2476805
Psychological therapies for Schizophrenia
- CBT - assessment of faulty beliefs
- A01
- Patients are encouraged to trace back origins of their symptoms in
order to get a better idea of how symptoms developed
- Encouraged to evaluate content of their delusions or of any internal voices they hear
+ to consider ways in which they may test validity of faulty beliefs
- Therapist lets patient develop their own alternatives to
previously maladaptive beliefs
- Ideally by looking for alternative explanations + coping strategies that are already present in patients mind
- Ideally by looking for alternative explanations + coping strategies that are already present in patients mind
- Patients are encouraged to trace back origins of their symptoms in
order to get a better idea of how symptoms developed
- A02
- Effectiveness - supporting research
- Research has tended to show CBT has significant effect
on improving symptoms of patients
- Gould et al
- Found all 7 studies in m-a reported statistically significant decrease in
+ve symptoms of Sz after treatment
- Found all 7 studies in m-a reported statistically significant decrease in
+ve symptoms of Sz after treatment
- Gould et al
- Research has tended to show CBT has significant effect
on improving symptoms of patients
- Appropriateness - negative symptoms
- -ve symptoms may well serve useful function for person +
so can be understood as 'safety behaviours'
- Within psychiatric setting, strong expression of emotions might lead to increases in medication or hospital admission
- Similarly, inactivity + withdrawal might be seen as a way of avoiding making +ve symptoms worse
- Similarly, inactivity + withdrawal might be seen as a way of avoiding making +ve symptoms worse
- CBT offers some hope of alleviating these maladaptive thought processes
- Within psychiatric setting, strong expression of emotions might lead to increases in medication or hospital admission
- -ve symptoms may well serve useful function for person +
so can be understood as 'safety behaviours'
- Effectiveness - supporting research
- A01
- CBT - outcome studies
- A01
- Outcome studies suggest patients who receive CBT experience fewer
hallucinations + delusions + recover their functioning to a greater degree
than those who receive antipsychotic medication alone
- Drury et al
- Found reduction of +ve symptoms + 25-50% reduction in recovery time for
patients given a combination of antipsychotic medication alone
- Kuipers et al
- Confirmed these advantages but also noted there were lower patient dropout rates +
greater patient satisfaction when CBT was used in addition to antipsychotic drugs
- Confirmed these advantages but also noted there were lower patient dropout rates +
greater patient satisfaction when CBT was used in addition to antipsychotic drugs
- Kuipers et al
- Found reduction of +ve symptoms + 25-50% reduction in recovery time for
patients given a combination of antipsychotic medication alone
- Outcome studies suggest patients who receive CBT experience fewer
hallucinations + delusions + recover their functioning to a greater degree
than those who receive antipsychotic medication alone
- A02
- Effectiveness - how much is due to CBT alone?
- Most studies of effectiveness of CBT have been conducted w/
patients treated w/ antipsychotic medication at same time
- This makes it difficult, therefore, to assess effectiveness of CBT on its own
- This makes it difficult, therefore, to assess effectiveness of CBT on its own
- Most studies of effectiveness of CBT have been conducted w/
patients treated w/ antipsychotic medication at same time
- Appropriateness - who benefits?
- Kingdon + Kirschen
- Conducted study in Hampshire w/ 142 Sz patients + found many patients weren't
deemed suitable for CBT because psychiatrists believed they wouldn't fully engage
w/ therapy
- Found older patients, in particular, were deemed less suitable than younger patients
- Found older patients, in particular, were deemed less suitable than younger patients
- Conducted study in Hampshire w/ 142 Sz patients + found many patients weren't
deemed suitable for CBT because psychiatrists believed they wouldn't fully engage
w/ therapy
- Kingdon + Kirschen
- Effectiveness - how much is due to CBT alone?
- A01
- Family intervention - reducing expressed emotion
- A01
- FI is a means to help fam. feel more
confident in their supporting role
- There to help fam. members support patient in best way
- Allowing them to understand disorder + provide them w/ poss. ways to deal w/ probs.
that can result from living w/ + supporting someone who has experienced psychosis
- Allowing them to understand disorder + provide them w/ poss. ways to deal w/ probs.
that can result from living w/ + supporting someone who has experienced psychosis
- There to help fam. members support patient in best way
- Reducing expressions of anger from fam. members
- Maintaining reasonable expectations of patients behaviour
- Reducing burden of care on fam.
- Reducing burden of care on fam.
- Maintaining reasonable expectations of patients behaviour
- FI is a means to help fam. feel more
confident in their supporting role
- A02
- Effectiveness - Pharoah et al meta-analysis
- Reviewed 53 studies to investigate
effectiveness of FI
- Studies conducted compared outcomes from FI to 'standard' care alone
- Main results were:
- Mental state
- Mixed impressions
- Some reported improvement in overall MS of patients
compared to those receiving standard care while others
didn't
- Some reported improvement in overall MS of patients
compared to those receiving standard care while others
didn't
- Mixed impressions
- Compliance w/ medication
- Use of FI increased patients compliance w/ medication
- Use of FI increased patients compliance w/ medication
- Social functioning
- Appeared to show some improvement on general functioning, however didn't
appear to have much effect on more concrete outcomes like living
independently or employment
- Appeared to show some improvement on general functioning, however didn't
appear to have much effect on more concrete outcomes like living
independently or employment
- Mental state
- Studies conducted compared outcomes from FI to 'standard' care alone
- Reviewed 53 studies to investigate
effectiveness of FI
- Appropriateness - cultural limitations
- Most research evidence comes from studies
conducted outside UK
- Hospitalisation levels may differ significantly across countries,
depending on clinical practice within those countries
- Therefore date of hospitalisation rates from non-UK countries might not be applicable to UK setting
- Therefore date of hospitalisation rates from non-UK countries might not be applicable to UK setting
- Hospitalisation levels may differ significantly across countries,
depending on clinical practice within those countries
- Most research evidence comes from studies
conducted outside UK
- Effectiveness - Pharoah et al meta-analysis
- A01
- FI - reduced relapse rates
- A01
- By helping fam. better understand how Sz works +
by getting them to work on their expression of
emotion this can reduce stress in patients
environment
- + as w/ help of FI compliance w/ medication increased
which will also help control patients psychosis
- This leads to a decrease in general relapse rates
- This leads to a decrease in general relapse rates
- + as w/ help of FI compliance w/ medication increased
which will also help control patients psychosis
- By helping fam. better understand how Sz works +
by getting them to work on their expression of
emotion this can reduce stress in patients
environment
- A02
- Effectiveness - supporting research
- NICE
- Conducted meta-analysis involving 32 studies + nearly
2500 patients which found significant evidence for
effectiveness of FI
- When compared w/ patients receiving standard care alone, there was a reduction in
hospital admissions during treatment + severity of symptoms both during + up to 24
months following intervention
- Relapse rate in FI condition was 26% + in control (standard care) condition 50%
- Relapse rate in FI condition was 26% + in control (standard care) condition 50%
- When compared w/ patients receiving standard care alone, there was a reduction in
hospital admissions during treatment + severity of symptoms both during + up to 24
months following intervention
- Conducted meta-analysis involving 32 studies + nearly
2500 patients which found significant evidence for
effectiveness of FI
- NICE
- Appropriateness - economic benefits
- Extra cost of Fi is offset by reduction in costs of
hospitalisation because of lower relapse rates associated w/ FI
- Also evidence that FI reduces relapse rates for significant period
after completion meaning more savings are then made
- Extra cost of Fi is offset by reduction in costs of
hospitalisation because of lower relapse rates associated w/ FI
- Effectiveness - supporting research
- A01
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