1.1.1 NICE (2009) - Meta-analysis of 32 studies, nearly
2500 participants. Found significant evidence for
effectiveness of family interventions. When
compared with standard care alone, a reduction
in hospital admissions during treatment, and
severe symptoms during and up to 24 months
following. Relapse rate with family intervention
26% and standard care 50%.
1.1.2 Pharoah et al (2012) -
Meta-analysis found family
intervention may be effective in
improving clinical outcomes.
Authors suggest reason for
effectiveness may have less to do
with any improvements in clinical
markers and more to do with
increases in medication
compliance. more benefits of
medication as they are more
likely to comply with the
1.2.1 NICE (2009) - Family intervention is associated with
significant cost savings when offered to
schizophrenics in addition to standard care.
Treatment cost is offset by reduction in costs of
hospitalisation due to lower relapse rates. ~ Higher
cost savings due to lower relapse rates over long
1.2.2 NICE (2009) -
may differ across
countries, depending on
their clinical practice.
from non-UK countries
may not be applicable
to UK. Most evidence
comes from China.
1.3 Family environment can influence
the course of schizohrenia.
1.4 Attempt to make family life less
stressful and reduce
1.5 Brown et al (1972) - Schizophrenics in
families with high levels of criticism,
hostility or over involvement had more
frequent relapses, than those with less
expressive emotion families.
1.6 1) Form an alliance with caring relatives
of schizophrenic. 2) Reduce emotion
climate in family and the burden of care
for family members. 3) Enhance relatives'
ability to anticipate and solve problems.
4) Reduce expressions of anger and guilt
by family. 5) Maintain reasonable
expectations of patient's behaviour
among family. 6) Encourage relatives to set
appropriate limits ad maintain a degree
of separation when needed.
2 Behaviour Therapy
2.1.1 Paul & Lentz (1977) - Chronic schizophrenics
put into 3 groups, a learning group, milieu
therapy group and how they would normally
treat a patient. Around 90% received drug
therapy at the start of the research. 4 years
later those in general mental institute group,
the number receiving drug treatment rose to
100%, milieu group dropped to 18% and token
economy fell to 11%. Members from all
groups returned to communities with
supervision. token economy did better in
2.1.2 Allyon & Azrin (1968) - Token economy
significantly reduced bizarre behaviour
and increased their helping behaviour.
2.1.3 Gripp & Magaro (1971) - Symptoms of
schizophrenics treated with token
economy improved more than those
treated with other methods.
2.1.4 Gershone et al (1977) - Schizophrenics
treated with token economy spent time
doing activities, spent less time in bed
and made fewer disturbing comments
to other patients than those treated
2.2.1 Proven useful in institutions, as
schizophrenics in isolation were given
2.2.2 Paul & Lentz (1977) - as been
effective on the behaviour of
schizophrenics, clinicians need to
be careful not to say they are
cured. It is a way to manage
2.3 To help sufferers with their behaviour, can
be used in conjunction with drug therapy.
2.4 Token Economy - Uses
principles of operant
are rewarded for displaying
"normal" behaviour, they
progressed and are rewarded
for performing actions with
2.5 Ayllon & Azrin (1968) - Studied a wing of a mental
institute to assess the technique in practice. 45 female
patients were rewarded for not showing psychotic
behaviour and for being helpful, they were given tokens
in exchange for benefits.
3.1 Therapy that aims to
address anc change a
processes and behaviour.
3.2 Meichenbaum (1977) - Majority of mental
disorders re products of abnormal thoughts and
feelings. Our behaviour is the product of our
thoughts and feelings, it would be logical to find
a way to adapt or change the thoughts and
feelings to alter the behaviour.
3.3 REBT Ellis (1962) - Dysfunctional behaivour and
emotional distress are the result of irrational
thoughts. These lead to "irrational dialogue" and will
impact the behaviour, should be replaced with more
rational thoughts and cognition.
3.4.1 Zimmermann et al (2005) - CBT was better at training the
positive symptoms that having no treatment. Proposed
the effect was long lasting, helping sufferers for up to 12
3.4.2 Turkington et al (1998) - CBT
was effective in trating the
symptoms in the short-term,
3.4.3 Sensky et al (2000) - Effective in reducing
symptoms, even 9 months after
treatment had been stopped.
3.4.4 Tarrier et al (2000) - Found no
benefits of CBT a year after it
had stopped, even less after 2
3.4.5 Kopelowicz & Liberman (1998) - CBT
moderately improved symptoms of
schizophrenia in 50-60% of sufferers. Only
when used in conjunction with drug therapy.
Relapse rate was moderate and treatment
was deemed moderately expensive.
3.5.1 Morrison et al (2003) - CBT can be adapted to
challenge the dysfunctional beliefs that
sufferers experience, could reduce their
symptoms and distress. Possibly leading to a
lasting decrease in symptoms.
3.5.2 Garrett (2008) - Successfully used
CBT to change a patient's mind
about taking the drugs she was
prescribed, therefore reducing her
3.6 Beck - Mental disorders are due to
errors of logic, addressing these will
effect the behaviour.
3.7 Helps sufferers understand the
hallucinations, Coping Strategy
Enhancement (CSE) IS USED.
They can develop ways of
managing specific symptoms.