Deck 15: Treatments for Schizophrenia and Other Severe Mental Disorders

Question 1

After seven months of treatment with Thorazine, Paula begins to exhibit bizarre and uncontrollable movements of the face, neck, tongue, and back. These undesirable effects are known as _____.

Answer 1

tardive dyskinesia

Question 2

Because they often produce movement similar to the symptoms of neurological diseases, first-generation antipsychotic drugs are also known as _____ drugs.

Answer 2

neuroleptic

Question 3

Explain why community treatment has failed those with schizophrenia.

Answer 3

not answered

Question 4

List and briefly describe two of the five key features of effective community care. Discuss each feature's challenges and failures.

Question 5

Why are individuals with schizophrenia so often perceived to be dangerous and violent, despite contrary evidence?

Question 6

Compare and contrast the two kinds of cognitive-behavior therapy used for people with schizophrenia.

Question 7

The second-generation antipsychotic drug clozapine has a dangerous side effect called _____, a life-threatening drop in white blood cells.

Question 8

Why is work so important to those experiencing schizophrenia? What type of work are people with schizophrenia MOST likely to be able to do, and what treatments have been developed to support them?

Question 9

Compare and contrast milieu therapy and token economy programs..

Question 10

The 1960s policy of releasing patients from mental health hospitals to community-based mental health facilities is called _____.

Question 11

How have living conditions changed for individuals with schizophrenia since their housing in a typical public state hospital in the United States in the mid-twentieth century?

Question 12

What effect did the emergence of antipsychotic drugs have on approaches to treatment of schizophrenia?

Question 13

The attempt to support the family of a person with schizophrenia, to help them cope and provide the best environment for continued recovery, is called _____.

Question 14

The family therapy approach to the treatment of schizophrenia includes bringing the members of the patient's family together with other families who are in the same situation to share their thoughts and emotions in a format called _____.

Question 15

First-generation antipsychotic drugs reduce the _____ symptoms of schizophrenia, such as hallucinations and delusions.

Question 16

How could the lobotomy have been considered to be a "miracle" cure for schizophrenia? What were the usual results of lobotomies?

Question 17

Maxwell Jones's therapeutic community is a form of _____ therapy.

Question 18

The symptoms that develop because of the experience of long-term mental institutionalization itself are collectively called _____.

Question 19

What happens to people with serious mental disorders who are not treated effectively? Be comprehensive in your answer.

Question 20

Interventions for schizophrenia that make sure clients take their medications and help patients with self-management, problem-solving, decision-making, and the development of interpersonal skills are called _____.

Question 21

The way people with schizophrenia were housed in mental hospitals during the first half of the twentieth century could be compared to a:

A) storage facility.
B) critical care unit in a modern hospital.
C) retirement community.
D) military barrack.

Question 22

Which statement is true regarding how people with schizophrenia were treated during the first half of the twentieth century?

A) People with schizophrenia were not given antipsychotic medications even when these were readily available.
B) Therapists would exclusively use "talk therapy" even when medical treatments were shown to be more effective.
C) People with schizophrenia were often neglected and abused even though the practice of "moral treatment" was widely endorsed.
D) Lobotomies were performed routinely even though the evidence supporting their usage came from a single animal study.

Question 23

Which statement is true of state mental hospitals in the United States in the mid-twentieth century?

A) They were intended to isolate mental patients from the general population.
B) They were built in large cities, so patients could stay in contact with the "real" world.
C) They were overcrowded and understaffed.
D) They were focused on innovative and experimental treatments.

Question 24

Which of these was NOT a major problem facing state hospitals during the mid-1900s?

A) overcrowding
B) inadequate state funding
C) administration of treatments by those with insufficient knowledge and experience
D) protocol of releasing "difficult" patients even though they still required treatment

Question 25

What was the dominant way of treating people with schizophrenia during the first half of the twentieth century?

A) institutionalization
B) outpatient services
C) individual psychotherapy
D) treatment with neuroleptic drugs

Question 26

One contributing factor to the increase in the number of homeless individuals was the mental health policy of _____.

Question 27

During the mid-1900s, why were the most "difficult" patients transferred to the back wards of state hospitals, where they were often isolated, restrained, and punished?

A) to avoid disturbing the other patients who did not have severe symptoms
B) because the priority of state hospitals shifted from treating people humanely to maintaining order
C) to make it easier for staff to treat those with the most severe symptoms
D) because the most "difficult" patients needed additional treatment compared to other patients

Question 28

Most patients who lived on the hospital wards in state mental hospitals in the mid-1900s:

A) were people with schizophrenia.
B) received individual "talk therapy" with no success.
C) interacted well with each other but not with staff members.
D) were in fact violent criminals.

