From medication to education
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From Medication to Education. Eve Mandre, doctoral dissertation Lund University 2002. Problem area. Suspected autism spectrum disorders in longterm psychiatric patients Patients can not be understood or treated from existing diagnoses

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From Medication to Education

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From medication to education

From Medication to Education

Eve Mandre, doctoral dissertation

Lund University 2002


Problem area

Problem area

  • Suspected autism spectrum disorders in longterm psychiatric patients

  • Patients can not be understood or treated from existing diagnoses

  • General psychologic knowledge insufficient for understanding behaviour


Educational programme

Educational programme

  • In 8 clinical psychiatric units in different areas of Sweden(in-patient, out-patient, forensic)

  • 6 two-hour-long sessions in the course of 8-12 months

  • Total of 100 participators: 60 on a more regular basis

  • Learning process evaluated through documentation, interviews, questionnaires


The learning process documented

The learning process documented

  • This was new for me in to-day´s session…

  • I did not previously think that…

  • There was really nothing new for me in to-day´s discussions

  • In other respects, I thought/was of the opinion…


Training sessions based on

Training sessions based on

  • The needs of each unit

  • Problem oriented

  • Patient focused

  • Anchored in the daily reality


Understanding autism as atypical psychological development

Understanding autism as atypical psychological development

  • Can not be understood from general psychological knowledge

  • Social dimension of learning is lacking

  • Consequences for personality development

  • Consequences for cognitive development


Early development

Early development

  • Face-to-face interaction

  • Rythm, turn taking, expectations on others´actions

  • Develops and consolidates non verbal communication

  • Assimilates inner image of The Other as partner in interaction


Social learning

Social learning

  • Perception is social and cultural

  • Social learning crucial for personality development

  • Self-image develops in dialogue

  • Common meaning and symbols develop through social learning


The world of objects

The world of objects

  • Assimilation through social interaction

  • The child seeks The Other´s reaction

  • Emotion+object= new concept


Concept formation

Concept formation

  • Is social and cultural – not only developmental

  • Through imitation and social interaction

  • Through language use

  • Through variation


Early symbolization and generalization

Early symbolization and generalization

  • Example (blocks on a slanting surface)

  • Imitation (trial, new experience)

  • Abstraction (the principle of slanting surface)

  • Generalization (slanting surface =slide on the playground)


Inner speech

Inner speech

  • Develops thinking

  • Inhibits impulsivity

  • Tries out possibilities before acting

  • Analyses, recreates new entities

  • Orientation towards future


Higher mental processes

Higher mental processes

  • Inner speech directs perception and organizes actions

  • Compares present to past and future

  • The symbols of language can select parts and reconstruct events

  • Ability for self-reflection


Thinking in complexes

Thinking in complexes

  • Thought is tied to the concrete and real

  • Unable to abstract elements and use in other context

  • Can not mentally reconstruct into new combinations


Consequences for learning

Consequences for learning

  • Obstacle for in-depth learning

  • Inability to move out of own frame of reference

  • Difficulties adapting to new demands

  • Absence of self-awareness


Quantitative results for patients

Quantitative results for patients

  • Re-evaluations (6 cases)

  • New diagnosis (2 cases)

  • Changes in treatment/new treatment plans (all cases)

  • Referred to community services (LSS)

    (3 cases, 2 from forensic psychiatry)

  • Referred from outpatient to inpatient unit (1 case)


Qualitative results staff reorientation

Qualitative results: staff reorientation

  • Staff gained useful knowledge of autism and educational approaches

  • Better understanding of patients leads to more adequate treatment

  • ”Unlearning” of previous knowledge

  • Increased staff´s behavioral repertoire


Qualitative results new knowledge in old organizations

Qualitative results: new knowledge in old organizations

  • New assessment creates problems

  • Individualized treatment problematic in existing organizations

  • Staff education problematic in existing organizations


From medication to education people with autism in adult psychiatry

From Medication to Education-People with Autism in Adult Psychiatry

  • http://www.english.certec.lth.se/doc/frommedicationto/


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