose and scope of program
Description of treatment program, policies, and procedures
Brief, written survey of specific family needs and requests
The Family Experience
Family burden and needs The family system Family subsystems Life span
perspectives
Mental Illness I
Diagnosis Etiology Prognosis Treatment
Mental Illness II
Symptoms
Medication
Diathesis-stress model
Recent research
Managing Symptoms and Problems
Bizarre behavior
Destructive and self-destructive behavior
Hygiene and appearance
Distressing symptoms
Stress, Coping, and Adaptation
The general model
The stressor of mental illness
The process of family adaptation
Increasing coping effectiveness
Enhancing Personal and Family Effectiveness I
Behavior management
Conflict resolution
Communication skills
Problem solving
Enhancing Personal and Family Effectiveness II
Stress management
Assertiveness training
Achieving a family balance
Meeting personal needs
Relationships Between Families and Professionals
Historical context
New modes of family-professional relationships
Barriers to collaboration
Breaking down barriers
Community Resources
The consumer-advocacy movement
Accessing the system
Legal issues
Appropriate referrals
Parents, and close family members, of children with developmental disabilities
experience challenges that differ from those experienced by parents of typically
developing children ,When a child with one or more disabilities is born into a
family or when parents receive the diagnosis of their child’s disability, they often
experience a range of emotions (e.g., shock, grief, anger) that are somewhat
similar to those experienced upon learning about the death of a loved one .Parents
experiencing such emotional reactions require a period of time to adjust, and
during that time, parenting and caregiving may be affected.

Some children with disabilities pose particular challenges because of


developmental needs and behaviors that require specific parenting skills

or actions not required for children who are developing typically (Durand et al.,
2013). In addition, parents of children with disabilities tend to experience
challenges at certain points of transition during the early childhood years (e.g.,
hospital to home, entry to early intervention programs, movement from early
intervention to preschool programs, movement from preschool to kindergarten)
(Malone and Gallagher, 2008, 2009). Young children with disabilities affect
families in different ways, but a common finding in the literature is that parents of
children with disabilities experience more stress than parents of typically
developing children (Woodman, 2014). Given the difficulties faced by parents of
children with disabilities, a range of programs focus on parenting skills and
engagement for these parents.

Several entities at the federal level define disability. The Eunice Kennedy Shriver
National Institute on Child Health and Human Development (2012), drawing on
definitions issued by the American Association on Intellectual and Developmental
Disabilities (2013) and the Centers for Disease Control and Prevention (n.d.),
states

Intellectual and developmental disabilities are disorders that are usually present
at birth and that negatively affect the trajectory of the individual’s physical,
intellectual, and/or emotional development. Many of these conditions affect
multiple body parts or systems. Intellectual disability starts any time before a
child turns 18 and is characterized by problems with both: intellectual functioning
or intelligence, which include the ability to learn, reason, problem solve, and other
skills; and adaptive behavior, which includes everyday social and life skills. The
term “developmental disabilities” is a broader category of often lifelong disability
that can be intellectual, physical, or both.
Objective: Psychoeducation about Intellectual disability
?Concept and Definition
?Prevalence
?Causes and Prevention of Intellectual Disability.
Adopted from
o ‘Mental Retardation’, A manual for Psychologists
o Clinical Practice Guidelines for the Diagno sis and management of
Children with Mental Retardation by Dr. Satish Chandra Girimaji

There are many good reasons for taking a self-help approach towards addressing
your problems and issues.

 Self-help is empowering. Developing a self-help plan keeps you in control


of your own destiny. The skills and methods you learn while engaging in the
self-help process are likely to be generally helpful to you across many
different aspects of your life. It is also emotionally satisfying to address
issues on your own; doing so helps you to feel like a responsible and
capable adult

 Self-help means a customized plan. Designing your own self-help plan


means that you can customize your efforts so that they fit your particular
strengths and weaknesses, and reflect your personal choices about how to
best address your specific issues.
 Self-help makes other people feel good about you. Your decision to
engage in self-help provides some assurance to other people who may be
upset with you because of your issues that you are working on your issues
and taking steps to overcome them. In many cases, your self-help efforts will
be noticed and appreciated by those people around you who care about you
or count on you.

 You become a role model. If you have children, your pursuit of self-help is
an excellent way to teach your children to be self-sufficient and capable
when they grow up.

 Self-help makes you a better, wiser person. By increasing your self-


awareness capabilities, self-help efforts can help you learn to recognize
potential problems before they occur (or at least early on in their
progression) so that you can head them off before they become substantial.
As your objectivity (your ability to see things as they are, rather than how
you would like them to be) increases, you'll find yourself increasingly able to
be your own best adviser, steering yourself away from bad decisions and
towards good ones with a minimum of fuss.

 Self-help can be a time saver. Pursuing self-help efforts saves you the time
you might otherwise need to spend with a therapist or counselor who could
help you with your problems.

 Self-help is private. If you are a private person who gets uncomfortable


with the thought of sharing secrets with others, self-help can save you the
embarrassment of sharing your issues and problems with another person.

 Self-help is available and inexpensive. Self-help is generally free of cost


and free or inexpensive to learn about. If you live in a rural area or small
town, self-help may be one of the only good options available to you for
receiving help.
 Like difficulties in social relationships and role functioning, difficulty in
caring for oneself
and living independently is a major problem for many individuals with psychiatric
dis- abilities, and often requires extensive supports from treatment providers and
family
members. As with these other areas, impaired self-care skills are incorporated into
the
diagnostic criteria of some disorders such as schizophrenia. For these reasons,
improving
 self-care and independent living skills is an important priority of many
rehabilitation programs.
A wide range of skills are needed to care for oneself, to present oneself to others in
a
socially appropriate way, and to live independently and safely without supervision.
Selfcare
skills typically include the ability to attend to hygiene and grooming, dress
appropriately
for the weather and social situations, and respond to medical needs, such as
seeing
the doctor, taking medication, and adhering to special dietary restrictions.
Independent
living skills encompass a broader-range of abilities, such as cleaning and
maintaining
one’s apartment, appropriate interactions with one’s landlord and neighbors,
cooking,
doing laundry, money management, shopping, and using public transportation.
Self-care and independent living skills are similar to role functioning in that they
both involve the ability to meet socially defined expectations. They differ only in
the
nature of those expectations. For role functioning, the expectations are social in
nature
and other people typically depend on individuals to meet those expectations. For
self-care
and independent living skills, the societal expectation is for relative self-
sufficiency, with
the recognition that some interdependency and social exchange will occur
cooperatively
in some of these areas, such as cooking and cleaning. These skills have their
greatest
social impact when they are lacking, when an adult is unable to meet them on his
or her
 own and requires help from others.

Schizophrenia is a severe mental illness and apart from pharmacological


interventions some basic psychological interventions can be very helpful in
improving the outcome. However, while working with a patient one should keep in
mind that if the patient is aggressive, abusive or violent then instead of an
attempt to interact with the patient, let him be calmed (e.g., by a medical staff by
using some medications).

Family psycho-education is one of the most effective interventions for preventing


relapse in patients with
schizophrenia.
Psychoeducation provides to the patient and his family members full information
about schizophrenia and all aspects
of the treatment. If the patient is not fully informed about the treatment and the side
effects, there is a higher risk for discontinuation
of the therapy without consulting his psychiatrist. Dicontinuation of the treatment is
one of the main reasons
for the relapse of schizophrenia.

On the other hand Abbadi


in his study showed us that psychoeducation can be
harmful for the patients because it seem to enhance mistrust,
suspicion, pretence and false self1

Several other studies have also demonstrated the efficacy of family psycho-
educational interventions in reducing of relapses, re-hospitalization [18-20] and
family burden [21-23]. The psycho-educational intervention is a set of systematic
interventions based on supportive and cognitive behavior therapy approaches with
emphases on patients and family needs. The intervention is focused on increasing
patient and family knowledge about mental disorders, adjusting to mental illness,
and communicating and facilitating problem solving skills [24].

Mental illness has been recognized as one of the


disabilities under Section 2 (i) of the Persons with
Disabilities (Equal Opportunities, Protection of
Rights and Full Participation) Act, 1995. “Mental
illness” has been defined under Section 2(q) of
the said Act as any mental disorder other than
mental retardation.

Self Care: Includes taking care of body hygiene, grooming, health including
bathing, toileting, dressing eating taking care of one’s health
SELF CARE: This should be regarded as activity
guided by social norms and conventions. The
broad areas covered are
• a. Maintenance of personal hygiene and physical health.
• b. Eating habits
• c. Maintenance of personal belongings and living space
• a. Does he look after himself. wash his clothes regularly, take a bath and brush
his teeth?
• b. DOES he have regular meals?
• c. Does he take food of right quality and quantity?

Activities of daily living (ADL) are the basic actions that involve caring for one's self
and body, including personal care, mobility, and eating.

https://academic.oup.com/acn/article/31/6/506/1727834
Group work with the mentally ill
according to the psycho-educational program
Guidelines
Manual for doctors
Salnikova L.I., Semenova N.D., Storozhakova Ya.A., Visnevskaya L.Ya., ShmuklerA.B.,
Movina L.G., Davydov K.V., Darodnova A.S., Yesayants J.L. (by Gurovich I.Ya.)

Introduction
Indications and contraindications
Logistics method
Method Description
Group Management Method
Content aspect
Features of psycho-educational work with relatives of patients
Features of psycho-educational work with patients with the first psychotic episode and their families
Selection of patients and families to be included in the psychoeducational group at pervompsihotich e skom
episode
The effectiveness of the use of the method
Appendix 1. assess the level of knowledge about the map of mental illness and the
effectiveness and psihoobrazov tion program
Appendix 2. Brief thematic content of the psycho-educational program
Appendix 3. List of recommended literature
Literature

INTRODUCTION

For the national psychiatric great ktiki psihoobrazova tion work with the sick schizo £ reniey and their
relatives - the owl p Chennault new kind of treatment and rehabilitation interventions. [1] Meanwhile, in the
foreign literature psychoeducation is presented as one of the most important Podhom of rows to learning and
psychosocial treatment of patients with mental disorders [3, 5, 10, 11] and is considered t Xia probably the
most important part of psihosotsial s Foot interference in a multi-faceted system psychosocial rehabilitation of
schizophrenic patients and her and their relatives nicknames [2, 4, 6, 12, 1 4].
The effectiveness of psychoeducational work is shown in different populations of mental e lift
patients, but especially in recent years, attention is given to patients with co psychoeducation and zofreni her
various stages of the disease [7,8,17], and there are indications of a preference may b about Lee early
inclusion of this type of intervention in a complex treatment and rehabilitation at the stage of formation of
therapeutic remission bols GOVERNMENTAL, underwent the first psychotic episode [15 ], as well as the
earliest possible provision of psychoeducational programs Rhodes t Vennikov patients [9,15,16,19]. In
general, underscore Kiva that psychoeducation - is one of the Legal-governing psi hosotsialnoy
rehabilitation, the most relevant example in the general humanistic laziness partnership model of mental
health care.
Psycho-education promotes stimulation of an active position. tion of the patient to overcome the
psycho and iCal disease and its consequences, the formation of responsibility for their own social behavior
of, and the development of an adequate strategy of coping with the disease, the restoration of violated
because of mental illness is, Skogen social contacts and increasing social competence.
Psychoeducational program pursues two main objectives, which are at mentally sick th ski-Chronicle
particularly closely linked. It is actually "education" when n cient and receives information about the mental
Zabolev NII to a proper understanding of his condition I Niya led, if not to the management of their disease,
its course and over, at least for the timely recognition of the mu and control of certain disease in proya tions
and symptoms.
The second task, which is not inferior in importance to the first, is the provision of “psychosocial
support”, when the group for patients is a constant source of support and one temporarily therapeutic
environment in which patients can be protected, but emotsional s safe conditions vyraba have adequate
behavioral skills, communication, coping with difficult situations. In addition, through participation in groups -
ne meets the needs of theSTI in communication.

INDICATIONS AND CONTRAINDICATIONS

Indications:
 included in the complex of medical and rehabilitation measures pleasant for
patients and co zofreniey and other mental disorders at various stages of e Zabol schemes;
 maintaining a proper, orderly, social reception lemogo behavior even when n and lichii
delusions and hallucinations constructions.
Contraindications.
A. Psychiatric.
It is not recommended to include in the ball of L GOVERNMENTAL:
 at the height of acute psychotic disorders;
 with a gross intellectual decline;
 severe anxiety;
 disinhibition;
 inability to control behavior.
B. Psychological:
 malevolent attitudes towards other members of the group;
 categorical rejection of this type of treatment.
There is even an opinion that psychological criteria are decisive, and the diagnosis or symptoms /
clinical manifestations are not crucial in selecting patients into a group.

MATERIAL AND TECHNICAL SUPPORT OF THE METHOD

For group sessions with the mentally ill and their relatives should be provided creations meeting the
sanitary and hygienic requirements, with the necessary packing of rum chairs or soft chairs (10–20 pcs.). It
assumed that there Demons t diet board with a set of crayons, pens, markers and paper, slide projector with
wall screen, audio and telecom m plex.