Question 29

Who was the first physician responsible for developing the prefrontal lobotomy for use on human patients?

A) Egas Moniz
B) Eliot Valenstein
C) Walter Freeman
D) Carlyle Jacobsen

Question 30

Harry was released from the hospital to a dormitory-like facility that gives him considerable freedom during the day. The live-in staff consists of paraprofessionals who emphasize resident responsibility and self-government. This facility is MOST likely a(n) _____.

Question 31

The main contribution of Philippe Pinel to the care of those with severe mental illnesses was to:

A) develop state hospitals for people who could not afford private care.
B) use antipsychotic drugs in highly controlled settings.
C) treat patients with sympathy and kindness.
D) promote deinstitutionalization.

Question 32

Individuals who were institutionalized for schizophrenia during the first half of the twentieth century probably received all of the following EXCEPT:

A) physical restraint.
B) food and shelter.
C) occasional abuse and neglect.
D) antipsychotic medication.

Question 33

One should be cautious when examining instances of schizophrenia using hospital records from much of the twentieth century because:

A) very few records were kept about diagnostic labels back then.
B) most residents of mental hospitals back then also had depression.
C) many people with psychotic symptoms were misdiagnosed as having schizophrenia.
D) people often faked having schizophrenic symptoms to receive treatment for some other disorder.

Question 34

Which statement about medication and schizophrenia is the LEAST accurate?

A) Medication is very helpful for some, moderately helpful for others, and ineffective for the remainder of those suffering from schizophrenia.
B) Medication can alleviate some problems, but it can also create new ones.
C) The approaches to treating schizophrenia have vastly improved over the last several decades.
D) Medication is the only effective way to treat schizophrenia.

Question 35

The institution that is supposed to provide the coordination among posthospitalization services is the _____.

Question 36

A person with schizophrenia who receives assistance with finding a job and ongoing psychological support once employed is receiving _____.

Question 37

Which statement accurately reflects current thinking about psychosis and schizophrenia?

A) Psychotic behavior is best labeled as schizophrenia.
B) Schizophrenia and psychosis are two distinctly different syndromes.
C) People with different diagnoses can exhibit psychosis; it is not limited to schizophrenia.
D) People with bipolar disorder or major depression don't exhibit psychosis; only people with schizophrenia do.

Question 38

The technique for treating mental patients that was pioneered by Egas Moniz was:

A) ECS therapy.
B) the lobotomy.
C) pharmacotherapy.
D) the cingulotomy.

Question 39

The usual way of dealing with troublesome or violent people with schizophrenia in institutions in the first half of the twentieth century was to:

A) use drugs.
B) beat them.
C) ignore them.
D) use physical restraint.

Question 40

If patients with schizophrenia show improvement during short-term hospitalization, the follow-up treatment they receive in the community later is called _____.

Question 41

Milieu therapy is based primarily on the principles of _____ psychology.

A) cognitive-behavioral
B) sociocultural
C) humanistic
D) psychodynamic

Question 42

Which therapy is based on the premise that when you change the social environment, you can change the patient?

A) milieu therapy
B) insight therapy
C) family therapy
D) the token economy

Question 43

Some hospitalized mental patients not only failed to improve but also suffered negative effects of their care. This syndrome is called:

A) schizophrenogenesis.
B) hyperinstitutionalization.
C) social breakdown syndrome.
D) downward drift.

Question 44

American Walter Freeman "improved" the procedure developed by Egas Moniz by developing the:

A) prefrontal lobotomy.
B) prefrontal leucotomy.
C) transorbital lobotomy.
D) complete prefrontal lobectomy.

Question 45

During a _____ a needle is inserted into the brain through the eye socket and is then rotated to destroy brain tissue.

A) prefrontal lobotomy
B) transorbital lobotomy
C) singular nigra lobotomy
D) facial-cranial lobotomy

Question 46

Patients who developed extreme withdrawal, anger, physical aggressiveness, and loss of personal hygiene as a result of poor institutional care were showing a pattern known as:

A) institutional deterioration.
B) social breakdown syndrome.
C) chronic back ward syndrome.
D) schizophrenic failure to thrive.

Question 47

Milieu therapy includes all of the following components EXCEPT:

A) creating an atmosphere of mutual respect among residents and staff.
B) enabling residents to make decisions for themselves.
C) getting residents to be more active and engaged in daily activities.
D) teaching residents to recognize when they engage in inappropriate behavior.

Question 48

Milieu therapy is to _____, as token economy is to _____.

A) humanism; behaviorism
B) humanism; capitalism
C) individualism; behaviorism
D) socialism; Darwinism

Question 49

A patient who is called a resident and who lives in a therapeutic community, actively working with staff members to create a life that is as much like that outside the hospital as possible, is probably receiving _____ therapy.

