What is Schizophrenia?

Schizophrenia is a chronic mental disorder that affects how a person thinks, feels, and behaves. The causes and symptoms can vary among individuals. Schizophrenia affects about one percent of the population, appearing in both men and women equally, though symptoms tend to begin earlier in men. The disorder is present in all ethnic groups. In extremely rare cases, children under the age of 16 have been diagnosed with schizophrenia.

Phases of Schizophrenia

The phases of schizophrenia are prodromal, active, and residual. At CooperRiis, we include ‘recovery’ on this list because we believe recovery is possible.

Prodromal Phase

People with schizophrenia are often misdiagnosed in the prodromal phase because of the wide array of symptoms that can be present and their subtlety. Symptoms in the prodromal phase include:

• Withdrawal from family and social life
• A preference for being alone
• Confusion
• Outbursts of anger
• Depression
• Loss of interest in normal activities and apathy
• Anxiety
• Odd behavior

Active Phase

Over time, symptoms worsen and the active phase of schizophrenia begins. Symptoms in this phase will be obvious to family and friends and include:

• Hallucinations
• Paranoid delusions
• Disorganized speech
• Disorganized behavior
• Confusing thought patterns
• Trouble concentrating

Residual Phase

Symptoms in the residual phase resemble those in the prodromal stage. While alarming symptoms of the active stage have mostly subsided, symptoms such as low energy, listlessness, and withdrawal can still be present.

Recovery Phase

With treatment, most people with schizophrenia will improve with time. Most of our patients come to us in the active or residual phases of schizophrenia, but regardless of where they are, our goal is always the same – to help patients move into the recovery phase by achieving the highest level of fulfillment and functioning possible.

What is a dual diagnosis?

Someone diagnosed with a mental health disorder and substance abuse disorder has what is variously termed a dual diagnosis, co-occurring disorder, or dual disorder. In this article, these three terms are interchangeable. Substance abuse includes addiction to or dependence on alcohol and/or drugs, as well as process addictions, which are addictions that is related to actions. These include gambling, television, the internet, video games, sex and porn, and shopping and spending money.

A dual disorder can be difficult to diagnose for a number of reasons:

• Complexity and severity of symptoms
• Symptom overlap
• Those seeking treatment have often been misdiagnosed
• People diagnosed with a mental health disorder do not realize or believe that their substance use is related to their diagnosis
• Substance abuse symptoms can veil symptoms of mental illness
• Symptoms of mental illness can be easily confused with symptoms of addiction

It is important that both the mental illness and substance abuse be addressed simultaneously. Dual disorders affect one another and impact the success of treatment.

Statistics on Dual Diagnosis

• About one third of all people experiencing mental health issues and about one half of people living with severe mental health issues also experience substance abuse.
• Around one third of all those who abuse alcohol and more than one half of all those who abuse drugs report experiencing a mental illness.
• Men are more likely to develop a co-occurring disorder than women.
• Individuals of lower socioeconomic status, military veterans, and people with physical illnesses are at higher risk. (NAMI)

Signs and Symptoms of Dual Diagnosis

The signs and symptoms of dual diagnosis vary greatly depending on which mental health disorder is diagnosed and the substance being abused.
Personality, demographics, and the mental illness identified often influence the drug of choice. For instance, an anxious person will often abuse drugs that make him or her feel calm. Someone with low, slow energy will use substances that give them energy. Older people tend to drink, while younger people are more likely to use hallucinogenic drugs. Background also determines the chosen drug. If a child observed their parents drinking alcohol, they are more likely to choose alcohol over other drugs as an adult.
Some generalizations can be made about the signs and symptoms of dual disorders, although they are not always applicable.

• If mental health symptoms worsen even while receiving treatment, it is often a sign a latent substance abuse issue is present.
• If alcohol or substance use problems seem resistant to treatment, there may be an unidentified mental health disorder.

Holistic/Intergrated Treatment

Research shows that those with a history of dual disorders are best treated when attention is paid to both mental health and addiction disorders. Thus, the most effective long-term treatment is integrated treatment: both diagnoses are treated at the same time, by the same treatment team, in the same environment.
Imagine for a moment that you want to lose weight and you have three experts to help you: a nutritionist, a personal trainer, and a doctor. Now imagine that these three people never speak to one another. The doctor knows that you have problems regulating your insulin, but never shares that with your nutritionist. Your nutritionist puts lots of fruit on your dietary plan not knowing that this may make your insulin regulation problem worse. Finally, you arrive at the gym with your blood sugar shooting sky high, or dipping too low, and your personal trainer doesn’t understand why your energy levels vary so much. You may make some headway on your goals, but you also may give up, frustrated with how terrible you feel. Now imagine an entirely different scenario where these three experts are communicating vital information with one another. It’s much more likely you’ll have success with your weight loss goals when everyone who is helping you has all the information needed. This example illustrates why integrated treatment works well for dual diagnoses.

What are the building blocks of Integrated Treatment?

• Coordinated treatment for multiple diagnoses
• All healthcare professionals cooperate and share information
• Bundled interventions (A bundle is a small, straightforward set of evidence-based practices that, when performed collectively and reliably, have been proven to improve outcomes.)
• No division between treatments

Why is Integrated Dual Recovery Important?

• Integrated treatment has been proven consistently more effective
• Recognizing the relationship between the diagnoses can help recovery planning
• Treating one without the other usually leads to relapse of both
• There is no evidence that one disorder causes the other
• To be aware of the risks of returning to use
• Integrated treatment is often less expensive than separate treatments

Holistic Treatment at AMHRTF: Treating the Whole Person

At AMHRTF, we apply the findings of evidence-based research to the care of patients with dual diagnosed disorders. And, most important, we ask questions and listen when patients tell us their needs. Some people thrive in group therapy sessions, while others benefit more from one-on-one therapy. Overall, we strive to provide a safe, healing environment with minimal triggers for relapse.
We offer all of the traditional treatments for dual diagnosis such as:
• Psychopharmacology
• Individual therapy and addictions counseling
• Weekly Dual Diagnosis Support Group (run by patients)
• Weekly Dual Diagnosis Psychoeducation & Process Support Group (run by the clinician)
• Weekly Addiction Education Group, including nicotine cessation
• AA group meets weekly
• Relapse prevention and sobriety resources
• Milieu Therapy within a Supportive Community
During dual diagnosis groups, patients talk about the substance and mental health aspects of their recovery. They discuss triggers, coping skills, and how mental health conditions and substance abuse affect each other. They also share stories and support each other, fostering a sense of community. It is helpful for patients to hear others’ stories to understand that they are not alone, and to appreciate that other people have similar challenges.
AMHRTF is focused on the whole person, we put a great deal of emphasis on all aspects of a person’s health. We call this the Seven Domains of a Whole, Healthy Person:

Seven Domains of a Whole, Healthy Person

1. Physical wellness
2. Emotional and psychological health
3. Spirituality
4. Intellectual creativity and learning
5. Social and community connectedness
6. Purpose, productivity, and fulfillment
7. Empowerment and independence
We know that if a person is suffering in one of the areas above, even if it is not directly related to their diagnosis, it will be difficult to focus on healing. Our community work and service programs give patients a sense of purpose, productivity, and fulfillment. Work and service also aids our patients in feeling connected to the community.