DESCRIPTION OF THE METHOD OF THE METHOD OF MANAGING GROUPS

Psychoeducational approach being one of the kinds of group working methods on t worn to a learning
type, in which the lessons are based on the principle that is mathic workshop with elements of social and
behavioral training. Psychoeducation centric with a holding that includes a list of some of the problems
discussed in the group. Before the participants were lent with information on specific issues (for example,
education in the field of disease and the physician and mentoznoy therapy) with the simultaneous
implementation of patient monitoring, researches and Niemi position regarding the fact of the
disease. Classes in the group allow you to maintain the patient at a stable level of functioning; help the
patient and his “significant others” understand better the x and the racter and especially STI crazy and iCal
disease and how it affects the patient and his family members;promotes knowledge of life stressors that can
trigger an exacerbation; help over to change family functioning in peri od deterioration of the patient.
The dynamics of group members' relationships is not essential for working in groups of
this type. Moreover, because of the short duration of activity of the group is not enough sp e Meni for the
formation of group dynamics. Work psychoeducational groups should remain at the level of content with
structured interaction, promotion de I telnosti members of the group within the social norms.
It is advisable to conduct a psycho-educational program in closed groups, i.e. after Mr. and chala
cycle do not accept new members (although in some cases there may be the inclusion of the first two
sessions), with a fixed start date and the end of the training course and the limited number of participants
from 6 to 10-15 people. Each cycle consists of 10-12 psychoeducation sessions cont telnostyu and 45
minutes each. Daily meetings are not the rivers of Mende. The frequency of classes is 1-2 per week (with a
limited length of stay of the patient in the hospital it is possible to increase up to 3 times a week). Each
subsequent meeting yavl I etsya continuation of the previous one, so that team members must attend the
entire cycle.
For optimal operation of the program group should be homogeneous both nozol of logically
Supplies Nost (schizophrenia, schizoaffective and schizo-typical RA stroystvami with different depth of
remission with the exception of patients, p and give other psychoses and mayhem Specialized niche states),
and by disease stage - the stage of the active process flow until about t Dalen its stages (patients who have
undergone the first psychotic episode, the mentally ill with cha with tymi hospitalizations, the mentally ill-
chronicling, genus The relatives of the mentally ill with the first ps and the hottic episode, relatives of patients
with frequent hospitalizations, etc., but are heterogeneous in their social characteristics (age, sex, education,
etc.).
Number of leading groups of the mentally ill can vary, but is usually about Leia and Naib best option
group work is the presence of two leading - psychiatrist and psycho on the log / expert in social work or social
worker.Roles in e duschih should be clearly structure customized and complementary.
The content of the tutorial, which is etsya main assembles n is the cycle assumes the psychiatrist. It
includes information about the disease, its causes, course, etc. on the projections extend, individual
characteristics, the role and nature of the drug ie rapii and side effects of drugs. Leading psychiatrist not only
provides and n formation, but also direct the discussion, activates the patients. Education - it just kind
of ne information transfer from one hand to another. The more training is about vanie stimulates the floor -
information.
Social Work Specialist monitors organizational E points: compliance with whom Che t the beginning
of time, graduation, attendance, and rule groups, maintains FIT t stvu group atmosphere (empathy,
emotional safepart of the curriculum
conducts classes to provide information about the resource Sah community, introduces a list of
organizations in which the mentally ill can get help; Dedicated individual classes can I tit stigma and
employment or to include these topics in the structure of each session, which is more acceptable in the issue
of stigma.
For the successful functioning of the psycho-educational program, it is necessary when selecting
candidates for the education group. pay special attention to the principle of the balance of roles
selected similar in one qualities and differing in others. The group must be pre d put various
behaviors. This is a necessary condition for the work of the group, since it is important that each participant
can see at least one polo a good example. Along with patients who Skr s vayut their experiences not only
from others, relatives, and on by doctors in the group is always to l wives to attend at least one patient who
has a good contact with the medical staff and share their experiences. As a positive example of
Nogo s participating in the group should see patients with osozna Niemi's disease, which are themselves
treated in clinic and actively cooperate with BP andChom during treatment, and to take a group tiyah eager
to share the experience of their experiences and obs w tions. Another example - if in the group there are
patients who get up late, inactive, passive, they need to learn about the experiences of others who force
themselves to get up early to do of a row, with a personal hygiene is observed, do household
chores. Meetings with patients who have been through the same difficulties, inspire confidence, hope to
improve and get better th of. It is the leader who is responsible for the selection of candidates and makes the
final decision on the inclusion in the group.
Before starting work in a group at the preliminary stage, a mandatory initial individual consultation
takes place. tirovanie, a personal interview, which used the neo go primarily to the establishment of
partnerships with patient otno sheney. Within 1-2 in a tanovochnyh interviews with leading (psychiatrist and
a specialist in social work) pe creases the inclusion of patients in the group evaluated the mental state of the
patient with the release of intact parties that well Well but will draw in group work , it is specified what
information the patient needs most. After determining understanding the information needs of each
participant wish to set up in the individual cial psychosocial rehabilitation plan, highlighted the most
important topics and the order of their e-LIGHT Niya, this about to Nove preparing detailed design course of
study with the composition of the group members. Considering that some patients have wife or are not
motivated to participate in such groups, c e pour a personal interview is its development. To do this, you must
emphasize the HV and manie of potential participants (patients and their relatives) to that group
events I lyayutsya an integral part of treatment and rehabilitation programs, and e duschie group - employees
of the psychiatric institution. Education, etc. of assignment requires knowledge about the clinical status of the
patient and his level of understanding of their condition and the disease of this paragraph on a the
preparatory stage, the presenters are introduced to the medical dock mentation, histories of each candidate
and draw attention to the particular cognitive and um on tional sphere.
Style of conducting classes in psycho-educational groups wives of decision-making, especially in the
early stages of the group’s work, using active leadership, but benevolent tion with respecting and tion to the
participants, to their Chuv stvam, deeds, experiences. Should be combined to Dir tive and highly structured
management group with the Partnach River skim rather than paternalistic relations, relying on individual
expectations and the general needs of each participant. Such relationships mouth and novit very difficult in
the group, especially with ps and hiatricheskimi patients who always said what and how they should do. From
the very beginning of the course introduces the new role of whose members have an chayut throughout
further Started you groups This role ka w dogo person in the group is expressed in "finding" the right to
vote; to assimilate and retain this role, you need time to encourage uch as ticipants, select one theme or
weaken, dampen sound different. We can not allow a group involve itself in the dispute. Should not enter into
bickering over the content of individual statements, it is necessary to Kojno to continue classes according to
a preliminary plan, to cover the Goth material that was planned, and to keep within Occupation time. If one of
the participants actively reflects sdisagreement with the leader, should not try to change his mind, resulting in
more and n o stems arguments. For example, if you have a situation where you have just talked about the
dangers of alcohol and p seals, and then some of the patients said that they it not only does not hurt, but the
pom on gayut, the facilitator should not dissuade. Instead, he may offer to speak in more detail on this topic,
and in the process of group discussion to lead the patient to the adoption of the opposite point of
view. Req of Dimo note that the information offered by the Vedas in boiling, must always be clear,
unambiguous and non-contradiction-ua. If a question is asked, the answer is assumed to be specific. It is
advisable to hear each participant - each ask a question and get an answer from each. When the audience is
very pas sive with, then we can try to stimulate it by pulling some versions. If members of the
group Playback continues to be silent, they do not want to speak out, then they should not be caught
nickname and-pressure. The group, when everyone is silent, is rare. There is always someone who
starts talking about ben. It should also formulate questions for patients who are not ready for verbal
communication, so they can ton of vetit monosyllables - yes or no. Req leading to Dimo constantly
demonstrate that are happy to answer any party member should make every effort to positive podkre -
captivity even disordered I-ordered sentences. There should be no negative comments. E to whether
participants are beginning to re talking to each other, you can invite them to share with the whole group what
they say to each other. Perhaps for some toryh participants is edi n-governmental way to break the silence.
Training is carried out using the accepted in psi hoobrazovanii model Interactive Foot in training,
ie model times Viva Learning not traditional, didactic or SOI Well Nome type, and the type of transformative
learning, in which the absorption and consolidation of educational mat e rial prois walks in the course of
mutual communication of participants, active discus process. The main methodological technique is to
stimulate participants to respond to the provided n and n formation, support of spontaneous leadership
behavior of participants. At the same time, taking into account the Features P Foot for schizophrenic
patients in the cognitive and communicative Foot inte deficit reactive training is carried out very carefully so
as not to show them excessive demands, not to expose them and of bytoch hydrochloric chre stimulation
and measuring of communication load.
Another requirement, compliance with which is especially important in the educational tarte d with the
mentally ill, a chronicle, a high degree of structuring both content associated I Tille and their modalities, which
greatly reduces anxiety. Leading ensure strict adherence organizational aspects (e initiate and
complete occupation of a defined Noah time, permanent venue), control group, in order to correspond to the
discussion of Contents and the NIJ activities and not break the sequence of information from a simple-to-
b about Lee complicated. At the same time leading pobu Well give participants in the initiative, organize and
stimulate interaction Corollaryparticipants with each other, provide feedback, which should reflect the
paragraph about trebnosti and opinions of participants, regulate the time and sequence of
statements. About d him from PRIE Movs supporting the structure of a group process are statements in a
circle. Another method which is also frequently used in the group with the mentally ill, is a technique
adjunction e of the connections. Leading into account the need for so switchgear e pour attention among the
participants to the group nN no one remained in the shadows. To do this, you must "contain" active and
sociable v Nosta some and encourage participation Drew GIH, more closed and
removed Mr. GOVERNMENTAL, as well as limit the time the statements to give a voice to everyone, it is
important not only to prospect and attract patients to participate in program, but later to keep him in the group.
Along with the assimilation of the content of the training programs we are no less important to be
holes on ditsya "psychosocial support". Using the group as a protected and under the refrain of a servation is
especially important when dealing with the mentally ill, chronicles. One of the tasks of a social work specialist
is to provide each member of the group with a sense of security and comfort. Support group starts small, so,
for example, a proposal to remove outer clothing, or put things on an empty chair, and about
the Others. Positive support is provided by n on constantly throughout the study period. This function is taken
over by a social work specialist, who also d keeps in a group an atmosphere of empathy, emotional security.
Psychoeducational group performed in the style of group psychotherapy, as uch as ticipants sit in a
circle facing each other. Presenters can use a projector, chalkboard, or drawing paper with felt-tip pens.
Classes are built according to the scheme, which is followed during all group work methods. Each
session includes entering hydrochloric portion, working time and discussion.
Only the first and final session have their own special Nost.
Successful start of great importance to the group Started you, so the first lesson Goth on vitsya very
carefully, especially when dealing with the mentally ill. Especially on ne p O take tiyah avoid congestion
pictures.
At the first session of the introductory part usually it takes more time because the participants
req about Dimo know each other, understand the rules of behavior in the group, what exactly will
conclude s All work; informed about the meetings of time, their duration, frequency, total quant e stve,
length telnosti, gathering place, for the band. Special attention is paid to the participants that the
Vedas have moieties - the staff of the psychiatric institution, once again emphasized that groups of stems
classes are mandatory integral part of the treatment and rehabilitation process.
Plan each psychoeducational course is based on the leading prefaces and tion evaluating the needs
of all members of the group in order to take into account the specific paragraph on trebnosti participating in
the group. For this purpose, the first class of the band requested to fill d of additionally questionnaire (Annex
1), koto ing includes a list SFOR formulated the purposes and must designate in points which of these goals
more and which are less important. The list includes 16 items that reflect cl e blowing
priority nye expectations: the ability to talk to people, to hear from the other uch as ticipants group their own
experience and share their own, learn how to overcome the aggravation, get knowledge about what is
causing the disease, its course, prognosis, a symptom of a move, l e chenii etc. From this list, all participants
rate important goals for themselves on a 5-point system. The presenters analyze the participants'
expectations and on the basis of this, in the future, the structures and the content of the classes are
being studied , it is determined what to pay less attention to and what more to pay attention to. So
page of GSI work ka w dogo psychoeducational cycle.
Participants meet for the first time with a large number of unfamiliar or unfamiliar people in an
unfamiliar environment. They are alarmed by many things: how to behave, what to say, how things
will be related to other members of the group, how they will be received, what kind of impressions they will
make , etc. Therefore Celje according to provide some time to adapt.
Each lesson begins with a greeting from the group members. Then, it should be recalled
authority and civilizational moments to talk about the goals and objectives of psychoeducational programs,
but their stories of penetration. You can say about the following.
For 2.5 months, we will be meeting every week and the room and discuss in a millet related
manifestations of mental illness, ways of overcoming them or reduce e Nia symptoms of the disease,
including the treatment and not only medical. Such meetings in psychiatric establi deniyah all countries have
been held for many years, and the results they claim to show that when a person knows more about the
disease, its symptoms, manifestations, that is, chenii, options and methods of treatment, it is easier to cope
with their ailment, adapts to it, learns how to live with its illness. The first such meetings by me occurred in the
late sixties of the last century, and the conversation in the group was limited only to the doctor's answers to
numerous questions concerning diagnosis and pharmacotherapy. But then, participative and ki groups began
to tell their "stories" that allow everyone a fresh look at the current situation, evaluate how others cope with
similar prospect of Bloem and find new ways to solve. At first these groups were organized only in a hospital,
and was shown to effectively form a coherent approach in terms of reducing the length of stay in hospital and
the number of hospitalizations and tions. Currently, the used transform of patients is realized not only in
hospitals, even more than in the outpatient conv aboutviyah.
After this introduction, and after the band slightly looked around uv and Delhi each other and leading
should begin well prepared znakoms procedure T va.
Before you tell us about yourself, the facilitator can suggest a rough list of Issues on the owls, which
will give an idea about each participant: name ( "How would you like to to you drawn and were?"), Age,
marital status, duration of follow-up, psychiatrist, etc. and the ranks of treatment in a dispensary or hospital,
manifestations of the disease, education, profession, a slave about that, hobbies, hobbies, what you do in
your free time and so on.
Lead first example takes and presents itself as an employee of medical y h rezhdeniya and
psychoeducational approach as an integral component of the treatment and rehabilitation process, explains
their role in the program, discusses the reason for his interest in the method L e cheniya and its obligations.
Then he asks for the group members to introduce themselves and tell something about
themselves. The facilitator should reassure the participants, saying that some wariness in the unfamiliar
is in ke - the phenomenon is quite natural, understandable and normal. Can offer once Vysk and binding in a
circle, starting with the most active. From the outset, you should use connection technique when
Accent in etsya attention not only to similar problems (a disease and the issues associated with it), but also in
the joint venture on lities or hobbies (sports, computer, drawing, p y kodelie, music and so on. P.).

