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The Prodromal Stage of Schizophrenia

Schizophrenia is a mental health disorder characterized by continuous or relapsing episodes of psychosis. “When schizophrenia is active, symptoms can include delusions, hallucinations, disorganized speech, trouble with thinking, and lack of motivation,” according to the American Psychiatric Association. “With treatment, most symptoms of schizophrenia will greatly improve and the likelihood of a recurrence can be diminished.”

As the late Colorado Recovery founder Richard Warner made clear in The Environment of Schizophrenia, the popular view that “schizophrenia has a progressive and downhill course with universally poor outcome is a myth. Over the course of months or years, about 20 to 25 percent of people with schizophrenia recover completely from the illness—all their psychotic symptoms disappear and they return to their previous level of functioning.”

As Dr. Warner explained, there is wide variation in the course of schizophrenia. In some cases the onset is gradual, “extending over the course of months or years; in others it can begin suddenly, within hours or days. Some people have episodes of illness lasting weeks or months with full remission of symptoms between each episode; others have a fluctuating course in which symptoms are continuous; others again have very little variation in their symptoms of illness over the course of years.”

Schizophrenia symptoms often only emerge well into adulthood, typically from the late teens to early 40s. The actual onset of psychosis is frequently preceded by a prodromal stage, wrote Michelle Pugle in a recent article on Verywellhealth.com, “where people (often still in adolescence) begin experiencing pre-psychotic mild or moderate disturbances in everyday functioning, including speech and movement difficulties. These changes can be attributed to heredity, genetic, environmental, and other causes.”

“Psychosis is preceded by a 3–4-year prodromal phase characterized by non-specific symptoms and deficits in approximately 75 percent of patients with a first episode of psychosis (FEP),” according to Michael First, Professor of Clinical Psychiatry at Columbia University in New York.

Since the prodromal phase is the earliest phase and schizophrenia symptoms are absent, it’s commonly diagnosed only after a person has entered the active phase of the disorder.

“Prodromal symptoms are generally seen as unspecific symptoms of schizophrenia (those involving an absence of normal interactions and functioning) that evolve over time,” wrote Pugle. “They can fluctuate in intensity, severity, and length of time. Such symptoms can begin in adolescence and the teenage years, although they aren’t likely to be seen as such unless a future diagnosis of schizophrenia is made later in life (a retrospective diagnosis).”

Early indicators are easy to miss. Small changes to personality and behavior or normal routine could be some of the first signs of prodromal phase schizophrenia. As we reported on this blog, researchers recently found new clues in young adults that could help predict the severity of symptoms later in life. According to their study published in the Journal of Abnormal Psychology, “Early detection of subtle, nonpsychotic forms of perceptual disturbance may aid in identifying individuals at increased risk for nonaffective psychosis outcomes in adulthood. Perceptual aberrations may constitute a useful endophenotype for genetic, neurobiological, and cognitive neuroscience investigations of schizophrenia liability.”

Early signs and symptoms of schizophrenia may include:

Nervousness and/or restlessness
Depression
Anxiety
Thinking or concentration difficulties
Worrying
Lack of self-confidence
Lack of energy and/or slowness
A significant drop in grades or job performance
Social isolation or uneasiness around other people
Lack of attention to or care for personal hygiene

“Some of the prodromal signs, such as a significant change in personal hygiene and a worrisome drop in grades or job performance, can also be early warning signs of other issues, including psychosis or detachment from reality,” explained Pugle in the article.

If your child or teen starts showing the above signs and symptoms, talk to a pediatrician or mental health professional as soon as possible. Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. About half of our clients are under 35 years of age and we expect good outcomes regardless of the duration of the disorder. Clients of any age will feel comfortable in our program. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

How Vocational Rehabilitation Can Reduce the Symptoms of Schizophrenia

People with schizophrenia can be treated effectively in a variety of settings with hospitalization mostly reserved for acute cases. Outside of a hospital environment, treatment should include social rehabilitation. People with schizophrenia typically need help to improve their functioning in the community. This can include training in basic living skills, assistance with a host of day-to-day tasks, job training, job placement, and work support.

Sadly this aspect of treatment is frequently missing. “Lacking a useful social role, many people with mental illness face lives of profound purposelessness,” wrote the late Colorado Recovery founder Richard Warner, MD, in The Environment of Schizophrenia (2000).

