schiz- psych treatments

Question 1

What does CBT aim to do with shiz patients

Answer 1

To help patients identify their faulty, delusionary beliefs and reduce stress associated with symptoms of schiz , as well as developing more rational, constructive ways of thinking, coping and functioning, in other words, managing their illness.

Question 2

Evaluation -Startup et al

Answer 2

Investigated theeffectiveness of CBT, by recruiting 90 patients whohad been admitted to hospital with an acuteepisode. 43 were given standard care i.e.antipsychotics and nursing care, whilst the other47 were given standard care plus up to 25, 90minute sessions of CBT. They found that 60% ofCBT group showed reliable and clinicalimprovement, with fewer positive AND negativesymptoms, compared to 40% of the control group.More importantly, these benefits stood the test oftime and remained at 6 and 12 month follow ups,compared to just 17% of the control group.

Question 3

Investigated theeffectiveness of CBT, by recruiting __ patients whohad been admitted to hospital with an acuteepisode. __ were given standard care i.e.antipsychotics and nursing care, whilst the other__ were given standard care plus up to __, 90minute sessions of CBT. They found that __% ofCBT group showed reliable and clinicalimprovement, with fewer positive AND negativesymptoms, compared to __% of the control group.More importantly, these benefits stood the test oftime and remained at __ and __ month follow ups,compared to just __% of the control group.

Answer 3

90
43
47
25
60
40
6
12
17

Question 4

According to Startup et al, what % of the CBT group showed improvement compared to the control group

Answer 4

60 - CBT 40 - Control group

Question 5

Evaluation of psych treatments -Garrett et al

Answer 5

Described successfully using CBT to change a patient’s mind about taking the anti-psychotic drugs she was prescribed and therefore reducing her symptoms in that way. This shows that CBT can be appropriate forschizophrenic patients.

Question 6

How did Garrett et al change a schiz patients mind about taking APs

Answer 6

Using CBT

Question 7

Evaluation of pysch treatments - Kingdon and Kirschen

Answer 7

Many clinicians have criticised the use of CBT with schizophrenic patients as they characteristically do not have coherent thinking and insight into their condition to actually gain therapeutic benefit. For example, many delusionary patients may not accept they are ill and need help in the first place. Kingdon & Kirschen (2006) found that clinicians significantly judged older schizophrenic patients as being far less suitable/appropriate than younger patients to benefit from CBT. Therefore, CBT may not suitable for all patients – some may be too old to benefit from CBT as cognitions are set.

Question 8

What did Kingdon and Kirschen find that clinicians did to older patients suffering from schiz

Answer 8

Significantly judged older schizophrenic patients as being far less suitable/appropriate than younger patients to benefit from CBT.

Question 9

Evaluation of psych treatments - Zimmerman et al

Answer 9

Furthermore, the appropriateness of CBT is also called into question when considering patients may suffer from different schizophrenic symptoms.Zimmerman et al. (2005) found that there does seem to be a place for CBT helping with the auditory and visual hallucinations that sufferers experience; and it particularly helps in reducing the distress and negative emotions experienced by individuals who suffer these hallucinations. However, it may be less helpful in treating some of the negative symptoms of schizophrenia, like flat affect and avolition.This could suggest… CBT is of limited usefulness as it can reduce the distress of schizophrenic patients who suffer more from hallucinations, but is less useful for those struggling with their negative symptoms.

Question 10

What did Zimmerman find when investigating CBT for schiz patients

Answer 10

Found that there does seem to be a place for CBT helping with the auditory and visual hallucinations that sufferers experience; and it particularly helps in reducing the distress and negative emotions experienced by individuals who suffer these hallucinations.

Question 11

What are the three main aims of family therapy

Answer 11

1) Improve positive and decrease negative forms of communication2) Increase tolerance levels and decrease criticism within the family dynamic3) Decrease feelings of guilt and responsibility for causing the illness.