CONTENT ASPECT

After meeting again (the need for frequent repetition of information), but should list the more specific
tasks that will be discussed during the meeting and breakfast and write them on the board or sheet of paper
(two ways of perception - auditory and sp and tion) (Annex 2) .
Commonly studied questions include:
 etiology;
 flow type and forecast;
 symptoms of the disease;
 ways to recognize and control painful symptoms;
 treatment options;
 possible side effects of treatment and control;
 first signs of disease and prevention of recurrence.
Considering these questions, in the e- mail the following tasks are set for the group:
 studying the causes of psychotic disorders, features of the course of the disease,
prognosis, methods of treatment, conditions and course of the healing process;
 the formation of the ability to understand the disease, learning ways to recognize a
symptom of mov able and develop STI control (self-control) over them;
 training in chronic disease management;
 familiarity with the role of pharmacotherapy in the treatment and healing process, the
involvement of patients in the treatment process;
 familiarity with the possible side effects of pharmacological therapy and control;
 development of compliance (compliance with appointments);
 discussion of the role of stress in the onset of exacerbation and ways to mitigate it;
 opportunity to get emotional support, discuss their feelings, share per e zhivaniyami, to
experience a situation in which turned out to others, to understand how they spra in lyayutsya with their
problems, to express their own views;
 Improving relationships among patients, creating or expanding their social networks.
It should tell the participants that psychoeducational programs help more at z nat about the illness,
the symptoms and medications, to accept the fact of the disease and its associated
restrictions Nia, with s given safety for their environment, supporting and giving the opportunity to talk about
worry , I boiling problems provide structuring, organized, etc. of Deductive spending time.
One of the key objectives of the first session is to focus participants on successful work within the
group. It is necessary to tell about the experience of patients who have undergone similar training cycle
Podcherye to pull the that spending time with people who have similar problems and experiences, creates
peace of mind and communication, which can not be found anywhere else. Here, people with
psycho cal disease have much to learn from others like themselves, and can take what their years in vain
Ube railway gave doctors and family. Patients learn how to reduce or spra curl with disturbing
symptom and E.
Psycho-education provides an opportunity to talk about problems and try out various ways to solve
them. Often the patients themselves offer worked out by them in the course of the disease on
methods used legcheniya painful symptoms. Different people may have effects in us different techniques. For
example, you can ignore the voices, to speak to them, so they were removed and were, to get away to a quiet
place. Some removed where calmer as they feel bad around people, especially in the ball b Shih groups.
Others try to stifle their painful pain . cutting music or trying to be where there are a lot of people. Relationship
ideas are also not easy to control or correct to the patient. It is necessary to help the patient understand that
such ideas are nothing more than one of the symptoms, and that is not always what he thinks and feels,
reflects the real progress with on byty.
It must be said that the manifestations of the disease, symptoms of the disease are very diverse and
and n dividual. This also applies to the ability to understand one’s illness. Some up to tatochno quickly come
to understand that patients who need medicines and can participate in lech ie research institutes, learn to
recognize the symptoms. Others simply can not to this in ourselves to, and live it from this difficult. You must
learn to capitalize on their op 's that and the experience of others.
I should say that in the classroom will be examined in detail the symptoms of painful n e rezhivany,
and it is important to understand and recognize those symptoms that will be said s camping. Especially
difficult life that the symptoms often appear and disappear for no apparent is w it causes. Psychiatric diseases
generally are cyclic in nature, some people Protek cycles are longer and heavier than the other. For some
time people on can feel better, and then the symptoms may come back a century. We must learn to
rejoice's about Roshim times and better to overcome bad as possible. It takes time, an image of Bani,
experience and patience. All this we will teach Xia in our classes.
Participants will then be asked to complete a questionnaire. I la based on the received data and
p and its individual composed cial psychosocial rehabilitation plan developed threads of a nyaty constructed
on the basis of the phase information, i.e., from the most simple to the b about Lee complicated, yell clues for
the individual needs of each member of the group, in which the receptacle and Nia are fixed through repetition
of key O with concepts and with the use of different sensory inputs, ie, auditory, visual and tactile.
In general, participants agree with sections offered by leading, but in the process the possibility of
some groups torye amendments, but usually for minor changes and accents.
Further discusses the rules of the group, which are also recorded in writing on the board and further
rigorous but complied. As a rule, they include a conf and den tsialnost and security, the right of everyone to
have their opinions and ask questions, not per e Shoot down the speaker and the right to withdraw from the
group. The right to withdraw from the GRU n nN should be discussed separately, but should not focus on this
issue, or talk about it repeatedly. Otherwise, this may be taken as advice.
At the end of class to thank the participants, recalled the time and place cl e blowing the meeting,
called the topic classes.
All subsequent classes begin and are conducted equally.
Each session begins with a welcome party and a survey on the state of health and mood is, the
patient's Research Institute: "How are you today feel", "What has changed in your state , I ? Research
Institute" In response focuses attention to anyone, even small positive changes in himself about feeling.
The next question, which can be interpreted as a warm-up, is: “What new happened between the
classes?” Or “How did the week go?” At the same time, attention is paid to the issues of adaptation, moments
of everyday life.
Then usually one of the top requested to recall briefly the topic of the previous meeting and
vyskazatsya s camping on the previous lesson.
Working, most of the time is dedicated to the topic of employment, covers about half of the time is, no
session, and is constructed in accordance with the content of the program, changes may be made at the
request of the participants, but in the framework of the program. The content is generally is
informative in character and is based on a method of interactive learning that involves an exchange of views,
a joint discussion op s is the opportunities and overcome the disease, etc.
Any information provided to be learned is repeated many times, and repeated in various sensory
forms. Using essentially verbal techniques added I etsya and visual information, making the learning process
is not a lecture, but ma to the maximum DUTY interactive, when in the process of training the patients interact
with each other in God. In addition, information during classes is repeated at least three times. First,
information is presented in the training, didactic e tion of the training, the participants then returned to her,
discussing something new that they have of Nali. Then, in the conclusion of the session, leading summarize
what you have heard from the participants in the fi e Scrap information day.
In addition, information is provided in small portions while the active item on the excitation of the
participants to the response. Patients should be encouraged to ask ioprosy Casa th schiesya their disease
and treatment. The facilitator should reassure the participants, saying that the content etc. e delivered
material can sometimes be complex and difficult to clear, suggest asking vopr about sy, not only leading, but
also each other. Last incentive and ruet participants to interact, learn to accept help and use feedback. This
communication style allows a certain share of the rymi advice on self-control and the joint venture of adheres
to the consolidation of the material covered.
It should be noted that there is no prapilnyh or wrong answers, everyone has the right to have an
opinion may not coincide with other conventional or i fifth. Can give you an example, that someone like Rose,
and who th - daisy chrysanthemums or e ma, who prefers black color, while others - red or blue. Encourage
participants obme Niva information both positive and negative, as some patients of a mechaya of other signs
of improvement, see this support for themselves.
The fundamental principles of psychoeducation - the reliance on and respect for individual
group of the first experience of the participants. Leading the group is not taking on the role of the therapist,
and are its participative kami. The role of moderators is to give participants the opportunity to do something
together, to learn while communicating with each other. From members of the group are expected to feel in
the group bezop with but also free, which is one of the specialist tasks of social and cial work - to provide
patient psychosocial social support.
By offering this or that information, are intended to SPRO votsirovat discussion of this
to Mr. indiscrete threads help Paci tomers to exchange views, share experiences or
problems GOVERNMENTAL sieve and tions.
The most important part is psychoeducation and that the individual is used in cial experience of group
members to itself of the learning process. It is necessary to repeat the importance of the patient
with a monablyudeniya and self-help, the benefit of treatment. Always considering etsya and attached
znach e of the responding patients, the reactions that are sounded. Attention is paid
personals of communities are high, indie vidual experience of the disease, which in the life of each individual
patient has its own unique appearance. Pr and measures are the starting point for new knowledge. If you can
ssy latsya on vyskazyv and Nia patients and their responses, then those with and by direct, they are inspired
by the fact that more than react, pain Chez involved, responsible. Every statement should receive positive
reinforcement. The main task - to help the PAC and en there to understand their experiences. Explain to
patients that sometimes they may not notice at the beginning of the exacerbation, painful cardinal symptoms,
side effects of medication, or even improve Nia conditions that are clearly visible to others, loved ones. In
such cases it is necessary to use these people as “signposts”, i.e. involvement encircling w boiling may be
useful in the recovery process.
The traditional approach to patients is focused on Patolo Gia, but if focus its efforts on the
rehabilitation progress, it is necessary to focus on those t and groin and behaviors that really can change,
one with timeencouraging and inspiring in s Moznosti Lich nostnogo growth. It is important to find a balance
between Otsu t Corollary excessive stimulation and promotion of maximum effort.
It is necessary to focus the attention of participants to the infusion present and not think about the
remote c e Lyakh and opportunities. For example, you can tell patients something like this: “We cannot know
what will happen in the future. Every year brings new discoveries. It is not necessary to claim and a thief
unrealistic expectations, but also you should not look to the future with despair. It is better to focus
our ourselves to at Malin s FIR steps and progress from week to week, so today's action brought nearer the
goal. And if we try to do at least small steps, life will become more contains nothing significant, and
samochuvs t Vie tomorrow will be better than yesterday " . At each session, patients are trained to observe
themselves, in s chlenyat at the painful symptoms, trace the beginning of the exacerbation and offer ways of
their pr e overcoming.
Terminates employment discussion, which, like the prologue takes approximately Thu p minute
lessons time. During the session, all participants are given the WHO possibility in s member of the main of
today, to speak on the subject of what good they have heard in today's lesson, and get a list of the leading
ideas that participants have heard of what they were told. This is an opportunity to repeat once again the
key is, stems words, key concepts.
The lesson ends strictly in time, but so that the participants do not leave the dejected. If a participant
is upset, you should talk to them individually after the ce with these. You should not abruptly interrupt the
speaker, you need to "round out" the statement. What follows is Poble sincerely and Godard participants to
recall the time, place and topic of the next meeting. Thanking the participants, we can say that it was nice
about the lead this time with N and E and call something useful that he brought to himself. Some leading
consider it important to say goodbye individualistic dually with each participant and each of th said that he
was waiting for him at the next busy I TII.
The second session is somewhat different in that the drive still continues to create a security
environment, comfort (at all subsequent sessions, this situation only by e der alive), which manifests itself in
encouraging the participation of smaller nicks to the answers and more in presenting the material leading
itself. This is the last session in which the lecture material prevails over active for b judgment, although, of
course, when sponds any statements of group members, positively est e Niva any opinion.
During the second session, as a rule, the causes of psychosis are discussed in some detail with
and with the use of the diathesis-stress-vulnerability model. Reported data on biochemical,
physics ologicheskih and psychological factors and stress as a triggering factor of occurrence of the individual
pc and hoticheskih episodes.
In this lesson, as well as at each subsequent session, in order to fight stigma should
claim to constantly draw an analogy with nai more common chronic somatic of a bo Levan (diabetes, peptic
ulcer disease, cardiovascular disease, etc.), comparing the last races with mental stroystvami. It should be
said that mental pa with stroystvo is not a new or uncommon disease, such as schizophrenia met so camping
at one percent of the population independent Mo from education in the family, religion, socio-economic
status, race, political system. Mentally ill people are ordinary people with a health problem. It Zabolev of other
similar long flowing Zabol e ments.
The vast majority of people suffering from mental illness, but it can lead p -formal lifestyle - live at
home, study or work, have a family, etc. The patient before l wives learn that he is one of many well known
diseases, such as diabetes or I h vennaya illness, and that his illness under the given treatment. You can
invite team members infor mation on the epidemiology and etiology of schizophrenia in comparison with such
common diseases as diabetes or g , and peripheral arterial disease, while emphasizing that the majority of
patients, such as diabetics do well with their illness, x on there are some who have great difficulties, and they
learn to live with it.
It must be said that there is a whole group of mental races stroystv, which have a number
of used boiling symptoms, common treatments, and to what extent we can predict them during and after
the forth consequence, but there are also many differences. It must be emphasized that it is not very
important titles as of disease. Whatever it is called, it is important to understand that these are certain
malfunctions in the activity of the brain, it is a brain disease. And in the classroom will say taking care of
manifesting e niyah, symptoms of the disease, to better understand what it is. Symptoms are variable. They
appear and disappear at times can otsuts t for weeks, months or years. However, it is very important to
distinguish these symptoms, since they can be repeated. This helps the district and zobratsya in themselves.
Talking about the causes of the disease, we can introduce the members of the group with the most
izves t -GOVERNMENTAL theories. Violations of the chemical balance of the brain play in the development
zabole Bani-t and kuyu same role, such as impaired insulin synthesis 11 When diabetes. When
with a responsible treatment of the imbalance can be reduced, resulting in a cure or significant improvement.
It is necessary to elaborate on the role of stress arose tration and exacerbation of mental e Sgiach
disorders, discuss model diathesis-stress vulnerability. Information about this can be a teacher-revenge like
this. There is an external factor that must be taken into account Vat when discussing the causes
crazy and iCal diseases - stress. It is not their cause, but it seems to aggravate the symptoms of those who
are subject to mental disorders. Many ispy Tyva excessive stress n and fire rate, but they do not develop
mental illness. But if you are prone to mental pa with stroystvu, it is likely to be more sensitive to stress.
Adverse th Corollary environmental stressors and the Life n nye events can be superimposed on the
bio logical disposition, and a person becomes ill. Stress - one of the factors that affects the softer or more
cord e Loe symptoms. Stressors can be anything that causes anxiety or concern to a person. It is necessary
to examine what for you is prich and Noah stress and find a joint venture of soby reduce its impact. It found
that a person with pre predisposition to the development of mental illness, requires camping only in a small
Streit with sovom alongside a th for a long time to lose mental balance. For some patients uro Wen stress to
provoke each subsequent episode is downward, ie, each item on the next exacerbation of fuss and repents
easier, if not carried out adequate therapy. Obra Thus Zoom, two factors - predra with position and stress -
complementing each other, may cause disease development.
Information is usually provided on the course and prognosis of schizophrenia.
At the end of session, be sure to remind the postulate that psychos cal diseases are biol about cal
problem. Then ask each one to list one or two things he learned. This procedure survey in each session is
Zavar depleting action and allows each isolate importantly for today, and leading to get an idea of what the
participants have learned from what they were told.
The following session conducted by the scheme described above, and include the information with
Nagle d nym description of the most characteristic symptoms of schizophrenia: modified affect (mania and
depression), thought disorder (including delirium) and perception, abnormal behavior. When before
the b appearance of a pleasure of the material it is advisable to offer patients obsu Well give it to their own
experience. To do this, write on a whiteboard or flipchart title, n as an example of "Depression", "thinking" or
"behavior", and invite participants to describe a typical, in their opinion, the manifestations of
RA with stroystva.
It emphasizes the fact that the disease is a biological problem, and that the treatment of
Mr. and steps improved. Participants should gain as more detailed inform a tion on the individual symptoms of
mental illness. To relieve th chit absorption of these and n should give examples of each sign taken from
experience and behavior pres formation stvuyuschih. After describing the active participation of members of
groups nN of a si m ptomu disease allocate necessary to teach the main features of display of each symptom
present and notice signs predshes m vuyuschie top aggravation or deterioration.
The common thread through all the classes must pass the idea that the first and most important
w and by God on the road to recovery is recognizing the presence of at mental illness, it is
necessary Mosti physician b Noah aid and, possibly including support conductive therapy for the duration I
was a prolonged period. It is ska show that you can not change the fact of the disease, but every pesetas
responsibility for their own recovery program. Avoid rec and diva illness or hospitalization may be only in the
case, if you learn to recognize signs of worsening and take active measures to whether to views. Any slight
change in typical behavior should be regarded as a warning signal.
As a rule, most often manifested exacerbation of symptoms, which are recorded as the patients
themselves, so claim their loved ones are as follows: tension and nervosa Nost, Neues d ity, inability to
concentrate and memory loss, appetite loss , and that, worsening of sleep, depressed mood, lack of joy,
increased enthusiasm than any one, reducing contact with others and a tendency to one -operation, fits of
laughter or any other inappropriate dis t Vij, the emergence of voices hostile attitude to the circle auschim,
suspicion.
We must bear in mind that each patient has his sob governmental symptoms and signs,
pre d Procession aggravation, and sometimes they are repeated from attack to attack. The task of leading
with about costs is to help everyone to find those with signs. It should also be taught n and cients to
determine those factors that enhance a particular symptoms, and qs gence to avoid them. Attention is drawn
to the fact that the most common cause of relapse is the lack of reception l e drugs on, the lack of
com p layensa.
It should be borne in mind that patients with schizophrenia question of overcoming his
Zab about Levan is a matter pervosti foam importance. Therefore, at each session, we recommend the
need Vat dis t Via, a method that can make their lives easier.
There are many ways to overcome and control bolez New. First of all req about Dimo continue
treatment, to learn how to reduce stress and control their psychotic symptom of us, its wrong, unhealthy
behavior. You can tell that to reduce inte n some patients are using headphones, others struggling with
delusions Presley sivnosti votes e dovaniya choose less crowded streets, trying not to look at
okra zhayuschih etc. The majority of patients with schizophrenia s work were their own rules. It is necessary
first of all to listen about those individual receptions that each of the patients can tell about.
Should focus group participants on the fact that a successful life with b about disease characterized
includes the implementation of a balanced regime of the day alternating periods of active STI, on t respiratory
and sleep. The general recommendations include lessons physics cal exercises, etc. and Villeneuve food,
employment favorite business, etc.
Providing information about the symptoms, it should be in every ses UIS include questions
Poveda e Nia, and subsequently one session to devote the issue of improper conduct, as of a part of the
name changed behavior is the main nastorazhi vayuschim sign of the beginning of the aggravation for the
patient and for his relatives.
It makes sense to remind patients that behavior change is usually the second hr nym, not a primary
symptom, ie, changes in the behavior of patients are usually reaction-her other violations that occur in the
brain that movedenie patients VNU t Rennes due and logical - they commit certain acts for reasons that
vyzva us their frustrated OJJJ in scheniyami and thinking, commit acts that make sense to them. It should tell
you about n about vedencheskih features observed during this Zabolev Research Institute. For example, you
can describe katatonich e skie disorders, mutism, or so-called ritual behavior, and then ask the participants to
share their own group 's first experiment.
One or two sessions are usually devoted to information about the use of different lekars t -
governmental agents on the possibility GOVERNMENTAL side effects and methods of correction and are
intended for trained e Nia patients the right to use them to improve the noncompliance.
It is useful to dwell briefly on the history and Execu mations psychotropic etc. e Paraty say that drugs
put under the control of symptoms, such as the treatment of diabetes of the second diabetes, explain that
psychotropic drugs singularity but effective in a t wearing productive symptoms.
It is necessary to tell about other medicines - antidepressants, tranquil and congestion, mood
stabilizers, proofreaders, nootropics, briefly describe their value. At the same time purposeful according
to stimulate discussion on this topic member group nN, asking them questions relating to th schiesya
personal experience of love with those or other drugs. Depending on the mood of the participants master
himself can answer or provide WHO possibility of an answer another ESTATE ie nicks.
Be sure to consider in some detail the problems mu side effects Leche e Nia, explain that most of the
side effects occur soon after starting the drug, and that many of them after a while may vanishing to
show. Despite this, it is necessary to set up participative and Cove of the fact that they consulted a doctor and
expressed their danger is, Niya about adverse reactions because it helps in the planning of treatment. It
should not only list the possible rather than a body effects, but stop in sufficient detail on ways to correct any
complicated e Nij.
Pharmacotherapeutic during the session is recommended by not only the support ve p ballroom
information detailed notes on the board with a list of drugs, partial Well GOVERNMENTAL side effects and
ways to overcome them, but it is advisable to offer the members of the group in advance Prepare to lenny and
printed ny material to such information.
The final lesson also plays a special role.
Usually the last session is less structured. Participants may have a lot of questions about
which prompts the host must answer.
Concluding the cycle of meetings, the facilitator may ask the following questions:
 What new and useful things did you learn during our meetings?
 How can I use in practice the ideas that prozvu Chali in the classroom!
 What he heard from you during our meetings is, in your opinion, you claim to be able to?
 What precautions should you take to avoid exacerbating e Nia?
At the last meeting it should be said that it would be good if at the end of busy , I Tille they will
continue to meet the smiling, keep in touch with each other. RASSC possible and to show that at the end of
the previous working groups, the participants exchanged phone numbers and continue to
SUPPORTED and Vat strong friendships, organized self-help groups and mutual aid. But we should not
crust and Vat, the participants have to decide whether to do it.
This session must be given to the support system of information about
Various hours GOVERNMENTAL forms of psychiatric Pomo soup and providing its institutions (in particular,
where and as kim way to go in case of exacerbation or crisis situa tion), the public body and zatsiyah mentally
ill and their kind stvennikov, social services, to offer addresses, tel about us, talk about rights and benefits, to
recommend a visit to one of the target groups or offer to continue working in a t covered psychosocial support
groups.
At the last session it is necessary to warn everyone that through neko given period of time after the
end and Nia cycle (typically 2-3 weeks) will be another additional meeting, whose mission is to
prospect for verification of the status of participants.
As a rule, the meeting shall be appointed in different day and time of the training sessions,
Province of ditsya in an informal setting, such as in the form of tea. Normally patients willingly come fall
St. about their views on the work of the group, is pleased to share Stu or seek help, to talk about their
uvl e cheniyah, ino GDSs bring photos, various crafts, sdela n nye own hands, etc.