This situation leads to severe functional deficits in schizophrenia, In a recent presentation for Psych Congress Network, Leslie Citrome, MD, MPH, clinical professor of psychiatry and behavioral sciences at New York Medical College, Valhalla, NY, in a recent presentation for Psych Congress Network about he importance of psychological rehabilitation, such as cognitive remediation and vocational rehabilitation in the treatment of schizophrenia.

The numbers are quite shocking. “Only 10 percent of all patients with schizophrenia work full-time. Only one-third ever worked part-time,” said Citrome. “Fewer than 10 percent of male patients with schizophrenia have a child, and the self-care deficit is reflected in high rates of medical comorbidity.”

These deficits are a big problem but there are things that can be done to change the situation. “Cognitive behavioral therapy or CBT, although it’s labor-intensive, can be helpful, even in patients considered treatment-refractory, and has been evaluated in controlled clinical trials in patients with treatment-resistant schizophrenia,” explained Dr. Citrome.

“Cognitive remediation is a very specific type of treatment. It’s a set of drills or interventions designed to enhance cognitive functioning. It’s a therapy that engages the patient in learning activities that enhance neurocognitive skills relevant to their chosen recovery goals. It’s very personalized.”

Ultimately, psychosocial rehabilitation includes improving functional and subjective outcomes. It consists of is a range of techniques, including CBT and cognition remediation, as well as addressing patient employment.

Meaningful employment is an important aspect of the treatment model originated by Dr. Warner. Clinical research shows that “patients discharged from psychiatric hospital who have a job are much less likely to be readmitted to hospital than those who are unemployed, regardless of the patient’s level of pathology,” as Dr. Warner wrote The Environment of Schizophrenia.

Dr. Citrome agreed. “One of the key goals in psychosocial rehabilitation is helping patients live independently and be employed. Employment is identified as a goal for most of our patients. They’ll tell us on many occasions, ‘Yes, I’d like to have a job.’”

There are multiple barriers to employment that need to be addressed starting with the psychiatric symptoms. In addition, there may be substance misuse, non-psychiatric medical conditions, stigma from employers, internalized stigma, and low self-confidence—even the fear of losing disability benefits.

“Vocational rehabilitation addresses these barriers by providing skill training, sheltered workshops, transitional employment, and supported employment, as well as the maintenance of benefits,” said Citrome.

Finding appropriate employment for patients is an important part of the treatment plan at Colorado Recovery. Employment support includes helping clients find a job, go back to school, or find volunteer work in the community.

“Patients who received both cognitive remediation and vocational rehabilitation demonstrated significantly greater improvements on a cognitive battery over three months than those who received vocational rehab alone and had better work outcomes over the two-year follow-up period,” explained Citrome. “A comprehensive approach is better, and for those community settings that can offer this, their patients are better off. With employment, one may expect increased self-esteem, reduction in symptoms and hospitalizations, enhanced social functioning, and improvement in overall quality of life.”

Empowerment and vocational rehabilitation are crucial elements of the Warner model. “Work helps people recover from schizophrenia. Productive activity is basic to a person’s sense of identity and worth,” Dr. Warner wrote. “Given training and support, most people with schizophrenia can work.”

The Colorado Recovery program approaches mental healthcare with a focus on self-reliance through developed practiced skills. Our non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation. Those in our care go to school, volunteer, or are employed in the beautiful surrounding Boulder area where they regularly take advantage of all it has to offer recreationally.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Perceptual Distortions in Young Adulthood May Predict Later Schizophrenia Symptoms

“Schizophrenia researchers have long been puzzled about why the illness normally begins in adolescence when important risk factors such as genetic loading and neonatal brain damage are present from birth or sooner,” wrote Colorado Recovery founder Richard Warner, M.D., in The Environment of Schizophrenia. “Many believe that the answer to this puzzle could tell us a lot about the cause of the illness.”

Schizophrenia is often diagnosed well into adulthood, typically from the late teens to early 40s. Researchers recently found new clues in young adults that could help predict the severity of symptoms later in life. According to a study published in the Journal of Abnormal Psychology, “Early detection of subtle, nonpsychotic forms of perceptual disturbance may aid in identifying individuals at increased risk for nonaffective psychosis outcomes in adulthood. Perceptual aberrations may constitute a useful endophenotype for genetic, neurobiological, and cognitive neuroscience investigations of schizophrenia liability.”