Question 12

What is the five step process of family therapy

Answer 12

1) Co-operative and trusting relationships2) Educate3) Practical coping skills4) How to express concern without resorting to high EE5) Recognising the early signs of potential relapse

Question 13

Evaluation of psych treatments - Leff et al

Answer 13

There is evidence to support the effectiveness of family therapy with schizophrenia patients. For example, Leff et al. (1982) used 24 participants in a programme that involved (i) educational sessions dealing with the nature of schizophrenia, its symptoms and the best way to deal with difficult behaviour. (ii) group meetings between families to discuss how they dealt with schizophrenic family members (iii ) family sessions where social workers and other professionals were present. Leff found that families involved in the intervention showed a significant decrease in critical comments directed towards the patient and reduced over–involvement (characteristics of high EE). Plus, 78% of patients in control group were readmitted to hospital compared to only 14% of the experimental group with schizophrenia.This implies that family intervention made a significant difference to the interactions within the families, and also helped to significantly reduce the chance of relapse.

Question 14

Leff et al. (1982) used __ participants in a programme that involved (i) educational sessions dealing with the nature of schizophrenia, its symptoms and the best way to deal with difficult behaviour. (ii) group meetings between families to discuss how they dealt with schizophrenic family members (iii ) family sessions where social workers and other professionals were present.

Answer 14

24

Question 15

Leff found that families involved in the intervention showed a significant decrease in critical comments directed towards the patient and reduced over–involvement (characteristics of high EE). Plus, __% of patients in control group were readmitted to hospital compared to only __% of the experimental group with schizophrenia.

Answer 15

78 14

Question 16

What were the three parts of the programme in Leff’s study

Answer 16

1) educational sessions dealing with the nature of schizophrenia, its symptoms and the best way to deal with difficult behaviour. 2) group meetings between families to discuss how they dealt with schizophrenic family members 3 ) family sessions where social workers and other professionals were present.

Question 17

Evaluation of psych treatments -methodological flaws with Leff’s work

Answer 17

In Leff’s research investigating comparing the use of FT & APs against just taking APs, there are multiple extraneous variables that have not been controlled.For instance, the schizophrenic patients may have had differing severity of symptoms to start with; they may be on different types of APs which all have different levels of effectiveness; some may not have been routinely taking their APs; also it is not reported why some relapsed (it may not be due to their schizophrenia and could be due to a different mental health problem).This implies that family therapy lacks rigorous experimental support which questions how effective it really is for schizophrenia.

Question 18

Evaluating psych treatments -Vaughn and Leff

Answer 18

Family therapy seems to be most effective when used in conjunction with powerful antipsychotics to treat schizophrenia.Vaughn and Leff (1976) looked at schizophrenic patients returning to either high or low EE in the household. The effect of no medication on low EE was insignificant. In the high EE household, relapse of schizophrenic symptoms increased with more face-to face contact, and with no medication relapse rate rose to 92%, showing the importance of effective treatment.This implies that focusing on both family dynamics and biochemistry is best for patients with schizophrenia and their families.

Question 19

What did Vaughn and Leff investigate

Answer 19

Looked at schizophrenic patients returning to either high or low EE in the household.

Question 20

In high EE households, relapse of schizophrenic symptoms increased with more face-to face contact, and with no medication relapse rate rose to __%

Answer 20

92

Question 21

Evaluating psych treatments -Anderson et al

Answer 21

Despite the high costs of family therapy, many argue it can reduce the ‘revolving door syndrome’ often seen with schizophrenic patients. A study by Anderson et al. (1991) found a relapse rate of almost 40% when patients had drugs only, compared to only 20% when Family Therapy was used and the relapse rate was less than 5% when both were used together with the medication.With a drastically reduced relapse rate with FT, will reduce the amount of times patients are hospitalised and therefore reduce the cost to the NHS, and therefore the economy.This could suggest that many psychologists would state that family therapy is a cost effective mechanism for dealing with schizophrenia.

Question 22

A study by Anderson et al. (1991) found a relapse rate of almost __% when patients had drugs only, compared to only __% when Family Therapy was used and the relapse rate was less than _% when both were used together with the medication.