FEATURES OF PSYCHOLOGICAL
WORKS WITH RELATIVES PACII N TOV

Psychoeducation with relatives, in addition to ease the burden of families and improve e Nia quality of
life of its MEMBER new in the presence of the patient's family, suffering from mental pa with stroystvom,
largely aimed at WARN REPRESENTATIONS frequent and repeated PRESSOL Schmiergeräte GmbH
Tel and tion of.
Responsible care for the mentally ill falls mainly on families, which are often not
prepared GOVERNMENTAL to ensure that for a long time to bear the burden of related psychosocial
problems. The study of families of mentally ill dormancy and shows that there are common mistakes
born stvennikov associated with underestimation of mental pa with stroystv or lack of understanding of the
behavior of a family member objectified e wish to set up a disease. In this regard, often marked by delays in
seeking medical advice or waivers l e for pharmaceuticals therapy.
Relatives should know how signs of mental bolez not manifest in the behavior of ball s Foot, his
actions and propositional niyah. As a result of a misunderstanding of what is not positioned
correctly s behavior of the patient is often due to illness, family members hold towards him
negative in hydrochloric, sometimes even hostile, or at least dissociate themselves from the situation. The
patient l and bo is left to itself, or vzaimootn of tions with relatives become permanent stressful factors for him.
A sound approach to the organization of interpersonal t worn with patients in the family, the Charter in Lenie
blah gopriyatnogo communicative style and emotional climate in the home should be based on awareness
akin nicknames of mental upset th SHALL their manifestations. It is particularly important that relatives are
informed of the initial prospect and marks exacerbated e Nia and know how to recognize them.
The behavior of the patient's family and the relationship with him is based on the following th boiling
rules:
 the realization that any prolonged illness requires a period of adjustment to it;
 the desire to perform a certain mode and daily routine;
 avoidance of emotional scenes and stressful situations;
 appeal and request to be put on the patient in a relaxed and convincing L hydrochloric
shape;
 it is necessary to stimulate personal hygiene and the observance of other daily living rules
for patients in the family
 should not ignore the presence of the patient, even if it seems that he does not
prislushiv and etsya to what is going on;
 speak slowly, calmly, clearly, giving instructions and asking questions about the e Nome,
at the same time as several made orders or questions can lead to a deputy e -interference;
 attempts to dissuade the patient in his mistaken belief does not usually reach their
p th result, and often end up camping deteriorating family relations, mutually violation of d of Berea;
 unnecessary criticism should be avoided;
 the desire to instill in the patient respect for oneself with the approval of his success, no
matter how small and insignificant;
 Software as the possibility of communication with the people and the
WHO Moznosti privacy when needed;
 striving to convince the patient to take medications and Vauvray on me refer to
BP and chu.
Information of the psychoeducational module for families of the mentally ill Practical and cally different
from the module to the patients themselves, and includes the same sections:
 the multifactorial nature of mental illness, the biopsychosocial model, the diathesis-stress-
vulnerability model;
 symptoms (depression, mania, hallucinations, thinking, delirium, abnormal behavior) and
their manifestations in the behavior of a mentally ill relative;
 acute and early recognition of improper behavior Nia due to illness n GOVERNMENTAL
experiences (Galju tsinatornoe behavior, delusional behavior, etc.) received and MAEM measures;
 social and legal issues, involuntary hospitalization tion (with the obligatory uk and zaniem
that decision unkindly freestyle hospitalization takes a doctor, not a relationship n patient nicks in order to
avoid further feelings of guilt from family and accusations by patsie n that );
 pharmacotherapy: different classes of psychotropic drugs, their principles of action and
side effects; the role of the physician mentoznoy therapy in the prevention of recurrent or frequent
hospitalizations; long-term maintenance therapy; compliance;
 the patient and the family (resolution of conflicts related to incorrect Poveda e NIJ);
 psychosocial therapy, its meaning;
 stigma, self-stigma;
 public organizations of patients and their relatives, institutions providing
ps and hiatricheskuyu help sotsi cial service.
As in the patient groups, the information in groups born stvennikov available in the style of interactive
learning using the advantages which enables the exchange of experiences for surmounting of Lenia disease
in each family. When the similarity of theme timetable, soda p zhanie pre tray with taking into account that it is
more important to know Rhodes t Vanik. Permissible under gentle discussion of prognosis, long-term
maintenance leche Niya, in s Moznosti disability, stigma.
The relatives of patients can be recommended for Find our Lenia available in Russian lang s ke
literature (Appendix 3).

FEATURES OF PSYCHOLOGICAL WORK


WITH PATIENTS WITH THE FIRST PSYCHOTIC EPISODE AND THEIR FAMILIES

The first psychotic episode, the first contact with a psychiatrist, the unpreparedness of n and or
patients and their families to be included in the system of mental health care, the lack of such experience and
knowledge about mental illness and features otno sheniya to the mentally ill - all this requires consideration in
psychoeducational program and entering, thus adjustment to psychoeducational straight on gram, realized for
patients except in step p of said flow psychosis. For psihoobrazovatel hydrochloric work with patients with first
psychotic episode and their families can be used Representat in lenny above module, but with the following
adjustments and binding and h the changes outlined in this section.