Study author Mark F. Lenzenweger, Ph.D., of the State University of New York at Binghamton and Weill Cornell Medical College in New York City found that subtle differences in perception during their late-teen years predicted the development of hallucinations, delusions, and, in some instances, psychosis later in life. These early perceptual distortions included a heightened awareness of sound or color, uncertainty about the boundaries of one’s body, feeling that the world around them is tilting, and similar experiences.

“We discovered that people, who were free of psychotic illness at age 18, would show hallucination and delusion symptoms in mid-life if they showed many very subtle disturbances in their perception early on,” he said. Anxiety and depression played no role in the development of psychotic symptoms in mid-life, Lenzenweger added.

The precise causes of illnesses such as schizophrenia are largely unknown, although genetics and brain-based factors are known to play an essential role. Approximately 3.5 million people have the illness in the United States, with an estimated annual healthcare cost of more than $155 billion.

“These new findings point to a specific focus for future research to drill more deeply into the biological factors driving psychotic illness and real-world experiences in the form of perceptual disturbances,” Lenzenweger said. “Understanding the nature of such perceptual aberrations might provide more clues as to what is going on in the development of schizophrenia and other similar conditions.”

The Colorado Recovery treatment model emphasizes the experience of empowerment, the strengthening of social relationships, and overall support for people with schizophrenia to improve all aspects of their lives. Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Words That Stigmatize

“Since first being diagnosed with depression and generalized anxiety in my early 20s, I felt the stigma of being considered ‘abnormal,’” remembered journalist and author Steven Petrow in a recent article in the Washington Post. Petrow often used to hear friends use pejorative words like “nuts,” “psycho,” “schizo,” “insane” and “looney tune” as general insults to anyone for any transgression. The not-so-subtle message he perceived: It’s okay to mock those with mental health issues—that “we are somehow weird, stupid, scary, or dangerous.”

Sadly, the stigmatization of people with mental health issues has a long history.

“Research on the stigma of mental illness has been fueled by interest in labeling theory. Once a deviant person has been labeled ‘mentally ill,’ argues sociologist Thomas Scheff, society responds in accordance with a pre-determined stereotype, and the individual is launched on a career of chronic mental illness from which there is little opportunity for escape.” wrote Colorado Recovery founder Richard Warner in his 1985 book Recovery from Schizophrenia.

Those stereotypes are largely still with us. And they are still exacerbating the mental health issues of many Americans.

“Stigmatizing language can become a stumbling block to treatment and support and increases the likelihood of these problems worsening before treatment is instituted,” Petrow wrote in the Washington Post. “According to the American Psychiatric Association, more than half of people with mental illness don’t get help for their disorders because they fear being treated differently or losing their jobs.”

When the Warner model of treating mental illness is all about empowerment, stigmatization is all about discrimination and disenfranchisement. Recovery from mental illness is about more than just controlling symptoms and staying out of psychiatric hospitals. It is about regaining a sense of identity, belonging, and purpose in life.

Empowerment is essential if people with mental health issues are to overcome the prejudices that many Americans still carry with them: the stereotype that makes them believe a person with a mental illness is incapable, unpredictable, even violent, and worthless.

Before his death in 2015, the late Dr. Warner noted that “popular television programs often depict people with mental illness as dangerously violent.” A 1992 study found that an astonishing 58 percent of respondents considered “lack of discipline” a cause for mental illness. Almost three decades later, Petrow makes a similar point, noting how Piers Morgan, a British television personality, criticized tennis player Naomi Osaka after she quit the French Open for mental health reasons as “an arrogant spoiled brat” who was “weaponizing mental health to justify her boycott.”

Gymnast Simone Biles didn’t fare much better after citing mental health concerns as her reason for pulling out of several Olympic competitions in Tokyo. “Media representation of the mentally ill have shown little improvement since the Second World War,” wrote Dr. Warner in The Environment of Schizophrenia (2000).

It may slowly be changing for the better now. Petrow’s niece, “a 21-year-old college senior, lives with generalized anxiety disorder, adjustment disorder, and attention-deficit/hyperactivity disorder but has made clear she does not feel stigmatized. Her grandmother, my mom, would be proud of her openness and that she has sought treatment at a relatively early age.”

