Specialist Interview

Specialist Interview
Started at 4:00 PM 2/12/14

For our interview, we chose to talk to Dr. Saz Madison from the Psychology Department at Rockhurst University.  Here are the notes from the interview:

1.       What is your attitude on dealing with patients affected by schizophrenia?  Do you enjoy working with them?

Saz:  I have.  Very much… Any population I work with, I consider the situation a person that is dealing with (x) whatever the psychological dysfunction.  This is an individual. I do what I can to understand and predict and intervene in regards to their lifestyle.  When I see a schizophrenic, mostly I experience determination and excitement.  I enjoy working with populations who experience significant psychological disabilities.  People think of it as a diagnosis.  It’s really more accurate to recognize that schizophrenia as a constellation of disorders.  Many different subtypes constitute to a set of disorders.  It’s hard to say how I like working with it.

Sarah:  cuz it varies so much

Saz:  right.  For example catatonic – muscular not as active

Paranoid schizophrenics are more active because they experience hallucinations. It might be exhausting dealing with emotionally effusive schizophrenics with a flattening affect because there are intense types of interactions.

2.       As a psychologist, how are schizophrenics’ brains different from a normal person’s brain?

·         There is less grey matter in a schizophrenic’s brain.  Fluid filled area (think central ventricles) they are larger in a person with schizophrenia evidence of tissue atrophy/loss.  In terms of overall brain tissue there tends to be less. 

·         Increased activity in dopamine pathogens and might be responsible for positive symptoms of schizophrenia.  We don’t know if we get these changes in neuro-anatomy or neurophysiology as a result of the onset of the disorder or if these changes are from development of disorder. 

·         Consistently evidence of tissue loss or atrophy from the onset of this disorder.  We don’t have a lot of very definitive evidence for this.  There is evidence for decreased activity in the limbic system changes in function of the hypothalamus, not any particular structures, some changes in function of the thalamus (which makes sense if thought responsible for interpreting info about senses and then we have hallucinations that are sensory in nature). 

·         When some schizophrenics have speech problems then they may have differences in their Brocca’s and Wernicke’s, the primary language areas of brain.  If we don’t use parts of our brains then different areas of the brain encroach on that area of brain. 

·         Don’t know if changes are from thought disorder/language disorder resulting in neurological changes.  Neurological anomalies result in the development of the disorder. 

3.       What challenges are associated with treating patients affected by schizophrenia?

·         Saz:  answer on two levels.  Challenges overall and challenges with specific patients

·         Typically poor treatments for some aspects of schizophrenia.  Positive symptoms of schizophrenia have pharmacological treatments, whereas negative symptoms are difficult to treat.  Positive symptoms are things you get during onset, negative are things you lose, like emotional mobility. 

o   Example of student:  so excited to see student haven’t seen in a while then realize they’re going to prison oh no!

o   Males are more likely to experience negative symptoms

·         Professionals are not good at treating emotional issues.  Much better treatments for, getting a little better at treating emotional reciprocity…

·         positive treatments have great treatments (drug treatments) antipsychotics.  Do a good job with positive symptoms.  Hallucinations and delusions.  Good at doing that

·         Challenges in general are trying to figure out ways to intervene with negative symptoms in schizophrenia. 

o   Specific patient:  youngest schizophrenic/person he felt was appropriately diagnosed was 17 years old and one of his negative symptoms was he had severe atonality (like when we talk our tone changes, might go to something different, helps communicate with things). 

o   Had serious affecting flattening – tonal completely delayed experienced emotions when talking (monotone).  Once lived in an inpatient facility and we were taking them and some of the other residents on a day trip a canoe trip.  He was afraid of water.  So on the trip, he’s in a canoe with me and we’re going and he’s just sort of sitting there and I said you seem very very quiet and he goes (shakes head) and that’s it and well that’s ok and we keep talking and these are the things we’re going to try. 

o   The river had many turns and a branch touched his face and he says oh no oh no oh no and he flips the canoe and ends up in the water and he’s just so afraid and he’s terrified and says can’t swim can’t swim and while I’m getting my arm around him he couldn’t communicate to me the fear he was experiencing. 

o   Normally, when he got angry his voice would get a little louder. 

o   Couldn’t scream when he fell in water just loudly spoke. 

o   Got to the side of the river and on shore and he’s expressing the same emotions tonally except tears are going down his face.  How could I have anticipated that this would have happened in this experience?  Earlier when I was enthusing about the canoe trip, was he trying to communicate to me what he felt?  It’s challenging in regards to how do I get to the point where I’m good at anticipating that this individual will respond (how they will respond and what’s the best way to respond to them)