SELECTION OF PATIENTS AND FAMILIES TO INCLUDE THEM IN


PSYCHOLOGICAL GROUPS AT THE FIRST PSYCHOTIC EPISODE

It would be wrong to include all, without exception, the families of patients with the first psychotic
episodes about the house in one group.
Even at the time of treatment in the clinic of the first psychotic first episodes, including when before
that had absolutely no contact with psychiatrists, families are different prepara tovlennymi to the perception of
information about the diagnosis of the disease in a family member, the prognosis of his illness, the burden
and the efforts of the family, about the possibility of recurrence, resistance to therapy and not always
bl and gopriyatnyh outcome of the disease.
In this connection, three variants of the development of the disease in patients can be distinguished,
the families of which should form three different groups for psycho-educational work with them.
1. The sudden development of the disease on the background of well-being with a pronounced
symptom sharpness of Matic (acute paranoid, affective-delusional, oneiric-catatonic attacks) without
those n Dentsu for a prolonged duration and a quick reduction of symptoms under the influence of biological
therapies, or the occurrence of Redu -skilled with acute attacks but nondegenerate and zhennoy symptoms.
In such cases, the patient himself, and his family are completely unprepared for information about cord e STI
disease, because it came against a background of overall health, often have quite successful in social
about t wearing individuals. Prior to that, the patients themselves and their families have been aimed at the
rapid completion of mod and mations, the achievement of certain social and cial position and focus on this
effort. Moreover, at this stage of submission of mental well-being, success
prednacher tannoy Seme th GOVERNMENTAL career plans are so stable that the disease appears
accidental, unwanted casus, only the result of an unfortunate situation, a response to a psycho on the injury.
Often, even the expression - a deep level - psychotic disorders are estimated tsp e contact the family as a
manifestation of personality traits, explains psychologists cal motives. The family members although there are
doubts about the gravity, the seriousness of the disease, but they have the n dency to crowding out. Often
attempt to interfere with, the proposals on the social landmark of bath care, emotional SUPPORTED ki from
the patients themselves and their families as a surprise to meet so kaz with conviction relative Short
time mennosti converse and Mosti psychosis and the impossibility at this stage representations about any
either serious social consequences. For example, one of the bol s GOVERNMENTAL, in an attempt to
spe a sheet in social work to discuss with him the difficulties that may WHO niknut In the future, the
second Shem said: "help to quickly cope with the attack, and these difficulties I somehow manage myself. "
On the other hand, the family members of cases usually are afraid that we can talk about so I zhelom
mental illness.
The inclusion of such patients or the families of such patients in general with other patients
psihoobr and tional group at the first psychotic episode, which discusses objectified e Retained diagnosis, the
possibility of frequent recurrence and the adverse pleasant social outcomes of the disease, with
rectilinear second nym transformation by PRESENT them such information would mean neobychay Noah
weighting associated with the used of the disease characterized stress, overturning all expectations and more
likely not to mobilize, the mood to fight b of disease characterized, and a sense of failure, depression, reaction
g of the convent.
Therefore, in groups with similar patients or their families isihoobrazovatelnaya program should be
carried out with PICs vanced, with no emphasis on the possible adverse prognosis. Eg on the contrary, the
emphasis should be placed on the correct interpretation of the manifestations of the attack, the inadmissibility
of weeks of assessment seriously STI diseases consequent on preventive measures, objectives and
scrupulous about STI performance of medical appointments with a view to possible complete disappearance
of symptoms, carry out the necessary maintenance therapy. In other layers contact, psychoeducation
program for these patients and their families should have nekot about rye restrictions other poles and be
aimed at emphasizing the importance of stress vulnerability and disease pathogenesis, harmonizing role of a
happy family, the values possible early onset of biological and psychosocial cial therapy to prevent
hospitalization. Of course, should be covered and discuss early Detection of Bani, etc. and signs of a possible
recurrence of the disease, questions of orientation in the system of specialized psychiatrist and cal assistance
in case of need for urgent action, but it should avoid printing neotvr and reversibility of adverse effects.
If it is impossible to form a separate group for psychoeducational specified item and cients, as well as
relatives of these patients, it is better not to include them in the overall group, and so forth on the drive with
them individually psychoeducational work that will allow both of escape for them more stressful influences.
2. The other pole are the patients and their families when the disease develops gradual n but with
children or young teens.
Speech in this case is about nevrozo- and psychopathic disorders, slowly build up th conductive
polymorphic symptomatology with catatonic inclusions emerging paranoid si n Dre. You can talk about the
following laws: the stress associated with the identification of psychosis cord e logo mental illness is greater,
the more suddenly it starts. When gradual Mr. develop it and TII experiences associated with illness of a
loved one, lose sharpness, taking other fo r us, they habituation occurs.
At the time of treatment in the clinic of the first psychotic epi Zod, despite the fact that this is the first
contact with psychiatrists, patients themselves and the families of these patients already have gradually
Naco drank n e rarely heavy enough negative experience zhiz nennyh difficulties related to unsuccessful
studies, communication with peers , deviations in behavior, relationships with parents and other chl e our
family. The family of such patients has long been dominated by stereotypical ideas about the uniqueness of
their character, actions, and behavior in general, and all family members are accustomed to that part of the
family . meni, which they carry, helping, arranging and taking care of the patient. Address to the psychiatrist in
these cases are usually associated only with the aggravation of the symptoms of tics when it is evident that
n e turndown therapeutically for the first intervention.
By this time the family is prepared to accept all associated with the disease, info r mation. Such
information only clarifies and makes her experience clear for the family, as if putting everything in its
place. Moreover, sometimes it becomes relieve th aspirants moment, simplifying relations inside with e Mga
helping to concentrate its efforts on the promotion of the treatment.
When you turn on these patients and their families in psihoobrazova to the group have to teach s Vat
following two points.
The first of these - the severity, and the presence of chronic disorders in the negative incl th Research
Institute of the patients or their families in the group with a first psychotic episode produces
deleterious so strange impression on the other members of the group, as an example of possible
n e gativnogo developments.
Second - we are in these cases there is no longer a stress response to the emergence of
Bole of either; here becomes more important that part of the educational program that is associated with a
better understanding of and eat the nature of the disease, its course, preventing Niemi exacerbations
regospital and tions, long-term therapy and ReA bilitatsionnymi activities.
In other words, taking into account these points, yet more pannym such patients and their
seeds s pits turns on and psychoeducational group for patients in advanced stage Zab about Levan.
3. psychoeducational program for the main group of patients, and also for them to e mei is built with
the following emphasis.
A. The question about the information of the patient himself and his family about the diagnosis of the
disease arises in the clinic of the first psychotic episode almost inevitably. It may be postponed due to the
need to complete the examination or prolonged observation, but at some stage of the patient ’s session the
problem of a diagnosis message arises again. Patsie called you, and their families are treated with some
natural distrust of soothing, and a certain degree fogging sere of The explanation of medical diseases,
realizing his desire to alleviate the stress associated with identified e Niemi from a loved one mental
pa with structure. When misrepresented often sick relatives themselves have expressed concerns about the
diagnosis of schizophrenia, since this diagnosis in pre d representation of the population most stigmatized. In
this regard, it raises questions about the possibility of Mr. and investigation of disease transmission sick
through parents and thus "fault" that of the district of freshmen who (or his relatives) had mental disorders,
about the possibility of STI have children, and if any - risk of getting the same disease, and on the
degree of cure, progressive course, necessarily unfavorable social outcome, and so on.
As is known, the question of openly and fully informing the patient and his relatives regarding the
diagnosis in different countries is solved in different ways. In Russia, the more cautious Noah rel about shenie
to post diagnosis on humanitarian grounds, which, in particular, is reflected in the RF Law "On psychiatric
care and guarantees of citizens' rights in its Normal display and Research Institute", which entered into force
on 1 January 1993. In Art. 11 (ch. 2) of the Act states that "the doctor is obliged to provide a person suffering
mentally ie skim disorder in up to -reach for him form and given its psy hicheskogo status information about
the nature of mental disorder, n e Lyakh, methods, including alternative , and about the duration of the
recommended treatment, as well as pain, possible risk, side effects and results and results. On the
information provided, an entry is made in the medical documentation of the mentation.
This provision of the law that determines the content of the "informing vannogo consent" for
treatment, def e fissile well as the conditions of information "in an accessible form" and "taking into account
the mental to a standing" of the patient, ie, It should be considered WHO therefore a possible reaction from
the patient (sometimes the former and is difficult and unpredictable). The same applies to the relatives of the
patient. Therefore tselesoo b Razna preference for a more cautious and relaxed forms of information
especially in otnosh e SRI diagnosis.
The same approach is typical for some other countries. For example, in Australian m on the muzzle of
psychoeducational work with the families of patients suffering first psychotic Scenes of the house (EPPIC),
recommends prefer diagnosis of "psychosis" instead of "schizophrenia" diagnosis as less traumatic and also
use the term "episode" as more reassuring and positive in terms of recovery instead of “illness.” This does not
exclude the fact that the patient’s family should receive specific answers to other questions that she poses
and which were mentioned above.
The diagnosis "schizophrenia" can have a shocking effect, while in itself is not yavl I etsya answer to
many questions asked by myself and the doctor, patients and their relationship n nicks CCA cially in the early
stages of the disease, when there is not clear its forecast. It is advisable to explain the family to
claim a patient's what this diagnosis combines different types of flow - from a single or malopristupnogo
variation n the one that ends in s zdorovle Niemi (final remission), and such a person can be very valuable
social and even decoration company (examples of such outstanding people general e stnye) - at one pole
and options really unfavorable course - on the other, as b s Vaeth and other diseases.
Therefore it is important at this stage to draw attention Related Cove on those characteristics, etc. of
the disease phenomena and condition of the patient, which could be signs of a more favorable and yatnogo
flow that gives hope and brings together in an effort to provide assistance and support for a more successful
l e cheniya.
B. Recent data on the neurocognitive deficits like a neurobiological hara to teristics schizophrenia
have opened up new perspectives in the evaluation of the first psychotic Scenes of yes. The first object of the
psychotic episode was Naras melting number of studies using neyropsiholo-cal techniques and
neuroimaging. Regardless of what is believed to NeurOK g nitivny deficit, according to various hypotheses
may occur intrauterine pa in the period of Vitia, postpartum or in adolescents vy lane and od - at least until the
manifest disease, namely a first psychotic episode turned out to be an object of study, since, firstly,
neuropsychological picture could not yet be of Menen previous pharmacotherapy, secondly, on the PSE could
have an impact to and Tel'nov the subsequent course of the disease, as well as therapeutic effects and,
thirdly, it was established and most importantly practically, it is during this period - during the first two years
(or for a somewhat longer time) there is a deepening of cognitive impairment ( and more ” toxic "disease
stage) (EPPIC), and during the subsequent period of illness ur about Wen cognitive untill sufficiency shows a
plateau, i.e. It remains ism e neny.
It should be noted that neurocognitive deficits in the modern concept of psychosis attaches so Xia
particular importance. Previously adverse social outcomes, social dezadap ting, nak of Heff, disability
associated with the so-called positive (abnormal thinking, delusions, gal w tsinatsii and so forth.), Or
particularly the negative (emotional decline, decreased activity and others.) B m ptomu, but now they are tied
with the third row of phenomena - social and cognitive deficits, largely responsible for the social
carrying a pendent patients.
As well as in the programs of the group work with patients in the advanced stage of psychosis in
events in le-oriented Paci ENTOV with a first psychotic episode, it focuses on multiphoton to the secondary
nature of psychotic disorders, biopsiho social character of their determinants. In private about STI, sets out
"diathesis-stress model" of schizophrenia, based on pre representation of personality "vulnerability" and the
role, along with the legacy of governmental, external, including the stress factors, the force to about toryh at
onset of psychosis is higher than threshold of vulnerability, as well as about diathesis, about which
phenomena can be w activity was observed examples of "advanced post-syndromes", "holes" in the form
erased, transient mental disrupt Nij, often observed in patients with a history ne p vym psychotic episode. All
this is very important for understanding the subsequent tasks of the patients themselves and their
ro d stvennikov.
Manifested in patients lack the ability to emo tional and verbal with a movyrazheniyu, adequate
assessment of the situation and modeling of the corresponding dressing e Denia,
whom munikativnaya inefficiency, reduced ability to sotsi cial learning disability - all these arguments in
psychoeducation for the early (after the disappearance of acute si m ptomatiki under the influence of
biological therapy), the use of psychosocial Hoc group work, along with the continuation of
psihofar makoterapii. The Group as of artificially created and protected by a sick environment provides a
positive emotional experience is safe and effect in personal contacts.
Therefore, even apart from the fact that in conducting group sessions used psihoobr and tional
equipment, the participation in the group - psychosocial therapy, direction n naya to overcome the various
aspects of the social and cognitive deficits described above. With regard to psychoeducation, it is critical for
patients with the first crazy about tiche skim episode, as well as for their relatives, for the first time
meet schihsya with problems associated with mental illness, si with the theme of assistance to such patients,
methods of their leche Niya, the need build a family of t wearing a psihotiche skim the patient and become the
first direct object stigmatizirova n representations of mental Zab about Levani s existing in society.
B. The emergence of psychosis - usually heavy Psychologic sky stress for the patient. One as to
when symptoms when stupa disease detects fast under the influence of therapy tends to Obra t Development
Organization, the patient is not always osozna is the seriousness of the situation. It can explain itself to
psychological causes disease symptoms, response to external factors, overwork, n e rezhivaniyami,
linked mi troubles, sometimes in a suitable culture medium - "SGL and Zoom", "guided spoilage." Hence - the
lack of assessment of the disease and as a result - easy otnosh e of a doctor's appointment, mankirovanie
necessity of taking the drugs quickly, before e temporary discontinuation of treatment despite
recom doctor mendations,
Awareness of patient severity of the disease can come in SLE teas longer duration
Mans and festnogo attack, his lingering of course. Additional traumatic circumstances mi yavl I are not only
came a clearer understanding of what he is mentally ill (understanding floor of the second can be from the
beginning of the disease), but still a depressing realization accumulating camping at continuing m Xia course
of the disease varies in different social patients and cial difficulties and losses and missed
WHO possibility (necessity of registration of Academic and Cesky vacation during prolonged absences for a
student in high school and, it should be consistently loss of the year, the gap with a girl from a hiding that he
used on linen, violation of production plans and career expectations, tension in the family due to the
n th relozheniya his duties on other family members, material damages). In some cases when
n e favorable ton nom flow and resistance to therapy join problems changing social roles, social status - the
transition from the guideline on the role of a ward in the family, forcing Mr. Nye change of profession, deferred
indefinitely or crashing Chiyah standby and Denmark or dimmed prospects. In some cases, these changes do
not occur in the period n, p Vågå, and after a second or even third attack that is important to consider when
implementing psychosocial and cial etc. of grams.
All these and other frustrating, aggravating circumstance ARISING accompanying prospect
for and stupa at least locat dyaschiesya in the doctor's attention, largely yavl I are important for psychosocial
work with the patient and his sotsi cial environment.
Family's reaction, as the patient, the emergence of his mental illness that to the same ambiguity can
be Noah. Much less the family did not immediately evaluate the severity of the disease and treats it as a
transient episode, without an understanding of important social opportunities after Dr. consequence, although
usually in these cases there are fears that the loved one will turn into a pc and hicheski patient. Most often,
one to, the occurrence of mental disorders and the diagnosis of mental f Family disease is perceived by
family members as a personal tragedy. In some cases these situations is preceded by a long phase where
family members reveal a lack of understanding the pain of making changes in the behavior, utterances and
actions of his son, a daughter, a friend of the first family member. They are interpreted as a bad influence of
peers, the company, which turned out to be the next patient, willfulness, upors t tion, manifestations of bad
character, and so on. All this can lead to the emergence vnutris e maine conflicts, grievances, the split in the
family situations that for a long time in the future can be objectified e lyat vnutrisemey ny climate. This may be
a prerequisite to establish intra style of t Wearing accompanied by excessive expression of emotions, which is
objectified e it possible in a subsequent pain Shui frequency y n a patient's repeated exacerbations and
regospitalizatsy.
One of the consequences of stress experienced by the family in connection with the emergence of
mental on the first disease in a loved one can be a desire to hide it from others, not only from the
receptacle and komyh, but also from other relatives, from all; such "closed" survived and Nij this family injury
usually leads to isolation of the patient and his family, and in turn is generated a further straight on Bloem.
This is partly due to the “stigma”, the widespread opinion in the population about the
compromise and diminishing nature of the presence of mental disorders. As well as the AUC previ- in respect
of PAC and cient, with a protracted course of attack and resistance to therapy of its manifestations, family
stress mustache in gublyaetsya in case of unfavorable storage s vayuscheysya situation with worsening
disease, social difficulties and the loss of "the destruction of family expectations and hopes, the need to
change much in the operation with e Mga in structure of family relationships, responsibilities of family
members.
G. Educational program focused on patients and their families associated with the first psychotic
episode should include exercises aimed at understanding req gence in of possible early detection and,
therefore, the beginning of the treatment of the first psychotic episode. This is due, as already mentioned, with
an established fact "zlokach e stvennosti" is the first years of manifest symptoms of the disease. In addition,
this is important since found that the earlier n and Chin pharmacotherapy for the more favorable and social
outcome. Skaza n Noe regard, in addition to biological therapy, and also psychosocial treatment that for the
first ps and hoticheskogo episode is particularly significant not only due to the disease itself, but also due to
Survive and Vai slaughtering lefties and family stress due to the establishment of the first mental
pa with stroystva.
Psychoeducational sessions within a single program, with a specific lesson plan, of course, at the
same time should take into account the need to discuss the individual s GOVERNMENTAL problems
associated with a particular response of the patient or his relatives in s penetration of the disease. Leading
group nN knowing or getting to know in advance to each of the band members, and taking into account the
differences in their positions, the relationship to the disease and the response to it must build a class in a way
that is not about the first tee by any of these problems. It is necessary to avoid a situation where after the end
of the session, one or more members find that the prospect of grams went past important questions for them.
This is important even during group work, but it is especially important for patients and their families, For the
first stems facing the problems of mental illness, as they not only do not have a receptacle and Nij in this
area, but also some experience, and themselves often can not correctly sorienti Rowan, losing tons
of camping, etc. e bark error. Such errors are often length Tel'nov complicate relations with patients generate
conflicts in the family, are not conducive to recovery.
The patient himself and his family need emotional support. This is largely due to the lack of
participation, untill cient information, the need for changes, etc. and nyatyh family stereotypes. Important to
talk with your family, WHO possibility for its members to talk, discuss with your doctor all
under robnosti situation, different approaches have a ton fittings for family members to develop a common
and close assessment and strategy to determine the need for and the possibility of providing tools n tal
assistance from the social Started t nickname. The group format of work is desirable not only with the patient,
but also with families - the group becomes a source of information and support, especially with e fact that
when a family Zab about Levan prone to self-isolation.
We note a number of provisions, which under certain conditions can have adverse claim about the
investigation and the need in the discussion Research Institute.
1. Underestimating the severity of the disease. Effects:
 late request for medical care;
 treatment of at least part of the manifestations of disease as character traits, nep of hearing
dur Nogo influence etc .;
 in this regard, the use of "disciplinary measures", the loss of contact with loved ones, confit to you;
 underestimation of the importance of treatment, the selective reception pre Paraty early termination
contrary to BP and chebnym appointed treatment Niyama, the possibility of recurrence of symptoms and tics;
 In these cases, understanding the pain of making measurable currently logged behavior helps
in s to take the correct way tic attitude toward ill: Avoid rectilinear Nogo counter, OSPAR and Niya, threats of
punishment. You must - participate, switching attempts, Spock ny tone, support medical and Qing assistance,
etc .;
 the different attitudes of family members (father and mother, husband and rhodium Teli, etc.) to the
evaluation of improper dressing is, Denia and other manifestations of the disease in general; an important
aspect that needs to work towards Garm on nization relations, in case of failure - to support a family member,
etc. and correctly appraising of situation;
 installation on the seriousness of the disease without pedaling possible unwholesome
problems of pleasant Techa Niya, the outcome, the social consequences.
2. Excessive tragedizatsiya of the disease (by the patient himself / close relatives), for d move to the disease
from the standpoint of "stigma". Effects:
 hasty decisions with the social consequences of s (about the design decision akademich e Skogen
holidays, the rejection of some or other plans in life, divorce, spouse, and so on.);
 demoralization instead mobilizing activity in organi medical care tion and L e chenii;
 summing up in the family a pessimistic assessment of treatment and outcome
 depriving a person of emotional support;
 underestimation of the systemic pharmacotherapy and psychosocial socially treatment.
3. Underestimation of the significance of social losses, including the tendency for a protracted course
and resistance to therapy. Effects:
 loss of educational opportunities in the relevant age period. Neo b walk balanced approach to the
design of sabbatical - the absence of other in s possibility, the harm this decision as "let him rest a year or
two", the ease in making a decision on the refusal of the Examination and onnoy session from increasing on
the work of scheduled Mr. GOVERNMENTAL career plans ; the need to consider the fact that the better
preserved social achievements, the more likely there is a social re easier and bilitatsiya.
4. Coping with psychosocial stress in the patient and his family - one of Central s ing problems of
psychosocial education program.
This is usually done through a stage of "acceptance of the disease" (though not always to produce
at L Foot for her performance), to work towards its de-stigmatization, rationalization otno sheniya and making
social decisions, save harmonic -border cooperation in the family, mobilization, etc. ie overcoming difficulties
reasonable relationship to the occasional req gence n the changing role and the patient's family and in
society.
5. The first psychotic episode sometimes arise about the problems connected with the needs of Stu
involuntary hospitals tion (although reportedly up to 60 percent of PAC and ENTOV may be assisted
outpatient or day hospital) with passage wo t sponds LEGAL POSITION cal procedures . Relatives need to
know about the purpose ie according STI organization involuntary hospitalization so that the patient had a
clear idea that this prini maetdecision doctor, not anyone from the parent and Cove; otherwise, the patient
often cannot forgive a close person for the fact that he was the one who placed him in a psychiatric hospital.
It does not attempt the task of enumerating all the problems that may arise in connection with the
n, p vym psychotic episode; they can be diverse, we need only note that the mod and the call -
inflammatory program should take them into account at some point or another ce implementation.
All of the above is only a supplement to the psychoeducational module, which utilizes e nyaetsya
when dealing with pain GOVERNMENTAL psychosis (schizophrenia) to indicate accents and problems that
have occurred at the beginning of the disease. As to the partitions 11 psychoeducational m of modulus, that
are mainly used are those which relate also to the top of the disease - ne p vomu (first) psychotic
episode. "Looking to the future" after the recovery (remission) on the x wa Tuva mainly preventive measures,
including with respect to relapse prevention.

EFFICIENCY OF USING THE METHOD

In the course of a psychoeducational program was attended by 85 people (76 patients and 9
Rhodes t Vennikov) or 10 groups (8 groups of patients with chronic disease, 1 group
Paci ENTOV n e renesshih first psychotic episode, and 1 group of their relatives).
Evaluating the effectiveness of a psychoeducational program was carried out using a specially
designed questionnaire (see. Annex), based on self-reporting and reflecting uro Wen knowledge about mental
illness, forms and services Pomo soup are available for patients with th May, as well as the level of
confidence in the definition of morbid behavior , signs of acute and difficult to overcome on stey related to
mental Zabolev Niemi.
Comparison of baseline assessments at the beginning of training and evaluation at the end of training
cycle showed significant improvement as a result of training on self-esteem, awareness and Art e penalties
confidence.
During the training, as patients and their families, learn to recognize the painful per e zhivaniya early
in their cart penetration, to distinguish between painful and healthy proya in leniyami psyche begin to abide by
the terms visit and seek the Medici n tion help at the first signs aggravations.
Psychoeducation not only increases the amount of knowledge, Wuxi Lebanon confidence in dealing
with b about disease characterized, but also attains gayutsya and indirect program objectives: improving
opportunities in sph e re confident behavior and samopredyavleniya, communication skills, and n and vyki
everyday life, strategy time solving problems It increases the level of social competent Nost. Equally
receptacle and chenie is the fact that one and the same information can cause resistance when leche comes
from a conductive doctor or master group, but more easily taken apart for the interactive training;
uch as ticipants can teach Xia something from each other, not only by the therapist. No less
zna chimym RESULT and that the program is that it helps to create more social network subtree g ki.
In addition, the group methods have several advantages over both individual organisms and Zion and
in terapevtiche skom plan. They are more economical, since the same amount of time is through a large
number of patients, and thus sat e Regal personnel resources.
Thus, the use psychoeducational under progress enhances Qual e -OPERATION psychiatric and
psi hosotsialnoy care for patients and their families and is the needs and by direct component of the
rehabilitative process psi hiatricheskoy practice.