Answer 22

40 20 5

Question 23

Evaluating psych treatments -Xiong et al

Answer 23

There is further support from family therapy in diverse cultural settings.Xiong et al (1994) randomly allocated 63 Chinese patients suffering from schizophrenia to either standard drug care or standard drug care plus family therapy. They found that 61% of standard drug care patients had relapsed compared to 36% of the drug care plus family therapy condition. This suggests that family therapy is an effective addition to drug care across diverse cultural settings. This implies that family therapy is a useful strategy for schizophrenia regardless of cultural settings.

Question 24

Xiong et al (1994) randomly allocated __ Chinese patients suffering from schizophrenia to either standard drug care or standard drug care plus family therapy. They found that __% of standard drug care patients had relapsed compared to __% of the drug care plus family therapy condition.

Answer 24

636136

Question 25

Token economies aim to ________ schizophrenia rather than ______ it.

Answer 25

manage treat

Question 26

How may a token economy address symptoms of alogia I.e not replying when someone speaks to them

Answer 26

Receiving a token for when they do give a reasonable length, coherent reply to someone

Question 27

How may a token economy address symptoms of flat effect I.e having dulled emotional expression

Answer 27

A token is taken away

Question 28

How may token economies adress symptoms of avolition I.e not engaging in activities in the hospital like playing a sports activity

Answer 28

AvolitionNot engaging in activities in the hospital like playing a sports activity

Question 29

Evaluating psych treatments - Allyon and Azrin token economies

Answer 29

There is evidence that token economies are very effective in the management of schizophrenia.Allyon and Azrin (1968) studied 45 female chronic schizophrenic patients, with an average of 16 years of hospitalisation. They screamed for long periods, were mute, assaultive, many were incontinent, and they no longer ate with cutlery. Following a system of TE they were carefully reinforced with tokens for their ward work and self-care behaviours which were later exchanged for chosen privileges (e.g. listening to music, renting a private room, seeing a social worker). This regime led to a dramatic improvement in self-care behaviours (approx 45 self care behaviours per week), however, When the system was removed these behaviours disappeared. This implies that TEs are a cost effective strategy to use with institutionalised patients suffering from schizophrenia.

Question 30

Allyon and Azrin (1968) studied __ female chronic schizophrenic patients, with an average of __ years of hospitalisation.

Answer 30

45 16

Question 31

Evaluation of psych treatments -methodological flaw token economies -

Answer 31

Many psychologists believe that token economies do nothing to attempt to cure schizophrenia and in fact provide nothing but ‘token learning’.It is difficult to keep this treatment going once the patients are back at home in the community. Kazdin et al. Found that changes in behavior achieved through token economies do not remain when tokens are withdrawn, suggesting that such treatments address effects of schizophrenia rather than causes. It is not a cure.This could imply that the benefits of TEs for schizophrenia are institutionally bound and disappear when patients rejoin the real world.

Question 32

What did Kazdin et al find about changes in behaviour achieved through token economies

Answer 32

They do not remain when tokens are withdrawn, suggesting that such treatments address effects of schizophrenia rather than causes. It is not a cure.

Question 33

What is coping strategy enhancements

Answer 33

A technique which tries to teach patients with schizophrenia better ways to manage the severity and frequency of their psychotic symptoms to reduce distress and their impact on day-to-day functioning.

Question 34

What behavioural techniques could drain out hallucinations

Answer 34

Listening to music
Meditating
Reading out loud

Question 35

What does integrated psychological therapy aim to do

Answer 35

To improve attention and refine concept formation - identifies specific cognitive deficits and remedy them in a non-confrontational manner.

Question 36

How can avolition and inappropriate effect be targeted with IPT

Answer 36

By teaching patients how to recognise and respond appropriately to social cues

Question 37

What is CSE based on

Answer 37

Thorough behaviour analysis of each symptom and the assessment of any coping strategy the subject may already employ.
It teaches coping skills to the patient.

Question 38

Another step of IPT is to use reality tests.
Why?

Answer 38

To challenge some faulty interpretations, to hopefully remove some of the patients false beliefs.