When Petrow asked her about the mean-spirited words some directed at Biles, she replied: “The language of belittling it, just putting ‘mental health issues’ in quotes, that’s super problematic because it’s making a serious issue. You just can’t do that anymore. That’s not where we’re at as a society, at least not in my generation.”

Our modern, non-institutional approach to living with mental health disorders is focused on individual empowerment and provides the services needed to address schizophrenia, bipolar disorder, and other serious conditions. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Employment Support at IOP Level

Colorado Recovery has expanded services outside our signature continuum of care. We are now admitting directly into our intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care, or for those in the process of stepping down from another program. One of the offerings now available at the IOP level is our employment group.

Meaningful employment is an important aspect of the treatment model originated by our late founder, Richard Warner. Clinical research shows that employment can improve outcomes of mental health treatment. “Several studies have shown that patients discharged from psychiatric hospital who have a job are much less likely to be readmitted to hospital than those who are unemployed, regardless of the patient’s level of pathology,” Dr. Warner wrote The Environment of Schizophrenia.

“Finding suitable employment for clients as part of their treatment plan is the task of the employment group,” explains relocation counselor Dalma Farkas. “Clients learn and practice social skills which are essential for job searches and placements. Participants receive continued support, assistance, and encouragement—from each other as well—to successfully get back into the labor market.”

Employment support includes helping clients find a job, go back to school, or find volunteer work in the community. The group covers a lot of territory: how to write a stellar resume, how to prepare for a job interview, and how to keep a job.

Farkas usually gets things rolling with a thorough career assessment. “I ask them what they would like to do, what’s their dream job? I inquire about their job record and also find out what didn’t work for them to avoid bad experiences in the future.”

The trick is not to overwhelm clients. “We choose two to three job openings, but not more. We work on the resume to fit the job description. And, of course, we prepare clients for job interviews, going over a lot of possible questions like ‘Where do you see yourself in five years?’ or ‘What is this gap in your resume?’ We prepare at least 20-25 questions.” says Farkas. “They practice every day and when they get the job, we’re not done, either. We check in, ask how it is going, and inquire about the stress levels. Every client is different and has different needs so we need to be attentive and flexible.”

Sometimes, Farkas recommends a short job experience just to practice being in a work environment. Many clients don’t have an extensive employment history, they are typically young people who haven’t had much of a career, so they require quite a bit of help.

“Often, they don’t really know what to do, that’s where I come in,” says Farkas. “They may have tried the wrong job with long shifts that exacerbated their symptoms. We’re using those work experiences to find the right job for them. We avoid stressful, triggering places to avoid a relapse.”

The Warner model is all about empowerment through engagement because if people with mental illness lack a useful social role, they “face lives of profound purposelessness,” as Dr. Warner wrote. Like most of us, they are much healthier if they care passionately about their job.

“I try to find jobs for our clients that are also their passion,” says Farkas. “Employment that still allows for recreational activities. Not a job that makes them go home exhausted and that makes their symptoms worse. Employment is supposed to improve their health after all.”

Another option is volunteer work. “Most of them have never volunteered before but Boulder offers many fantastic options here, one of my clients recently volunteered at a local museum,” recalls Farkas. “It turned out to be perfect for her—she is the happiest person now.”

For more information about direct admission to our intensive outpatient program or our other services, connect with a specialist who can answer your questions at (720) 218-4068.

Assessing Cognitive Symptoms in Schizophrenia

Cognitive dysfunction is a core feature of schizophrenia, wrote Christopher Bowie and Philip Harvey in their study “Cognitive deficits and functional outcome in schizophrenia.”

“Deficits are moderate to severe across several domains, including attention, working memory, verbal learning and memory, and executive functions. These deficits pre-date the onset of frank psychosis and are stable throughout the course of the illness in most patients.”

It is now widely recognized that these deficits are among the best predictors of functional outcomes in schizophrenia. In a recent presentation for Psych Congress Network, Leslie Citrome, MD, MPH, clinical professor of psychiatry and behavioral sciences at New York Medical College, Valhalla, NY, discussed the significance of cognition in schizophrenia.