ANNEX 1
MAP OF KNOWLEDGE ASSESSMENT ABOUT MENTAL ILLNESS
AND EFFICIENCY OF THE PSYCHOLOGICAL PROGRAM
FULL
NAME. __________________________________________________________________________
__
Year of birth ______________________________________________________________________
Research Date __________________________________________________________________

Rate in points the degree of need for the following information. If you hesitate to e Tes between
answers 1 and 3, then select Reply 2. If you hesitate between the responses of 3 and 5, then select the
answer 4.
1. Do you view other people with mental disorders are known (their ro d stvennikov), about
mental illness?
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
2. Would you like to communicate with people who have (their relatives) have mental
pa with stroystva?
not not sure Yes
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
3. Are you willing to discuss with other members of the group used their own
experience of existing illness (illness of a relative experience)?
not not sure Yes
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
4. Do you want to discuss other people's experiences regarding mental disorders?
not not sure Yes
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
5. How would you assess your knowledge of what is the cause of our (your kinship n nick)
disease that causes the disease?
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
6. How would you rate your knowledge of your (your relative) mental ill and Research
Institute?
A. About the symptoms of the disease
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
B. About the course of the disease
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
B. About the forecast
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
7. How do you assess your knowledge of the manifestations / symptoms of an exacerbation?
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
8. How do you assess your knowledge of the techniques / methods / warning or smya
opportunities g cheniya exacerbation of symptoms?
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
9. Do you know how to behave during exacerbation of the disease?
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
10. Do you have knowledge about the treatment of mental disorders?
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
11. Do you have any knowledge about the possible side effects of drugs?
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
12. Do you have knowledge of your own role in the treatment process?
not not sure Yes
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
13. Can you identify painful behavior and other symptoms of the disease?
not not sure Yes
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
14. Do you have the knowledge to overcome the difficulties related to your (your
Rhodes t Vanik) disease?
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
15. How do you assess your knowledge of services and forms of assistance in mental
Zabol e Vania?
nothing know but I know
I do not know Insufficient hours but d about enough
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five
16. Do you wish to receive additional information about services and forms of assistance in
psycho and Český disease?
not not sure Yes
1 ------------- 2 ------------- 3 ------------- 4 ------- ------ five

APPENDIX 2
BRIEF THEMATIC CONTENT OF THE PSYCHO-FORMATIVE ABOUT GRAM

Lesson 1. Acquaintance.
Goals, objectives of the psycho-educational program. Presentation of participants. Inform a tion of
how classes will be conducted (online training). Familiarization with the preliminary s nym
pla nom classes. Filling out the questionnaire. Adoption of the rules of the group.
Lesson 2. Causes, course, prognosis of mental disorders.
The adoption of the final plan on the basis of filled in the previous lesson TRE with
a nickname. Causes of mental disorders (diathesis-stress-vulnerability model). Circulated n NOSTA mental
diseases. Current and forecast.
Classes 3. Mood disorders: depression, mania.
The main symptoms, their recognition. A comparison of the description of these symptoms with
whether hours nym experiences of participants. Discussion of experience to overcome this symptom (Nawa-ki
sovlad and Nia). Behavior control.
Lesson 4-5. Hallucinations, disturbed thinking and delirium.
General brief description of painful symptoms. Learning to recognize at a b manes perceptions
(voices), delusions, hallucinatory and delusional behavior. Test and tion bolez nennyh phenomena of
reality. Training methods of self-control symptoms of so drive from painful experiences, is
distancing Bani from them coping skills. Formation of motivation for recognizing and of exacerbations of
painful disorders to make its e temporary adjustments to the treatment, control for preserving
great rect behavior and thereby preventing e Nia hospitalization.
Classes 6-7. Pharmacotherapy.
The role of drug therapy in relieving symptoms, preventing their recurrence and preventing repeated
and frequent hospital admissions. The value of compliance, forms and of the motivation for drug regime
compliance. Information about the different classes l e for pharmaceuticals drugs used in psychiatry, route of
administration, purpose l e cheniya. Neuroleptics. Antidepressants. Tranquilizers. Mood stabilizers.
Nootropics Corre to tori. Side effects and ways to overcome them. Monitoring the effectiveness of
pharmacotherapy and n of the side-effects. Stimulation of the activity of patients by discussing personal
experience ESTATE t nicknames about the relationship between drug intake and improvement. Justification
of long-term maintenance treatment, psychosocial of Hoc ter and FDI.
Session 8. Incorrect behavior due to illness. Detection Methods si m ptomu and control over
them.
Teaching patients to observe themselves and the ability to celebrate the onset of exacerbations.
C of soby overcome persistent sim ptomu (coping skills) and disease control. Sick and family (conflict
resolution, attitude to wrong behavior). Necessity of b rashchenija a physician when identified SRI initial signs
of acute-compensation for possible tion drug therapy and prevention of hospitalization. Techniques of self-
observation and self aboutimproper behavior control Niya. Formation of responsibility for socially acceptable
behavior, the need to comply with the daily social programs requirements. Self-control in order to prevent
frequent repeated PRESSOL Schmiergeräte GmbH Tel and tion of conservation and social and cial position
of the patient and his family.
Session 9. Stigma.
The concept of "stigma". Ways to overcome the difficulties of life as a result of stigma, St. I bound
with mental illness and disability. Self-stigmatization of patients and their ro d stvennikov (low self-esteem, a
diminished level of claims, the underestimation of their rights). H e gativnye myths about mental
illness. Positive examples of stigma psi hicheskogo disease.
Lesson 10. Final.
Description of the various forms of aid: institutions providing conductive psychiatric care and
p e depleting urgent about Bloem, public organizations, social services and other resources of
the society. Addresses and phone numbers of local public organizations, support groups. Social and legal
issues. The need to continue participation in groups supporting psychosocial therapy.

APPENDIX 3
LIST OF RECOMMENDED LITERATURES

1. Vulis R. If your loved one suffers from mental illness. A guide for family members, friends and
social workers. Per. from English - M .: “Knowledge”, 1998. - 192 p.
2. Carling P.D. Return to the community. Per. from English - Kiev: “Sphere”, 2001. - 418 p.
3. R. Carter Helping people suffering from mental slaughtering Levan. Per. from English - K and EV:
“Sphere”, 2000. - 399 p.
4. Cuppers L., Leff J., Lam D. Schizophrenia. Working with family in E: A Practical User
guide for dstvo. Per. from English - Amsterdam-Kiev, 1996.-128 p.
5. International norms and standards relating to the problems of persons with disabilities. Overview. -
M .: VOI, 2000. - 151 p.
6. Townsend M.S. Nursing diagnosis in psychiatric practice: Pocket Guide for n on It turned structure
plan Nia care to patients. Per. from English - And m Sterdam-Kiev, 1996. - 427 p.
7. Hell D., Fisher-Felten M. Schizophrenia. Basics of understanding. Assistance in
orient and roving . Per. with him. - M .: Aletheia, 1998. - 197 p.

LITERATURE
1. Semenova ND, Salnikova L.I. The problem of education of the mentally ill // Social and classical
psychiatry. - 1998. - V. 8, № 4. - p. 30-39.
2. A. The Barbato, D'Avanzo B. interventions in the Family schizophre nia and related disorders: a
critical review of clinical trials // Acta Psychiatr. Scand. - 2000. - Vol. 102. - P. 81-97.
3. Buchkremer G., Klinberg S., Ho! Le R. et al. Psychoeducational psychotherapy for schiz o phrenic
patients 2: 1 year follow-up // Acta Ps y chiatr. Scand. - 1997. - Vol. 96. - P. 483-491.
4. BustilloJ.R, LaurielloJ, Horan WP, Keith SJ of The I of the psychosocial reatment of
schiz.. O phrenia: the update of An // Am. J. Psychiatry. - 2001. - Vol. 158, N 2. - P. 163-175.
5. Dixon L., Lehman AF Family interventions for schizophrenia // Schizophr. Bull. - 1995. - Vol. 21, N
4. - p. 631-643.
6. Dixon L., Adams C, Lucksted A. Update on family psychoeducation for schizophrenia //
Schizophr. Bull. - 2000. - Vol. 26, N1. -P. 5-20.
7. Psychosocial Strategies MJ goldstein for Maximizing the effects of psychotropic medications for
schiz o phrenia and mood disorder // Psychopharmacol. Bull. - 1992. - Vol. 28 N 3. -I '. 237-240.
8. Herz MI, Lamberti JS, Mintz J. et al. A program for schizophrenia. Co A n trolled study //
Arch. Gen. Psychiatry. - 2000. - Vol. 57. - p. 277-283.
9. GA Hinrichsen, The JA Lieberman and the Family Attributions cop ing in the In game Prediction of
em o tional adjustment in family members of Patients with first-episode schizophrenia // Acta of
Ps y chiatr. Scand. - 1999. - Vol. 100. - p. 359-366.
10. Lam DH Psychosocial family intervention in schizophrenia: a review of empirical studies //
Ps y chol. Med. - 1991. - Vol. 21. - P. 423-441.
11. Leff J., Kuipers L., Berkowitz R. et al. Controlled trial of A social intervention in the fam i lies of
schizophrenic patients // Br. J. Psychiatry. - 1982. - Vol. 141. - P. 121-134.
12. Merinder LB Patient education in schizophrenia: a review // Acta Psychiatr. Scand. - 2000. -
Vol. 102. - p. 98-106.
13. Miller T. Group sociotherapy: A psychoeducational model for schizophrenic patients and their
families // Perspectives in Psychiatric Care. - 1989. - Vol. XXV, N 1. - p. 5-12.
14. Perm DL, Mueser KT Research update on psychosocial treatment of schizophrenia // Am. J.
Ps y chiatry. - 1996. - 153. - p. 607-617.
15. 1. Psychoeducation in early psychosis / M. Mooney, St. Haines (Eds.); Manual 2. Working with
families in early psychosis. - Prevention and Early Intervention Psychosis Ce n tre
(EPPIC), Melbourne , Australia .
16. L. Tennajcoon, D. The Fannon, Doku V. The Experience of caregiving of: Relatives of people
Experiencing a first ep i sode of Psychosis // Br. J. Psychiatry. - 2000. - Vol. 177. - p. 529-533.
17. G. The Thornicroft, E. Susser by Evidence-based Psychotherapeutic interventions in the
comm u nity care of schizophrenia (Editorial) // Br. J. Psychiatry. - 2001. - Vol. 178. - P. 2-4.
18. J. Psychoeducational program Walsh evaluation: one practi cal method // Journal of Ps y chosocial
Nursing and Mental Health Services. - 1987. - Vol. 25. - p. 25-31.
19. Zhang M., Wang M., Li J., Phillips MR Randomized-Schisophrenic Patients. An 18-month study
in Suzhou , Jiangsu // Br. J. Ps y chiatry. - 1994. - Vol. 165, Suppl. 24. - p. 96-102.

one
The project - 07/11/2013. Discussion on the website P USSIAN About bschestva P sihiatrov - psychiatr. ru

FGBU "Moscow Research Institute of Psychiatry" of the Ministry of Health of the


Russian Federation

PROJECT

FEDERAL CLINICAL RECOMMENDATIONS


FOR THE DIAGNOSTICS AND TREATMENT OF MENTAL
REMEDIATION IN ADULTS
October 2013
Table of contents
one. GENERAL PROVISIONS

1.1 Relevance and purpose

1.2 Methodology (levels of evidence)

2. DEFINITION, PRINCIPLES OF DIAGNOSIS OF MENTAL DEVELOPMENT IN ADULTS

2.1 Diagnosis of mental retardation in adults

2.2. Differential diagnosis of mental retardation in adults

2.3. Psychological (pathopsychological) study

2.4.The degree of mental retardation

2.5. Complicated forms of mental retardation

3. TREATMENT

3.1 Lemma chenie mentally retarded patients with mild behavioral problems.

3.2 Treatment of mentally retarded patients with significant behavioral disorders

3.3 Selection of treatment regimen (indications for inpatient treatment)

4. PSYCHOSOCIAL TREATMENT AND PSYCHOSOCIAL REHABILITATION OF ADULT


PATIENTS WITH MENTAL RETARDATION
1. GENERAL PROVISIONS

The clinical guidelines define the basic rules for the management of mentally
retarded adult patients at successive stages of the provision of mental health care in
accordance with the requirements of evidence-based medicine. Recommended are
those methods and preparations that have convincing evidence of advantages in safety
and efficacy over others.

Mental retardation is a disease for which help cannot and should not be limited
to biological therapy. It should include psychosocial therapy and psychosocial
rehabilitation, psychotherapy, clinical and social activities and the use of various
organizational forms of care. This is consistent with the current provisions of the
brigade approach in working with patients and approaching the provision of assistance
to community-oriented psychiatry.

1.1 Relevance and purpose

The relevance of the development of clinical guidelines is explained by the


following principles:

 medico-social and economic burden of mental retardation in


adults ;
 differences in the quality and organization of psychiatric care in
different regions of the country and individual health care facilities;
 different levels of training of medical and social workers;
 insufficient awareness of psychiatrists about the results of clinical
studies and recommendations on the use of certain psychotropic drugs;
 significant differences between recommended and real (everyday)
practice of diagnosis and treatment of patients;
 low level of legal protection for consumers of psychiatric care
(patients and their families);
 limited funding for mental health services.
The purpose of these recommendations is to improve the quality of care
services for adults with mental retardation in specialized medical and preventive
institutions, while ensuring the appropriate level of mental health care.
This publication is restricted lighting aid adults with mental retardation (F 70 -
F 79 ICD-10).

1.2 Methodology ( on par with evidence)

The recommendations are equipped with a four-level system of evaluation of


evidence, according to the hierarchy of reliability of scientific data (it should be borne
in mind that a low level of evidence is not always evidence of unreliability of data):

Rating scheme for assessing the strength of recommendations (Table 1) :

Strength Description

A The evidence is convincing: there is strong evidence for


the proposed statement, which is obtained on the basis of one
well- planned, or several randomized clinical trials (RCTs) or
a large systematic review ( meta-analysis ) of RCTs.
B Relative credibility of evidence: there is enough
evidence to recommend this assumption. Evidence obtained
on the basis of at least one controlled study or systematic
review of cohort studies or trials.

C There is no sufficient evidence: the available evidence is


not enough to make a recommendation, but recommendations
may be given in the light of other circumstances. The
evidence was obtained on the basis of cohort studies or
descriptions of a series of clinical observations (cases) or are
agreed expert opinion or a consequence of common clinical
experience (practice).

D There is enough negative evidence: there is enough


evidence to recommend not using this drug or treatment
method in a particular situation.

The prevalence of mental retardation among different age groups of the


population is significantly different, which is explained by the great importance of the
criterion of social adaptation in the diagnosis. The maximum values of this indicator
fall on the age of 10–19 years, that is, the age at which society places the highest
demands on the level of cognitive abilities of the population (universal school
education, conscription for army service, etc.).
The prevalence of mental retardation in the world, according to official medical
reports, varies widely: from 3.04 to 24.6 and higher per thousand of population. This
is largely due to the lack of unified diagnostic criteria.