A) token economy
B) custodial
C) milieu
D) lobotomy

Question 50

People who were treated in state hospitals during the mid-1900s often developed additional symptoms that were more troubling than the original symptoms for which they were being treated. This is thought to be due to:

A) the dehumanizing conditions associated with being institutionalized.
B) the spread of contagious diseases that occur when people are overcrowded.
C) poorly trained nurses who failed to respond to the needs of patients.
D) the side effects of dangerous treatment procedures that were routinely used.

Question 51

Throughout much of the twentieth century, long-term institutionalized mental patients developed additional symptoms as a result of their institutionalization. The most common pattern of decline was:

A) psychosis.
B) schizophrenia.
C) social breakdown syndrome.
D) neuroleptic malignant syndrome.

Question 52

Why are lobotomies no longer routinely used to treat people with severe psychological disorders?

A) We now know that the side effects of the procedure are like those that are produced by antipsychotic drugs.
B) A growing body of research indicates that the procedure is not as effective as the early studies indicated.
C) The physical problems produced by lobotomies pose ethical problems for their continued use.
D) As with any fad, it simply lost its popularity among neurosurgeons.

Question 53

Why were lobotomies so enthusiastically accepted by the medical community in the 1940s and 1950s?

A) They were based on sound experimental studies with animals.
B) The inventors of this procedure were gifted and dedicated physicians.
C) There were relatively few of them and side effects were mild.
D) They could be used to control criminals as well as mental patients.

Question 54

It was thought that lobotomies could effectively treat the symptoms of schizophrenia and other disorders because:

A) cutting the nerve pathways that produce abnormal thinking should prevent such thinking from occurring.
B) animal studies showed that this procedure calmed animals that were easily agitated.
C) therapists were desperate to try anything that might help those with the most severe symptoms.
D) they could be performed quickly and easily with almost no side effects.

Question 55

Maxwell Jones (1953) created an approach to psychotherapy of the institutionalized in London called:

A) oral therapy.
B) group therapy.
C) a token economy.
D) milieu therapy.

Question 56

The primary goal of milieu therapy is to:

A) create a social environment that promotes productive activity, self-respect, and responsibility.
B) decrease inappropriate or maladaptive behavior while increasing appropriate and adaptive behavior.
C) change how the individual thinks about and perceives the social world.
D) isolate those with severe psychological disorders from stressful situations or from environmental factors that trigger psychotic symptoms.

Question 57

If one were treated by therapists who believed that patients need to live in a social climate that promotes productive activity, self-respect, and individual responsibility, one would be likely to be living in the:

A) 1920s.
B) 1930s.
C) 1940s.
D) 1950s.

Question 58

Which of the following was NOT a factor that contributed to the expanded use of lobotomies during the 1940s and 1950s?

A) An early study showed that lobotomies were successful in treating patients with psychological disorders.
B) The neurosurgeons who developed the lobotomy were highly respected and influential.
C) Because of overcrowding, state hospitals were receptive to treatments that would help maintain standards.
D) Early antipsychotic drugs were ineffective in treating psychotic symptoms and produced dangerous side effects.

Question 59

How is milieu therapy related to social breakdown syndrome?

A) Milieu therapy incorporates institutional practices that are likely to prevent social breakdown syndrome.
B) Milieu therapy is more likely to produce social breakdown syndrome than institutional practices that were used prior to the 1950s.
C) Milieu therapy is costlier to implement than other approaches, which is why it is rarely used to prevent social breakdown syndrome.
D) Milieu therapy uses institutional practices that neither cause nor prevent social breakdown syndrome.

Question 60

Theorists propose that institutionalized patients deteriorate because they are deprived of opportunities to develop self-respect and independence. The therapy that counters this effect by creating an environment that encourages self-respect and responsibility is known as:

A) token therapy.
B) social therapy.
C) milieu therapy.
D) environmental enhancement.

Question 61

In behavioral terms, what is a token?

A) a stimulus
B) motivation
C) a reinforcer
D) punishment

Question 62

In a token economy, if a person no longer receives tokens for saying his or her correct name when prompted, then what is likely to follow?

A) Delusional thinking will return.
B) The person will start developing auditory hallucinations.
C) The person will continue to say his or her correct name when prompted in the future.
D) The person will eventually stop saying his or her correct name when prompted.

Question 63

First-generation antipsychotic drugs are to _____, as second-generation antipsychotic drugs are to _____.

A) neuroleptic drugs; atypical antipsychotic drugs
B) the 1920s; the 1980s
C) fewer side effects; more side effects
D) conventional drugs; neuroleptic drugs

Question 64

Which statement BEST describes the effectiveness of token economy strategies?