“We’ve known for quite some time about the positive symptoms of schizophrenia, such as delusions and hallucinations, and the negative symptoms of schizophrenia, such as the lack of motivation, lack of interest, and difficulty in expressing emotion,” Dr. Citrome explained.

“We’ve also learned to acknowledge the existence of cognitive dysfunction. Problems, for example, with verbal fluency, with paying attention, with problem-solving. At the same time, we’ve also paid more attention to the affective symptoms of schizophrenia. These overlap somewhat with negative symptoms.”

Cognitive impairment is quite common in people with schizophrenia. This has been confirmed by a number of studies. For example, in a 2019 study published in the American Journal of Psychiatry, Zanelli, Mollon, et al. found that patients with schizophrenia and other psychoses had a cognitive decline in memory, verbal learning, and vocabulary over a 10-year period.

“Cognitive impairment occurs in first-episode and chronic schizophrenia,” said Dr. Citrome. “We can observe that people with schizophrenia have a lower degree of cognitive abilities, relative to the general population, right from the beginning.”

Cognitive dysfunction can serve as an early warning sign. “This can be apparent at the very first episode. In fact, can predate the first episode of psychosis,” said Citrome. “People who are in the prodrome, or even in their childhood or adolescence, can exhibit some degree of cognitive impairment.”

It’s not always easy to detect cognitive impairment associated with schizophrenia. In his presentation, Citrome explained some of the diagnostic tools. “Cognition in clinical trials with schizophrenia can be formally assessed using neuropsychological testing. The standard today is to use a battery of tests called the MATRICS Consensus Cognitive Battery or MCCB.”

The MCCB consists of 10 tests that include testing the speed of processing, attention or vigilance, working memory, verbal learning, visual learning, reasoning and problem-solving, and social cognition.

Measuring cognition has an important purpose. “Cognitive deficits do predict functional outcomes,” explained Dr. Citrome. Testing cognition “helps us predict how well someone will function.”

Current research appears to indicate that the existence of positive schizophrenia symptoms may not necessarily impair functioning, but impairment of cognition can lead to impairment in functioning, and negative symptoms may impair functioning.

That means that “hallucinations and delusions by themselves aren’t going to be the determinants whether someone can work or have social relationships,” said Citrome. “It’s going to be negative symptoms and cognitive impairment.”

The Colorado Recovery treatment model emphasizes the experience of empowerment, the strengthening of social relationships, and overall support for people with schizophrenia to improve all aspects of their lives. “Recovery from mental illness is about more than just getting rid of the symptoms and staying out of hospital. It is about regaining a sense of identity, belonging, and meaning in life,” said the late Richard Warner, M.D. and founder of Colorado Recovery.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

The Correlation of Mental Health and Substance Use Disorders

According to the National Survey on Drug Use and Health, 9.5 million adults in the United States experienced both mental illness and a substance use disorder (SUD) in 2019. It’s a well-known correlation, complicating the treatment of the mental health disorder and the SUD.

“Many individuals who develop substance use disorders are also diagnosed with mental disorders, and vice versa,” explains an information page of the National Institute on Drug Abuse (NIDA). “Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa.”

Mental health conditions and SUDs are frequently co-occurring because many people with addiction are primarily misusing addictive substances to self-medicate emotional pain caused by serious mental health disorders.

According to NIDA, “Data show high rates of comorbid substance use disorders and anxiety disorders—which include generalized anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD). Substance use disorders also co-occur at high prevalence with mental disorders, such as depression and bipolar disorder, attention-deficit hyperactivity disorder (ADHD), psychotic illness, borderline personality disorder, and antisocial personality disorder. Patients with schizophrenia have higher rates of alcohol, tobacco, and drug use disorders than the general population.”

Trauma in particular is an important predictor for substance misuse. According to PTSD United, 70 percent of adults in the US have experienced some type of traumatic event at least once in their lives, and 20 percent of those adults suffer from PTSD. Many traumatized people self-medicate with alcohol and drugs. “For many, if not most, people with addiction, trauma is perhaps the critical factor that causes the problem,” writes addiction expert Maia Szalavitz in her influential book Unbroken Brain.