2. DEFINITION, PRINCIPLES OF DIAGNOSIS OF MENTAL


DEVELOPMENT IN ADULTS

Mental retardation - group heterogeneous state nd caused's innate or early


acquired hypoplasia with severe mental intelligence failure zatrudnyayusch it or
making it impossible to fully adequate social functioning of the individual.
Primarily in mstvennaya of tstalost characterized by impaired abilities that arise
in the development process, and skills that determine the overall level of intelligence
(ie, cognitive abilities, language, motor skills, social s ability s).
A variety of pathogenic factors and nonspecificity of mental retardation make it
difficult to assess cause-effect relationships in the origin of mental retardation. In most
cases, environmental and endogenous (hereditary) factors appear in a complex
interaction and unity. However, there are also pathogenetic links common to all forms
of intellectual hypoplasia, leading to similar clinical manifestations of mental
retardation syndrome.
With mental retardation, which is a polymorphic group of pathological states,
there is a large variety of clinical and psychopathological disorders. Clinically
differentiated and clinically undifferentiated forms of mental retardation are
distinguished.
The group of clinically differentiated mental retardation includes nosologically
independent diseases with a specific clinical, psychopathological and
somatoneurological picture, for which mental underdevelopment is one of the
symptoms, as a rule, the most severe. More often, these are genetically determined
disorders, or clinically defined syndromes with characteristic somatoneurological
manifestations, the etiology of which is not yet clear.

Classification of differentiated forms of mental retardation (table 2):

Differentiated forms of mental retardation

Hereditary forms 1. Sindro we with multiple congenital anomalies:


- Chromosomal diseases
-Genetic syndromes with unclear type of inheritance
- Monogenically inherited syndromes
2. Hereditary defects of exchange
3. Fakamatozy
4. Neurological and neuromuscular diseases with mental
retardation
Mental retardation 1. Mimkrotsefaliya
of mixed 2. Hydrocephalus
(hereditary- 3. Craniostenosis
exogenous) nature 4. Congenital hypothyroidism

Exogenously 1. Alcoholic fetopathy


conditioned forms 2. Infectious embryopathy
of mental
retardation
For clinically undifferentiated forms of mental retardation include violations in
which the etiology of the disease can not be accurately determined, while the specific
clinical, psychopathological and somatoneurological picture of the disease are absent.

2.1 Diagnosis of mental retardation in adults

The diagnosis of mental retardation is purely clinical and is made on the basis
of complaints, anamnestic data, clinical and psychopathological examinations ,
including external examination , as well as genetic research , pathopsychological and
instrumental methods , in the absence of unified diagnostic criteria.
The most important factor in diagnosis is the collection of anamnesis , which
indicates the possible causes, the time of occurrence of the disease, the duration of the
existing complicating symptoms, the presence of such disorders in the blood relatives
of the patient.
In the diagnosis of mental retardation is, adults should not be limited to the
finding of a general mental underdevelopment in children, because intelligence is not
a single characteristic, and is evaluated on the basis of a large number of different
more or less specific skills. Although each person has a general tendency to develop
all these skills at a similar level, there may be significant differences, especially
among mentally retarded persons. Such people can detect severe violations of mental
retardation, they can show higher productivity in one particular area (for example, by
simple visual-spatial tasks). This situation makes it difficult to diagnose mentally
retarded persons. The definition of the intellectual level should be based on all
available information, including clinical data, adaptive behavior (taking into account
cultural characteristics) and productivity by psychometric tests.
For a reliable diagnosis, a low level of intellectual functioning should be
established , leading to a lack of ability to adapt to the daily needs of a normal social
environment based on an overall assessment of abilities, and not on an assessment of
any particular field or one type of skills. Concomitant mental or somatic disorders
have a great influence on the clinical picture and the use of existing skills.
Scales of social maturity and adaptation, also standardized according to local
conditions, should, where possible, be filled on the basis of questioning parents or
caregivers who know the abilities of the individual in everyday life. If standardized
procedures are not followed, the diagnosis should be established only as temporary.

Algorithm for the diagnosis of mental retardation (Figure 1):


When formulating an exhaustive diagnosis of mental retardation, it is
necessary to evaluate:

 the severity of the intellectual defect and its features;

 clinical and psychopathological characteristics of the structure of


the defect;

 the presence of comorbid disorders;

 etiological factors;

 degree of adaptation in the environment;

 socio-psychological factors.
Factors affecting the development and manifestations of mental retardation. Etiological factors
(table 3 ).

Factors Description

Internal factors. 1. Genetic factors


2. Gender (men suffer more often)
3. Intrauterine infections
4. Intrauterine hypoxia
5. Immunological incompatibility of blood of
mother and fetus

Environmental 1. Use of certain drugs by the mother during


factors pregnancy
2. Severe birth and postpartum injuries
3. Severe somatic diseases (with intoxication,
dystrophy)

Clinical signs that increase the likelihood of a diagnosis of mental


retardation:

 mental underdevelopment of varying severity;


 the total nature of the underdevelopment, concerning not only the
intellectual activity and personality of the patient, but the whole psyche
as a whole;
 signs of underdevelopment are found not only from the side of thinking,
but also from other mental functions - perception, memory, attention,
emotional-volitional sphere, etc .;
 insufficiency of higher forms of cognitive activity - generalization and
abstraction. The weakness of abstract thinking is also reflected in the
features of perception, attention, memory;
 social disadaptation patients. The maximum values of this indicator fall
on the age of 10–19 years, that is, the age at which society places the
highest demands on the level of cognitive abilities of the population
(universal school education, conscription for army service, etc.).

Clinical signs that reduce the likelihood of a diagnosis of mental


retardation:

 mikrosotsialno-pedagogical neglect;
 deprivation at an early age;
 comorbid symptoms;
 the delay in the formation of local cortical functions;
 pronounced symptomatic polymorphism;
 an indication in the history of the absence of delayed psychomotor or
speech development.
 instruction in history is, in the organic brain damage after 3 years.

Initial examination:
Diagnosis is based on the presence of characteristic symptoms and signs in the
absence of alternative explanations for their occurrence . Essential is an accurate
assessment of the clinical picture.

Diagnostic study includes:

 psychiatric study consisting of an objective history obtained as a result


of questioning relatives or persons who know the patient’s character and
ability in everyday life , analysis of medical records, subjective history (if
obtaining information is possible due to the patient’s cognitive abilities);
 conducting clinical (psychopathological), physical , instrumental and
functional methods of research, attracting doctors-consultants of other
specialties (neurologist, therapist, ophthalmologist, etc.);
 experimental psychological (pathopsychological) research, consisting of
various techniques, the choice of which depends on the objectives of the
study and the questions posed to the psychologist doctor.

Objective history includes:


- information about the hereditary burden of mental illness, including
information about whether the parents of the patient are blood relatives;
- obstetric and gynecological history of the mother, her state of health before
pregnancy and during pregnancy ( cardiovascular disease, etc.), information on
pathogenic biological effects in the period of prenatal and perinatal
development of the patient, past diseases;
- data on the early psychomotor development of the patient, features of speech
formation, school skills, patient's personality, family and social status, post-
natal exogenous hazards, features of the psycho-emotional response, mental
trauma;
- data on the peculiarities of the mental state and patient's behavior in adulthood,
self-service skills, level of social adaptation (the ability to establish and
maintain productive contact with other people, to build their behavior taking
into account existing moral, ethical and cultural traditions, in full or with
limitations to cope with their social responsibilities, the presence of related
anomalous psychosocial situations).
The source of relevant information is the characteristics from the place of study
or work (if the patient is studying or working ) .

Subjective history:
With the help of the inquiry, a subjective history is collected (if the level of the
patient’s mental development allows) and clinical facts are identified that determine
the patient’s mental state.
The questioning should be conducted in an atmosphere of trust and ease, as
much as possible excluding outside intervention and any other distractions. The
questions asked should be as concise, simple, unambiguous and understandable to the
patient as possible. Given the increased suggestibility of mentally retarded persons, it
is necessary to abandon suggestive (suggestive) questions. Anamnestic information is
collected, as a rule, from the past to the present.

Clinical (psychopathological) studies e:


During the conversation with the patient are identified:
- the formation of spatial-temporal representations - the degree of orientation in
the environment, in time;
- the level of speech development, including the ability to maintain speech
contact with time , to give coherent and consistent anamnestic information, to
understand complex logical and grammatical constructions;
- the formation of mental operations (analysis, synthesis, the establishment of
cause-effect relationships);
- the level of knowledge about the world, the degree of orientation in matters of
hostel surrounding the patient society;
- especially the need-motivational sphere;
- features of memory, attention, performance;
- features of emotional manifestations; -
- concomitant mental and neuropsychiatric disorders that are present at the time
of the survey;
The clinical study ends with the systematization of the identified phenomena,
their psychopathological qualifications for a holistic analysis, correlation with the
accepted criteria of syndromological and nosological diagnostics.

Physical examination :
A general examination of the body includes : the identification of stigma of
intrauterine dysgenesis, the identification of traces of various injuries, a study of the
condition of the organs and systems and the presence of somatic diseases in history.
Neurological research determined : p asstroystva functions cranial Nervo in
reflexes and their changes, extrapyramidal disorders, cerebellar pathology, and
disorders of coordination of movements, sensitivity and its disorders, disorders of the
functions of the autonomic nervous system.

Functional research methods:


Instrumental research methods are aimed at the possible establishment of a
nosological diagnosis in case of mental retardation, as well as verification of the
nature of the organic lesion of the CNS ( electroencephalographic ,
rheoencephalographic , echoencephalographic , magnetic resonance imaging of the
nervous system and brain).

2.2. Differential diagnosis of retinal retardation in adults

Conducted with the following diseases and conditions:

- W isofrenia with oligophrenia-like defect ..

- Organic dementia .

- Epilepsy with decreased intelligence.

2.3. Psychological (pathopsychological) study

Experimental psychological research should be focused on the analysis of the


patient's cognitive activity, including:
- assessment of the level of intellectual development;
- a characteristic of the structure of intellectual activity with the identification of
the most and least formed of its functional formations;
- the characteristic of the general prerequisites for the productivity of intellectual
activity (mental performance, attention, memory).
High diagnostic significance of the Wechsler test in this type of diagnostic
examination confirmed by many studies it dry When all the diagnostic value of
psychometric studies should take into account a certain volatility of intelligence
quotient ( the IQ ), its sensitivity to changes in the environment, as well as depending
on the cultural and social factors, in connection with the than the analysis of
experimental data should be carried out in the context of a holistic assessment of the
mental activity of the subject. P atopsihologichesky method aimed at qualitative
analysis of violations of intellectual activity can not exist without a quantitative
assessment of the level of development of intelligence. The main methodical feature
of the latter is the installation to determine the level of learning , determined by the
amount of assistance needed by the subject to solve the proposed problem and by its
ability to translate the learned.
Investigation of mental capacity and attention is carried out using the following
methods: Table Schulte (black-and-white and color), the score of Kraepelin ,
correction sample Bourdon test Toulouse-Pieroni and others - at least one procedure..
The study of individual psychological characteristics is carried out in patients
with a shallow intellectual defect: various self-assessment scales (according to
Dembo-Rubenstein , “Well-being-activity-mood” - SUN, etc.), projective tests
(“Thematic Apperceptive Test” - TAT, Rosenzweig tests , Wagner, drawing
techniques, etc.) - at least one technique.
Memory research: memorization of 10 words, pictures, indirect Leontiev
memorization, pictogram, memorization of short stories, pictures, tests for
identification of memorized objects, etc. - at least two methods.

2.4. Degree and severity of mental retardation

Depending on the level of intellectual development, the following degrees of


severity of mental retardation are distinguished:
Degrees of mental retardation (Table 4):
Degree of mental Clinical manifestations
retardation

Easy When studying in specialized schools, according to

Iq specially developed programs, most are able to master the


skills of reading, writing, counting, and later acquire work
from 50 to 69 units
skills that do not require high qualifications . at a social
and cultural environment that does not impose special
requirements on the abstract logical level and does not
require independent decisions in a dynamic, changing life;
persons with mild mental retardation are fully
compensated.

Moderate From early childhood, children lag behind in

Iq psychoverbal development. Self-service skills do not fully


master. Need for life in the control and care of
from 35 to 49 units
intellectually full persons.

Heavy The level of speech development allows only to

Iq communicate their needs. By deployed speech utterances


are not able to . Own only elementary self-service skills. In
from 20 to 34 units
everyday life helpless , in need of control and care.

Deep Speech is absent or consists of separate words, often


there is no understanding of the speech addressed to them.
Iq They do not even have simple self-service skills; they are

less than 20 units untidy, they need constant care and supervision. Left to
themselves remain motionless or are in monotonous
senseless excitement (swing, make stereotypic
movements).

The degree of mental retardation is usually evaluated by standardized tests that


determine the patient’s condition. They can be supplemented by scales assessing
social adaptation in a given environment. These techniques provide a rough definition
of the degree of mental retardation. The diagnosis will also depend on the overall
assessment of intellectual functioning at the identified skill level.
The cited coefficients of mental development should be used taking into
account the problems of cross-cultural adequacy. Selected categories are an arbitrary
subdivision of a complex continuum and cannot be determined with absolute
precision. IQ should be determined by an individually assigned standardized test, for
which local cultural norms are established, and the selected test must be adequate to
the level of functioning and additional specific adverse conditions for the functioning
of the individual, for example, impaired expression somatic factors.
Intellectual abilities and social adaptation may change over time, but rather
weakly. This improvement may result from training and rehabilitation. The diagnosis
should be based on progress to date level of mental activity.

2.5. Complicated forms of mental retardation


The structure of mental underdevelopment may be uneven (the presence of more
severe violations in any one area, for example, speech) and not be exhausted by
characteristic symptoms. In connection with this, complicated forms of mental
retardation stand out - variants with the presence of an additional relative to the
syndrome of general mental underdevelopment and tiopathological symptoms - forms
of mental retardation complicated by behavioral disorders.
Behavioral disorders can be relatively compensated (phase without
exacerbation) or decompensated (phase exacerbation). The transition to the acute
phase is due to several reasons:
- exposure to psychogenic stress factors;
- the occurrence of abnormal psychosocial situations in the family, at work
in persons with mild mental retardation;
- the impact of additional asthenizing factors (somatic diseases, head
injuries, etc.);
- Somato-endocrine rearrangement of the body (the unfinished sexual
metamorphosis, the phase of involution);
- autochthonous seasonal fluctuations;
- a combination of several factors.
To determine the severity of behavioral disorders in the ICD - 10, use the
following notation:
F 7x0 - mental retardation indicating the absence or weakness of behavior
disorders;
F 7x1 - mental retardation indicating a significant violation of behavior that
requires care and treatment;
F 7x8 - mental retardation indicating the otherer behavior violation .
3. TREATMENT

The main objectives of the treatment of mental retardation in adults are:


 activation of the patient's compensatory mechanisms;
 elimination of accompanying mental (behavioral) and
somatoneurological disorders.

Principles of therapy.
 Individual approach, taking into account the established or suspected
etiology, clinical components of the disease, the presence of additional
comorbid disorders.
 Combined use of drug and non-drug methods of treatment, in
combination with behavioral therapy, psychotherapy, psychosocial
therapy.
 Participation in medical events of specialists of different profiles:
doctors, psychologists, social workers, etc.

Due to the completeness of the morphofunctional development of the brain, the


stimulation of mental development with neurometabolic action drugs in adult mentally
retarded patients, unlike children, is not performed.
Treatment is reduced to the reduction of complicating symptoms, while it
should be noted that mental retardation can be combined with any mental and
neuropsychiatric disorders occurring in fully intelligent individuals. When mental
retardation syndromes are caused by metabolic disorders in the framework of
differentiated forms that are independent diseases, patients who reach maturity are
treated with specific therapies, including diet and hormone replacement therapy.
Depending on the leading cause of the formation or enhancement of
behavioral disorders , the structure of therapeutic measures shifts towards
predominantly drug therapy, or strengthening the psychotherapeutic component of
complex treatment.
The integrated use of drug and non-drug therapies in combination with
psychotherapy, occupational therapy, social work with family and patient is one of the
fundamental principles of curative behavioral disorders in people with mental
retardation.
The main criteria for the effectiveness of the treatment are the data of the
pathopsychological examination and observation of the patient's behavior, which
make it possible to identify the dynamic characteristics of the behavior,
communication functions, emotional response, as well as the nature of the patient’s
complaints and self-reports and their correspondence to the information received from
relatives and their substitutes.

