Schizophrenia - Psychological Therapies

Question 1

Relationship between psychological and biological therapies?

Answer 1

Although the use of antipsychotic drugs is crucial in the treatment of SZ, additional psychological treatments are needed to sustain improvement

Question 2

Types of psychological therapies?

Answer 2

CBT and family intervention

Question 3

Assumption of CBT?

Answer 3

People have distorted beliefs which maladaptively influence behaviour, e.g. delusions result from faulty interpretations of events

Question 4

CBT recommendations in NICE 2014 guidelines?

Answer 4

For 1st and subsequent acute episodes, delivered on a one-to-one basis over at least 16 planned sessions

Question 5

Researcher on CBT?

Answer 5

Drury et al

Question 6

Drury et al?

Answer 6

Benefits of CBT in terms of a reduction of positive symptoms and a 25-50% reduction in recovery time for patients given a combination of CBT and medication

Question 7

How many stages in CBT?

Answer 7

4

Question 8

1st stage of CBT?

Answer 8

ABC model is used to help patients organise confusing experiences

Question 9

Example of using ABC model?

Answer 9

Rating intensity of distress in experiences on a scale of 1-10 and identifying what activating events seemed to cause the consequences

Question 10

2nd stage of CBT?

Answer 10

Therapist uses methods to encourage the client to test the validity of their beliefs

Question 11

Examples of methods used to test validity of beliefs?

Answer 11

Empirical disputing, logical disputing, pragmatic disputing and evaluating the content of their delusions/internal voices

Question 12

Example of logical disputing?

Answer 12

“Does it make sense that the voices come from the radiator? In general do radiators talk?”

Question 13

Example of empirical disputing?

Answer 13

“Can you think of any events that have happened which give you evidence that the shop keeper wants to kidnap you?”

Question 14

Example of pragmatic disputing?

Answer 14

“How has believing that if you tell people about your visions that they will no longer speak to you helped you?”

Question 15

3rd stage of CBT?

Answer 15

Develop own alternatives to maladaptive beliefs, looking for alternative explanations and coping strategies already present in mind, and setting goals

Question 16

4th stage of CBT?

Answer 16

Replaces disordered or delusional thinking with rational thought processes

Question 17

Strengths of effectiveness of CBT?

Answer 17

Reduces positive symptoms

Lots of benefits

Question 18

Weaknesses of effectiveness of CBT?

Answer 18

Methodological

Question 19

CBT reducing positive symptoms?

Answer 19

Gould et al

Question 20

Gould et al?

Answer 20

Statistically significant decrease in positive symptoms of SZ after CBT (meta-analysis of 7 studies)

Question 21

Research on benefits of CBT?

Answer 21

Tarrier et al

Question 22

Tarrier et al?

Answer 22

Persistent evidence of reduced symptoms (especially positive), lower relapse rates and speedier recovery of acutely ill patients (20 trials)

Question 23

Methodological problems with CBT?

Answer 23

NICE guidelines recommend CBT in combination with anti-psychoitcs, so its unsure whether effects are actually due to CBT

Question 24

Strengths of appropriateness of CBT?

Answer 24

Lower drop out rates than drugs

Question 25

Weaknesses of appropriateness of CBT?

Answer 25

Individual differences

Question 26

Research on drop out rates in CBT?

Answer 26

Kuipers et al

Question 27

Kuipers et al?

Answer 27

Lower drop out rates and greater satisfaction when CBT was used in addition to antipsychotics (instead of just antipsychotics)

Question 28

Individual differences with CBT?

Answer 28

Kingdon and Kirschen

Question 29

Kingdon and Kirschen?

Answer 29

Many patients (in particular older ones due to memory deficits, negative attitudes to change etc.) weren't deemed suitable for CBT as psychiatrists believed they wouldn't fully engage

Question 30

What does family intervention aim to do?

Answer 30

Doesn't aim to 'cure' SZ but to prevent relapse by reducing EE and stress

Question 31

Research on EE?

Answer 31

Brown

Question 32

Brown?

Answer 32

SZs in families with high EE have more frequent relapses

Question 33

What does family intervention do?

Answer 33

Teaches coping and problem solving strategies, creating a warm and supportive atmosphere

Question 34

NICE recommendations on family intervention?

Answer 34

That it be carried out for between 3 months and 1 year and include at least 10 planned sessions in conjunction with antipsychotics

Question 35

How many stages in family intervention?

Answer 35

5

Question 36

First stage of family intervention?

Answer 36

Therapist establishes alliance and co-operative relationship with family and gives information about SZ (causes, course and treatment), patient discusses their symptoms

Question 37

Second stage of family intervention?

Answer 37

Relatives and patients told it's normal to feel angry/impatient towards each other and discuss how they feel when certain events happen

Question 38

Third stage of family intervention?

Answer 38

Family learns more constructive ways of communicating and are encouraged to concentrate on good things rather than the negative events

Question 39

Fourth stage of family intervention?

Answer 39

Practical coping skills and problem solving skills are taught

Question 40

Fifth stage of family intervention?

Answer 40

Family and patients trained to recognise early signs of relapse (e.g. withdrawal, difficulty concentrating) so they can respond rapidly and reduce severity

Question 41

Strengths of effectiveness of family intervention?

Answer 41

Support Effective with drugs Long-term benefits

Question 42

Support for family intervention?

Answer 42

NCCMH

Question 43

NCCMH?

Answer 43

26% relapse in family intervention condition compared to 50% in the control standard-care condition (meta-analysis of 32 studies)

Question 44

Research on effectiveness of daily intervention with drugs?

Answer 44

Pharoah et al

Question 45

Pharoah et al?

Answer 45

53 studies from 2002-10 in Europe, Asia and N America - family intervention increased mental state, social functioning, and compliance with medication (so more likely to reap the benefits)

Question 46

LT benefits of family intervention?

Answer 46

Hogarty et al

Question 47

Hogarty et al?

Answer 47

At a 2 year follow up 25% of those who'd received family intervention had relapsed compare to 62% on medication alone (103 SZ patients in high EE households)

Question 48

Strengths of appropriateness of family intervention?

Answer 48

Economic benefits

Question 49

Weaknesses of appropriateness of family intervention?

Answer 49

Cultural limitations

Question 50

Economic benefits of family intervention?

Answer 50

NCCMH found the extra costs of family intervention is offset by a reduction in costs of hospitalisation because of lower relapse rates (26% v 50%)

Question 51

Cultural limitations of family intervention?

Answer 51

NCCMH found hospitalisation levels may differ significantly across countries depending on clinical practice (e.g. most of the evidence has come from studies outside the UK, principally in China)