The combination of bipolar disorder and substance misuse may be particularly challenging to diagnose and treat successfully. “Comorbid bipolar disorder and substance use disorder are frequently the rule rather than the exception,” wrote Suzanne Bujara on Psychiatry Advisor. “Bipolar disorder has among the highest rates of comorbidities, including anxiety disorders, obsessive compulsive disorder, impulse control disorders, eating disorders, cardiovascular and respiratory disorders, and sleep apnea. Not only are comorbid bipolar disorder and substance use disorder difficult to manage, but they also increase a patient’s likelihood for chronic infectious diseases, injury, and suicide.”

Co-occuring mental health and substance use disorders should be addressed concurrently in a comprehensive treatment program addressing all needs of such patients. “Dual diagnosis” is a term used to describe the presence of addiction and other co-occurring mental health conditions.

Colorado Recovery understands the importance of coordinated and integrative treatment care and provides substance use services to all clients who require them as part of a specialized dual diagnosis track. We recognize that many of our clients have employed non-prescribed substances to control the symptoms of their mental illness, and as a consequence may have exacerbated their health issues.

The treatment process at Colorado Recovery starts with evidence-based assessment instruments that help a client understand the severity of their substance use disorder. Colorado Recovery uses the Substance Abuse Subtle Screening Inventory (SASSI-4) an empirically tested tool with a high-reliability rate. We also use the Addiction Severity Index (ASI-6) which was introduced in 1980 and it is probably the most widely used instrument to assess the severity of substance use disorders. Colorado Recovery also has the ability to administer screening tools to assist in identifying gambling and internet addiction disorders.

Colorado Recovery provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Movement Therapy at IOP Level

Colorado Recovery is now expanding services outside our signature continuum of care. We are admitting directly into our intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care, or for those in the process of stepping down from another program. One of the offerings now available at the IOP level is our movement therapy group.

Dance/movement therapy (DMT) is defined by the American Dance Therapy Association (ADTA) as “the psychotherapeutic use of movement to promote emotional, social, cognitive, and physical integration of the individual, for the purpose of improving health and well-being.”

“The basic tenet is that emotions live in the body,” says Colorado Recovery’s movement therapist Elise Alvarez. “It’s about creating awareness around clients, and then use movement to process those emotions. In case of anger management issues, we could ask ‘Is there a specific part of your body that you feel anger in?’ Anxiety might manifest as feeling a weight in the chest.”

By expanding the awareness of such feelings, people are better able to recognize what’s happening in each present moment and then make more informed decisions about their feelings instead of simply reacting to them impulsively.

Even without verbal information, movement therapists are able to work with their clients. According to the ADTA movement is everybody’s first language. Without using words, just moving the body “can be functional, communicative, developmental, and expressive. Dance/movement therapists observe, assess, and intervene by looking at movement, through these lenses, as it emerges in the therapeutic relationship in the therapeutic session.”

Alvarez goes into each session with a couple of specific ideas to be able to address the needs of individual clients in each particular group. In one recent session, she had clients toss a ball to each other in a pattern – a kind of group juggling. The purpose of the little game was to make people “wake up a little bit and become alert to what’s happening right now,” says Alvarez.

Movement therapy has also physical benefits like improving reflexes and coordination. Group games strengthen cohesive teamwork, connecting people to each other as they work as a unit.

“Sometimes we just throw a frisbee around—just having the movement aspect makes it feel more natural and fluid. People may open up a bit more because they’re moving and not just sitting in a circle, talking.” There is also walking meditation: “Everybody is paying attention to bodily sensations while walking, catching the mind should it start to wandering off,” says Alvarez. “At the end of a session we typically share our experience with the group. Our checkout question is often ‘How we are feeling right now?’”

For more information about direct admission to our intensive outpatient program or our other services, connect with a specialist who can answer your questions at (720) 218-4068.

Treehouse Planning Session at IOP Level

Colorado Recovery is now expanding services outside our signature continuum of care. We are admitting directly into our intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care, or for those in the process of stepping down from another program. Community integration and social engagement continue to be at the heart of the approach, setting the course for a life of engagement, purpose, and connection.

This non-institutional approach created by Colorado Recovery founder Richard Warner is key to outcomes associated with independence and self-respect. One of the offerings now available at the IOP level is our Treehouse Planning Session.

