Therapies For SZ

Question 0

Atypical antipsychotic?

Answer 0

Clozapine - binds loosely to D2 receptors then rapidly dissociates

Question 1

Conventional antipsychotic?

Answer 1

Chloropromazine - dopamine antagonist

Question 2

Evaluate effectiveness of antipsychotics

Answer 2

Davis et al - 19% relapse rate on antipsychotics compared to 55% on a placebo

Question 3

Evaluate appropriateness of antipsychotics

Answer 3

Hill - 30% of users taking convention for 7+ years develop tardive dyskinesia and in 75% of cases it’s irreversible

Question 4

Psychological therapies

Answer 4

1. CBT

2. Family intervention

Question 5

Psychological therapies: CBT

Answer 5

Drury et al - benefits 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 6

CBT: stages

Answer 6

1. ABC model used, rate intensity from 1-10
2. Tests validity (empirical, logical, pragmatic, evaluating content)
3. Develop alternatives and coping strategies, set goals
4. Replace delusional thinking with rational beliefs

Question 7

Evaluate effectiveness of CBT

Answer 7

Gould et al - statistically significant decrease in positive symptoms

Question 8

Evaluate appropriateness of CBT

Answer 8

Kuipers et al - lower drop out rates and greater satisfaction when CBT was used in addition to antipsychotics

Question 9

Psychological therapies: family intervention

Answer 9

Brown - SZs in families with high EE have more frequent relapses

Question 10

NICE recommends that family intervention..

Answer 10

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

Question 11

NICE 2014 recommends that CBT…

Answer 11

Be used for 1st and subsequent acute episodes, delivered on a one to one basis over at least 16 planned sessions

Question 12

Family intervention: stages

Answer 12

1. Establish alliance and give information
2. Discuss how they feel
3. Learn constructive ways of communicating
4. Learn practical coping skills and problem solving
5. Trained to realise early signs of relapse

Question 13

Evaluate effectiveness of family intervention

Answer 13

NCCMH - 26% relapse in FI compared to 50% in control standard-care

Question 14

Evaluate appropriateness of family intervention

Answer 14

NCCMH - extra cost of FI is offset by a reduction in costs of hospitalisation due to lower relapse rates (26% v 50%)