3.1 Treatment of mentally retarded patients with mild behavioral disorders.

Symptomatic treatment of patients with mental retardation is carried out in the


case when the accompanying psychopathological syndromes interfere with the
patient's optimal adaptation, make his condition worse.
Therapeutic sensitivity to psychotropic drugs in patients varies depending on
the processes of absorption, features of pharmacodynamics , metabolism and the
action of metabolites.
Given the wide range of therapeutic response to the appointment of
psychotropic drugs, it is necessary to titrate to obtain a therapeutic effect. The
optimum is considered to start with 0.5 estimated therapeutically active dose, followed
by an increase. It is necessary to take into account the likelihood of side effects,
paradoxical effects and complications of psychotropic therapy in case of mental
retardation with residual organic failure of the central nervous system or manifested
against the background of a sluggish current organic process within the framework of
differentiated forms of mental retardation, often with hereditary metabolic defects.

Treatment of mentally retarded patients with mild behavioral disorders (


table 5):
Drugs affecting the central nervous system Average The power of
(neuroleptics) therapeutic recommendations
dose
Risperidone 2 mg B
Levomepromazine 200 mg C
Periciazine 30 mg C
Thioridazine 100 mg C
Chlorprotexene 50 mg C
Haloperidol 3 mg B
Zuclopentyxol 6 mg C

3.2 Treatment of mentally retarded patients with significant behavioral disorders

For behavioral disorders accompanied by psychomotor disinhibition, aggression


and auto-aggression , refusal to take drugs, treatment begins with neuroleptic drugs
with pronounced sedative effect, which has dosage forms for parenteral administration
( chlorpromazine , levomepromazine , sultridede , zuclopentixol ). In order to avoid
orthostatic hypotension after the introduction of the 1st dose, the patient should lie for
30 minutes. With a decrease in affective excitability, the absence of aggressive and
auto-aggressive actions are transferred to oral receiving these antipsychotic drugs. In
the event of extrapyramidal side effects, you should resort to the appointment of one
of the correctors of anticholinergic action.
In the process of a diagnostic interview, the reasons that caused the
decompensation of the patient's condition with increased behavioral disorders are
identified:
 the impact of psychogenic stress factors;
 the occurrence of abnormal psychosocial situations in the family,
at work in persons with mild mental retardation;
 the effects of additional asthenizing factors (somatic diseases,
head injuries, etc.);
 somato-endocrine rearrangement of the body (the unfinished
sexual metamorphosis, the phase of involution);
 autochthonous seasonal variations;
 combination of several factors.

Treatment of mentally retarded patients with significant behavioral


disorders (Table 6):

Drugs affecting the central nervous system Average The power of


(neuroleptics) therapeutic recommendations
dose

Risperidone 2 - 8 mg B
Levomepromazine 200 mg C
Clozapine 200 mg C
Periciazine 30 mg C
Thioridazine 100 mg C
Chlorpromazine 200 mg B
Chlorprotexene 50 mg C
Haloperidol 4.5 mg B
Zuclopentyxol 6 mg C

Sex hormones and their antagonists- 100 mg C


Tsiproteron

In the event of pronounced extrapyramidal disorders or other side effects and


complications of drug therapy, including paradoxical effects (psychomotor agitation in
response to the introduction of sedative antipsychotics), often observed in mental
retardation with organic-residual insufficiency of the central nervous system or
manifested against the background of sluggish organic process in hereditary metabolic
defects, it is advisable to receiving neuroleptic transition from mild effects on
extrapyramidal and autonomic o- c suspicious system ( peritsiazin , thioridazine ,
tiaprid , chlorprotixen ).
In patients with severe and deep mental retardation, behavioral disorders can be
associated (especially in men) with unrealized sexual desire. In this category of
patients often not only psychosexual identification and sexual orientation are not
formed , but also there is no understanding of the resulting somatic sensations. In
these cases, antiandrogenic drugs are effective treatment .

The duration of therapy is determined by the patient's condition and in the form
of maintenance therapy with low doses can be used for many months.
When exogenously-organic form of mental retardation supporting
decompensation of the patient psihopatopodobne type factor may be a violation of
liquor on - and hemodynamics. This is an indication for prescribing intracranial
pressure lowering agents, promoting the normalization of cerebral hemodynamics (
diuretics , drugs that improve brain metabolism and brain blood circulation).
This is an indication for prescribing intracranial pressure lowering agents,
promoting the normalization of cerebral hemodynamics ( diuretics , drugs that
improve brain metabolism and brain blood circulation).
With increased intracranial pressure from diuretics drug of choice is Diacarbum
, suppressing carbonic anhydrase in the choroid plexus of the brain ventricles,
resulting in decrease of production of cerebrospinal fluid.

3.3 Selection of treatment regimen ( indications for inpatient treatment )

When choosing a treatment regimen for patients with mental retardation, it is


necessary to be guided by some psychopathological criteria:
-the presence of complicating symptoms, especially behavioral disorders ;
- outbreaks of aggressive, auto-aggressive or threatening behavior caused by the
impossibility of control and representing a clear danger to others and the patient
himself;
- patients with deep and severe mental retardation, with severe limitations of mobility,
with severe complications of therapy.

4. PSYCHOSOCIAL TREATMENT AND PSYCHOSOCIAL


REHABILITATION OF ADULT PATIENTS WITH MENTAL
RETARDATION

Psychosocial rehabilitation is a continuous, continuous process that includes a


complex of medical, psychological, educational, socio-economic and professional
measures that enable people with poor health or people with disabilities as a result of
mental disorders (including the mentally retarded) to achieve their optimal level,
independent functioning in society .

Psychosocial therapy and psychosocial rehabilitation, along with


pharmacotherapy, are necessary and complementary therapeutic strategies (the
strength of the recommendations is C ) .
C fir st rehabilitation is to improve the quality of life and social functioning of
people with mental disorders by addressing their social exclusion , as well as
increasing their active life and citizenship.
H Adachi rehabilitation:
 reducing the severity of psychopathological symptoms using the triad - drugs,
psychotherapeutic methods of treatment and psychosocial interventions;
 increasing the social competence of mentally ill people through the
development of communication skills, the ability to overcome stress, and work;
 reducing discrimination and stigma;
 support for families in which someone has a mental illness;
 creating and maintaining long-term social support , meeting at least the basic
needs of mentally ill people, such as housing, employment, leisure time
activities, the creation of a social network (social circle);
 increase autonomy (independence) of the mentally ill.

The psychotherapeutic link of non-drug therapy should cover not only the
patient, but also the close circle of his communication. In the conditions of outpatient
care, individual conversations are most accessible , aimed at increasing patient
tolerance, teaching communication forms that reduce the risk of inadequate affective
response, identifying and helping to eliminate (if possible) anomalous psychosocial
situations.
If psychotherapeutic work with patients is established in PND, patients with
shallow degrees of mental underdevelopment can join group forms of psychotherapy.
The goal of group psychotherapy is to reduce the communicative tension of the
patient, to acquire a safe experience of social contacts , to form the skills of solving
life problems. In patients with mild PA, an analysis of intragroup interaction can be
conducted , helping them to realize their role in disharmonious interpersonal contacts,
leading to social isolation.
Conducting outpatient psychocorrectional work allows optimizing the social
functioning of patients, increasing their overall confidence, ability to relieve
situationally conditioned tensions, and must necessarily be carried out against the
background of psychopharmacotherapy .
After the removal of psycho-emotional stress, patients with disabilities and
not working anywhere are assigned to occupational therapy in the conditions of
treatment and labor workshops (if the patient is able to perform labor operations in
workshops in terms of cognitive indicators and characteristics of the motivational-
volitional sphere). Patients with low cognitive performance and persistent behavioral
disorders can perform simple labor operations at home.
From the additional range of psychotherapeutic treatment methods, the one
that is most suitable for the patient is selected, taking into account his cognitive
abilities, personality characteristics, aptitudes, presence or absence of psycho-
traumatic experiences (family psychotherapy, art therapy , behavioral) .

When carrying out psychosocial activities it is necessary to take into account a


number of fundamental provisions.
The process of psychosocial rehabilitation can be started at any stage of the
provision of psychiatric care - out of acute conditions (exacerbations), but perhaps
earlier after stopping acute manifestations of mental disorder. The earlier psychosocial
activities begin in relation to the onset of the disease, the sooner you can count on a
favorable outcome.
It is necessary to formulate the goal of each intervention with the definition of
the time period during which the specified goal is supposed to be achieved.
Psychosocial interventions should be, firstly, differentiated and aimed at achieving a
specific goal (or goals), and, secondly, limited in time.
The choice of the form of intervention for a particular patient should be made in
accordance with the peculiarities of his psychosocial deficiency (social maladjustment
).
The sequence of psychosocial influences is carried out taking into account the
increasing approximation to normal life requirements and the achievement of social
competence.
At the completion of each stage or the entire psychosocial rehabilitation
program, supporting psychosocial interventions are needed.
Staging and consolidation of the achieved results by repeated repetitions is a
usual requirement for psychosocial rehabilitation.

The choice of methodology depends on the characteristics of the state and


social maladjustment , the stage of psychiatric care and the tasks that are set at this
stage of its social recovery. It is preferable to use a psycho - educational approach
with elements of problem-solving techniques and social skills training.

one

experience and can provide useful insights to one


another about what has worked for them; this infor-
mation complements and extends what the worker
has presented. It also provides reassurance because it
suggests that change is possible. In addition to the
obvious benefits associated with sharing information,
members’ feelings of self-e cacy and esteem are en-
hanced when they are able to o er guidance to others
( Yalom & Leszcz, 2007).
PROMOTING MUTUAL AID AND
COLLABORATIVE LEARNING
A basic first step in creating a climate conducive to
collaborative learning is attention to physical space.
A room set up with chairs in rows is “probably the
least conducive to learning. It announces … that the
name of the game here is one-way transmission”
( Knowles, 1985, p. 15). A semicircle or circle ar-
rangement of chairs or, if needed, desks or tables,
immediately suggests a di erent set of expectations—
that member participation is valued and, indeed,
expected.
Here is an example. A practitioner developed a
psychoeducational group for patients with chronic
mental illness. The purpose of the group was three-
fold: (1) to enhance members’ understanding of their
disorders and the medications designed to manage
them, (2) to enhance members’ ability to manage
their condition and the side e ects of the medica-
tions, and (3) to promote increased member compli-
ance with taking their medications as prescribed.
The social worker identified the topics for discussion
for each of the six sessions but did not understand
the need to encourage collaborative learning and
mutual aid. In the first session, the worker set the
room up with tables in rows and a white board in
front of the room. He stood next to the board and
wrote out information about mental disorders.
After the first session, the social worker expressed
frustration and confusion about the group, since he
was the only one who talked. What this novice social
worker failed to appreciate was that his arrangement
of the room undermined members’ ability to connect
with him, the material, and one another. Unwittingly,
he set himself up as the sole authority on members’
mental health problems. The room arrangement dis-
couraged member-to-member discussion and the
development of mutual aid. The worker engaged in
a “lecture” rather than a discussion.
Collaborative learning is immediately encouraged
when the social worker assists group members i
seeing what they have in common and explains the
purpose of the group. Members are invited to pro-
vide feedback and confirm their understanding of,
and agreement with, the group’s focus. Out of this
discussion, an initial mutual understanding about
group purpose is forged. This includes an explicit
discussion about the importance of dialogue among
members and between members and the leader, as
well as the worker’s commitment to collaborative
learning and to viewing members as the experts on
their own lives ( Gitterman, 2004, 2009).
For example, in a psychoeducational group for
homeless individuals, a social worker introduced
herself and the group’s purpose in the following
way:
I will be providing you with information about
resources that can help you find permanent
housing and assist you with your financial prob-
lems. Sometimes it is really confusing trying to
obtain services, so we’ll also tackle how to do
this. I’ll bet many of you have suggestions about
what has worked for you and how you have
worked the system to get what you need. So,
this is not just about me providing you with
information. It’s about you sharing your sugges-
tions, experiences, and frustrations with one
another.
This worker made it clear that members would be
actively involved in the learning and teaching process.
Her comments conveyed her belief that members
have something to o er one another, thus setting the
stage for collaborative learning and mutual aid.
If members are to integrate the information the
social worker is presenting, there must be a culture
of open discussion. When members begin to talk
more openly with one another, they come to rec-
ognize that they are not alone. This reduces isola-
tion, depathologizes problems, and diminishes
stigma, which promotes members’ ability to make
meaning of the curriculum being presented.
Promoting open discussion begins in the very first
session, when the worker creates a climate that allows
members to talk to one another and explains her or
his role and that of the group. The worker also en-
courages open discussion when she or he asks mem-
bers to introduce themselves to one another and to
share their commonalities.
As another example, in a group for older adoles-
cents aging out of foster care, the worker, Rachel

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ducational_Groups_Opportunities_and_Challenges

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zadachi.html
Types of outcome measures

For the first version of the review (Pekkala 2002) we did not pre-specify specific time periods into
which to cluster outcomes. For this update we asked an editor of the Cochrane Schizophrenia Group,
who was not familiar with the data to help us divide the data by time. For this update we grouped
outcomes into the short term (up to 12 weeks), medium term (13-52 weeks) and long term (over 52
weeks).

Primary outcomes

1. Compliance
o 1.1 Compliance with medication
o 1.2 Compliance with follow-up
2. Relapse

Secondary outcomes

1. Knowledge
o 1.1 Improvement of understanding of his/her illness and need for treatment -
recipient/family member
o 1.2 Level of knowledge about expected and undesired effects of medication -
recipient/family member
2. Behaviour
o 2.1 Level of psychiatric symptoms
o 2.2 Symptom control skills
o 2.3 Problem-solving skills
o 2.4 Social skills
3. Social functioning*
o 3.1 No clinically important change in social functioning
o 3.2 No change in social functioning
o 3.3 Average endpoint in social functioning
o 3.4 Average change in social functioning
4. Global functioning*
o 4.1 No clinically important change in general functioning
o 4.2 No change in general functioning
o 4.3 Average endpoint in general functioning
o 4.4 Average change in general functioning
5. Service utilisation
o 5.1 Use of outpatient treatment
o 5.2 Length of hospitalisation
6. Global state*
o 6.1 No overall improvement
o 6.2 Use of additional medication
o 6.3 Average endpoint score
o 6.4 Average change score
o 6.5 Average dose of drug
7. Mental state*
o 7.1 No clinically important change in general mental state
o 7.2 No change in general mental state
o 7.3 Average endpoint general mental state score
o 7.4 Average change in general mental state scores
8. Expressed emotion*
o 8.1 No clinically important change in expressed emotion
o 8.2 No change in expressed emotion
o 8.3 Average endpoint general expressed emotion
o 8.4 Average change in general expressed emotion
9. Quality of life*
o 9.1 No clinically important change in quality of life
o 9.2 Not any change in quality of life
o 9.3 Average endpoint quality of life score
o 9.4 Average change in quality of life scores
o 9.5 No clinically important change in specific aspects of quality of life
o 9.6 No change in specific aspects of quality of life
o 9.7 Average endpoint specific aspects of quality of life
o 9.8 Average change in specific aspects of quality of life
10. Satisfaction with care*
o 10.1 No clinically important change in satisfaction
o 10.2 No change in satisfaction
o 10.3 Average endpoint in satisfaction
o 10.4 Average change in satisfaction
11. Adverse effects/event*
o 11.1 Clinically important general adverse effects
o 11.2 Any general adverse effects
o 11.3 Any serious, specific adverse effects
o 11.4 Average endpoint general adverse effect score
o 11.5 Average change in general adverse effect scores
o 11.6 No clinically important change in specific adverse effects
o 11.7 No change in specific adverse effects
o 11.8 Average endpoint specific adverse effects
o 11.9 Average change in specific adverse effects
12. Health economic outcomes
o 12.1 Treatment costs

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