4.       There are several subtypes of schizophrenia.  Is there a subtype that you’ve experienced more than others?

·         Paranoid schizophrenia – it’s so significantly more common than the others that probably unless someone is specialized in a particular type it’ll be paranoid with positive symptoms

·         hallucinations and/or delusions (more frequently)

o   Hallucinations are still very very frequent in paranoid schizophrenia.  In terms of symptom prevalence paranoid with delusions of persecution.  ßanecdotal – probably the most common delusions found in people with paranoid schizophrenia.  Any delusions, false belief that there are forces outside of myself that are allied against me in some way. 

o   Example:  It may be in the form of I’m a university professor and I feel like my students are working against me so I won’t get hired and that one student is a super hero who is using her power to influence others to get students to get at me and I know this because I have had encounters with aliens before.  If I don’t engage in some behavior designed to protect me from then then I’ll be vulnerable. 

·         Sarah:  How do you deal with those interactions (without laughing)?

·         We laugh but the fact of the matter is any time we go into any field before we get into it and learn about it (especially post-grad education), we often think that we know how we will respond in certain situations.  We mature in knowledge, understanding, and professionally.  I was absolutely sure when I went to Rockhurst that I wanted to be a child psychologist.  Ended up that I didn’t have the emotional maturity to deal with it.  Swore would never do it again.  In undergrad I was not aware enough of what I would want and experience.  When experienced in grad school, I was not emotionally or intellectually prepared for the encounters in childhood psychology.  Now I can work with any population and I can respond to it. 

o   Purpose of rotations in grad school – really all part of professional development (literally us developing into a professional). 

1.       What are some of the most common misconceptions about the disease?

o   First one thinks of bothers him a lot.  People see them as dangerous/threatening.  A good way to characterize it is you picture the person standing on street corner talking to themself.  Oh hey there’s that crazy person.  Parent with children pull kids closer.  In actuality them engaging in negative acts is very unlikely, even more unlikely compared to normal people. 

o   We presume that because they suffer from psychological dysfunction that they are dangerous.  Significant mistreatment of them.  Leads to isolation.  We could avoid this.  They could have a better quality of life. 

o   Major misconception:  relates to what we talked about.  Schizophrenia means one thing that it’s one disorder which we can list criteria for.  However, it is a constellation of disorders.  Believe it could better be thought of as a schizophrenia spectrum disorder.  Much like autism spectrum disorder considered now.  The way it manifests itself in regards to the different types, they are all so fairly distinct but also functionally different.  We can anticipate different symptoms, levels of functioning, ability to engage in activities of daily living (for example) depending on the type. 

2.       Are there are any alternative treatments for the treatment of this disease?  Do you think they’re effective?

o   For positive symptoms I said psychopharmacology for positive symptoms best treatments

o   Talk therapies have yet to show empirical data

o   Cognitive therapies remediate some of the negative symptoms

o   Ex:  we talked about lack of social reciprocities:  behavioral social skills training interventions actually train the person with the disease who is experiencing symptoms

o   They can be taught to respond appropriately by helping them recognize social behaviors ex:  how to respond during a funeral or when to laugh and when not to

o   interventions are designed to increase my ability to engage in daily activities and get out and maintain employment, healthy relationships, romantic interpersonal relationships.  Behavioral interventions (most empirical support)

MISCONCEPTION:  can I say one thing about a misconception

o   A major misconception is that people think it’s a split personality.  That’s a completely different disorder (dissociative identity disorder).  Because it is schizophrenia and that it translates as “split mind”, they think that it means split personality.  Example:  Jim Carry movie – me, myself, and Irene – media feeding misconception

Have you ever heard about Jeni?  How do you feel about her?

o   Childhood diagnosis of major psychological disorders is bad.  Earlier this year, not me being/distracting, the APA released latest DSM5:  where we define what schizophrenia is.  One of the trends in DSM5 does a greater deal with childhood manifestations

o   The average age of onset for schizophrenia positive symptoms is young adulthood – very late teens into twenties this is when it typically manifests itself. 

o   Anything pre-pubescent aka any time diagnosis is made pre-puberty, I tend to be skeptical about those diagnoses.  There might be a better explanation for the behaviors being seen.  I am very behavioral oriented.  I believe that behavioral theory could go a long way in explaining the presence of many of these behaviors that are associated with schizophrenia in children. 

o   Example:  Have an obsession with set of items and engage in obsessive relationship with them (ex:  believe media is talking to them).  Behavioral theory suggests that those behaviors are shaped by the reinforcement in their environment and maintained by the presence of their environment. 