A) They are ineffective in the long run.
B) They reverse the progress of schizophrenia.
C) They are successful at changing the patient's behavior.
D) They are successful in altering the patient's distorted thinking.

Question 65

One criticism of token economies is that:

A) people can pretend to act "normal" even though psychotic symptoms remain.
B) it is unethical to change a person's behavior against their will.
C) being able to purchase cigarettes with tokens is dangerous to one's health.
D) they produce only a temporary change in behavior.

Question 66

How can one BEST determine whether the use of token economies is an effective means of changing problematic behavior?

A) Observe how behavior changes after people receive tokens for appropriate behavior.
B) Record a person's behavior before and after administration of tokens.
C) Ask therapists and staff if they think the use of tokens changed patients' behavior.
D) Record and compare behavior between a group that received tokens against a group that did not.

Question 67

The first antipsychotic drug to be approved for use in the United States was:

A) Haldol (haloperidol).
B) Prozac (fluoxetine).
C) Thorazine (chlorpromazine).
D) Mellaril (thioridazine).

Question 68

What is the concern regarding the changes produced by token economies?

A) Many studies of token economies are methodologically flawed.
B) Some patients can function in normal life but deteriorate in the hospital.
C) The skills learned in the hospital may not generalize to the outside world.
D) The person may have learned new behaviors without changing distorted thinking.

Question 69

The discovery of antihistamine drugs in the 1940s indirectly led to the development of:

A) lithium.
B) antianxiety drugs.
C) antipsychotic drugs.
D) antidepressant drugs.

Question 70

A therapist wants to implement a token economy. To help ensure that the program is effective, the therapist should:

A) create a plus and minus system, awarding tokens for desired behavior and taking tokens for undesired behavior.
B) define the behavior to be reinforced and establish expectations for earning tokens.
C) first create a bare minimum standard for living comforts so that the tokens and rewards become more desirable.
D) be generous when initially awarding tokens to increase interest in the reward system.

Question 71

One reason why people often have difficulty transitioning from an institutional token economy to community living is because:

A) few people are available to monitor behavior.
B) community members offer little support for those transitioning to community living.
C) the contingencies for earning reinforcers are different in community living than in an institutional setting.
D) tokens are worthless outside of an institutional setting.

Question 72

Jerry is a resident in a psychiatric ward. When he makes his bed, brushes his teeth, and sweeps the floor, he gets a plastic chip. He can exchange the plastic chips he has earned for extra privileges, such as additional TV time. This example illustrates the basic features of:

A) a token economy.
B) milieu therapy.
C) social therapy.
D) a behavioral contract.

Question 73

Although token economies can change delusional behavior, _____ may not change.

A) catatonic symptoms
B) appropriate behaviors
C) delusional thinking
D) facial expressions

Question 74

In a token economy, if therapists and staff required patients to earn tokens to receive meals at the cafeteria, this would be considered:

A) unwise due to the increase in aggressive behaviors that would follow.
B) unethical and illegal.
C) a cruel form of punishment.
D) a necessary first step toward changing behavior.

Question 75

A hospitalized patient no longer talks about delusions and hallucinations, thanks to participating in a token economy program. However, critics of the token economy program would say that the token economy program has:

A) worsened the negative symptoms of the disorder.
B) treated the schizophrenia without medication.
C) not eliminated the delusions and hallucinations but has improved the patient's ability to imitate normal behavior.
D) changed a Type I disorder into a Type II disorder.

Question 76

A third-grade teacher gives students stickers throughout the school day when they engage in appropriate behaviors. At the end of the day, students can trade in their stickers for treats from the class "treasure chest." This program is MOST similar to which form of therapy used for institutionalized people with schizophrenia?

A) milieu therapy
B) insight therapy
C) token economy
D) partial hospitalization

Question 77

Antipsychotic drugs were discovered accidentally when researchers were trying to develop:

A) antihistamines.
B) analgesics.
C) sedatives.
D) antibiotics.

Question 78

A token economy approach to treatment is based on principles from the _____ view of abnormal behavior.

A) psychodynamic
B) biological
C) behavioral
D) humanistic

Question 79

Which statement about token economies is NOT supported by research?

A) Many studies of effectiveness do not include a control group, confounding the treatment with attention.
B) Although token economy programs can change patients' delusional statements, they may not be changing delusional thoughts.
C) Token economy programs do not change the behavior of the most severely ill patients.
D) It is difficult for patients to make the transition from a token economy program to the community.

Question 80

Token economies use the principles of _____ to treat people with schizophrenia.

A) classical conditioning
B) operant conditioning
C) cognitive-behavioral therapy
D) milieu therapy