This group gives clients the opportunity to participate in their recovery plan and voice what they seek from the psychosocial program. We review any needs that they have toward connecting and contributing to the community or improving the space. It’s also a time for people to meaningfully get to know each other and develop friendships outside of a strictly therapeutic setting.

Dr. Warner considered schizophrenia and similar conditions bio-psycho-social disorders significantly affected by the environment surrounding the client on multiple levels. The Warner method harnesses the benefits of client empowerment to increase skills and work preparedness and assist them with social integration.

The Treehouse planning group is an important element of that. On the one hand, it’s “a safe space to take a break and just hang out,” says Treehouse community organizer Elise Alvarez. “At the same time, it’s a great opportunity to build more comfortable relationships.” The Treehouse group highlights the value of social integration, “many people have found roommates and best friends here,” says Alvarez. “Treehouse gives a population that doesn’t have too much opportunity to socialize the chance to do just that.”

People are able to reach a deeper level of knowing one another while engaging in fun activities. “Hiking is always the most popular group,” reveals Alvarez. “Especially people who are not from Boulder appreciate the nature side Colorado Recovery has to offer.”

In Treehouse planning, people work out their budget, another aspect of empowerment. “It’s an important skill to come to a decision yourself and not just defer to the judgment of the coordinator. Often, I keep pushing it back to them, telling them ‘this is your space,’ so they get to make the call.”

It’s important to give clients some measure of control, to let them work out the budget and create the space the way they want it to be. “We typically start with me making announcements, and then open the floor to things they want to talk about,” explains Alvarez. “We’ve had discussions about terminology: should it be mental illness or biopsychosocial disease? Other times, we plan out dinners or days at the beach.”

For more information about direct admission to our intensive outpatient program or our other services, connect with a specialist who can answer your questions at (720) 218-4068.

People With Schizophrenia Have A Higher Risk of Suicide Study Confirms

The suicide risk for people with schizophrenia between the ages of 18 to 34 years is ten times higher than that for the general US population, according to a new study published in May.

The study from the Columbia University Department of Psychiatry looked at a large population of adults diagnosed with schizophrenia and found that the youngest group (18-34) had the highest suicide risk and those aged 65 and older the lowest. By comparison, in the general US population, the reverse is true: younger adults have a smaller risk and older age groups have a greater risk.

The Columbia study, published online in the journal JAMA Psychiatry also showed that people with schizophrenia, overall, have a 4.5-fold increased risk of dying from suicide, the 10th leading cause of death in the United States.

“When a person with schizophrenia is becoming suicidal, an attempt can happen with little warning,” said Mark Olfson, Elizabeth K. Dollard professor of psychiatry at Columbia and lead author of the study. “Often, suicidal behavior in schizophrenia is driven by psychotic processes. This aspect can make it difficult to anticipate and prevent.”

The study, which provides a significant amount of data on age and suicide risk, could help suicide prevention efforts for people with schizophrenia. “Knowing more about which age groups and what personal characteristics are linked to higher risk could increase attention and support for the most vulnerable patients,” Olfson said.

Colorado Recovery founder Richard Warner believed that recovery rates for schizophrenia and suicidal thoughts are also linked to the social and economic environment.

In his classic Recovery from Schizophrenia, Dr. Warner pointed out a strong statistical correlation between lack of employment and suicidal ideation. “Work problems, economic stress, and unemployment appear to be important in precipitating suicide.” (2nd edition, 1994)

Unfortunately, discrimination and stigma prevent many people with a mental illness such as schizophrenia and bipolar disorder from finding purposeful employment. Too many of their fellow citizens believe people with such mental disorders are unable to work.

In a more recent book, The Environment of Schizophrenia, Warner wrote that “the mentally ill are among the most alienated people in our society, daily confronting the key elements of alienation—meaninglessness, powerlessness, normlessness, and estrangement from society and from work.” This induces an “existential neurosis” which in turn drives a significantly higher risk of suicide. “Many people with mental illness face lives of aimlessness and boredom,” wrote Warner.

Work can help overcome that sense of aimlessness and provide a better chance of recovery. “Productive activity is basic to a person’s sense of identity and worth. Given training and support, most people with schizophrenia can work,” Warner wrote. A productive life in recovery can also shield from suicidal ideation.

Colorado Recovery approaches care for mental health based on a path of self-reliance through developed practiced skills. This non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.