o   Example:  If you give attention for a behavior – child is being reinforced for performing behaviors (parents or teachers expect them to act that way, provide reinforcement for when they do behavior).

o   Example:  child who throws temper tantrum – parents – fix kid.  My first thought is why are you paying them to throw temper tantrums.  How do you respond when they do it?  You respond the way they want (too busy to pay attention). 

o   Example:  Friend is over, child throws temper tantrum for sweets, you’re embarrassed so you give them a cookie.  Child got what he/she wants, which increases likelihood of behavior

o   Behavioral theory can explain some adult schizophrenics.  Look at other possibilities before you think it is actual childhood onset.  Is it possible?  Yes, literature says that it is.  Have I ever seen a child be diagnosed with it?  No.  Youngest experience = seventeen year old with schizophrenia – agreed with diagnosis, a little skeptic at first but eventually agreed

o   Should look for alternative ideas for treatment

o   Our field (parent fields:  philosophy and biology) this sort of biological model, medical model that a lot of clinicians employed really leads us to look for a diagnosis which often leads us to missing the individual.  Might miss things that are specific to the individual.  Might be environmental conditions from parents behaviors – symptoms may be from psychosocial or environmental

o   Monica:  parents just want a label, don’t really care what’s going on just want to label kid

o   Saz:  look at it from parent or sibling, boy doesn’t it feel so much more comfortable to know what it is.  For professionals, to understand and intervene, we don’t have that luxury or at least it’s not appropriate for us.  It’s lazy and unethical.  I think it’s important that we look at the individual that is experiencing these things and respond to that individual.  If you get a diagnosis, that’s great for communication and treatment planning, but the important thing is the individual and they are idiosyncratic.  Sadly, we use this sort of population/data driven approach to make a decision about an individual sitting in front of us.  Want to respond to that individual first… sometimes there’s an over reliance on diagnosis

o   Think of it as people experiencing these life challenges – may be better to describe by explaining with this disorder or this disorder.  We are trying to understand human beings (don’t rely on label)

o   Danger to paying more attention to a diagnosis overall as opposed to the individual.  When looking at a diagnosis and no longer the person, you may miss something

o   Respond on level of individual not the level of the diagnosis.  Look at the whole picture not just one little side.

1.       What kind of perspective should people take?

o   Saz:  the way he approaches them, working with them, they are people who are suffering from psychological distress problems in life.  The way that we approach interacting with them initially family member, clinician is as that they are another human being.  They have had experiences that we cannot understand.  These people who are experiencing these difficulties that we cannot understand may be experiencing life differently because of misconceptions due to their disease.  They are treated poorly and they almost anticipate being treated dismissively or badly.  It’s a really unfortunate thing.

o   Approach them:  I like this part of the question.  Need to remember that schizophrenics recognize that they see the world differently and inaccurately.  It’s not consistent with the reality that everyone else experiences.  Now imagine coming to understand that the way you understand the world is not like anybody else.  All of these things I believe are wrong.  Someone who has visual or auditory hallucinations:  I have this friend I see all the time… what?  what do you mean they do not exist.  This is the reason depression is so frequent with diagnosis of schizophrenia. 

o   We should approach them with compassion and try to be as understanding as possible.  We have to approach them with humility.  If we go into interactions and expect what they’ll be like, we go in with assumptions that will mislead us with the interaction.

Interview ended at 5:04 PM 2/12/2014

Reflection:

1.       It was very insightful.  I learned things I had never thought of before.  Dr. Madison told many good stories.  We really enjoyed his quote that we are trying to understand human beings not focusing just on diagnosis.  I learned how schizophrenics saw the world and how diverse the disease is.  When we asked him about misconceptions, he opened our eyes to many different aspects of this disease. 

2.       From the interview, we had a change of insight.  We feel more caring and compassionate toward schizophrenics.  We feel less afraid of approaching people with this disease.  Dr. Madison told us to approach schizophrenics with compassion and humility. 

3.       The only thing that disturbed us from the interview was his example of his patient that could not express his emotion.  We felt that it would be frustrating as the therapist to have to find ways to understand and help with that.  We were also disturbed by the one size fits all diagnosis that is given by many psychologists that help people with psychological disorders. 

4.       The connections we had between the interview and the classwork we have been doing was how he mentioned that schizophrenia can be highly hereditary.  Also, we had asked him about how schizophrenia affected brain function in an attempt to compare what he said to what we had researched in our first blog post.  Dr. Madison also seemed very surprised and interested in us contributing to grid-computing for our evolution class.