schiz- psych treatments Flashcards
What does CBT aim to do with shiz patients
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.
Evaluation -Startup et al
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.
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.
90
43
47
25
60
40
6
12
17
According to Startup et al, what % of the CBT group showed improvement compared to the control group
60 - CBT 40 - Control group
Evaluation of psych treatments -Garrett et al
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.
How did Garrett et al change a schiz patients mind about taking APs
Using CBT
Evaluation of pysch treatments - Kingdon and Kirschen
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.
What did Kingdon and Kirschen find that clinicians did to older patients suffering from schiz
Significantly judged older schizophrenic patients as being far less suitable/appropriate than younger patients to benefit from CBT.
Evaluation of psych treatments - Zimmerman et al
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.
What did Zimmerman find when investigating CBT for schiz patients
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.
What are the three main aims of family therapy
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.
What is the five step process of family therapy
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
Evaluation of psych treatments - Leff et al
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.
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.
24
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.
78 14
What were the three parts of the programme in Leff’s study
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.
Evaluation of psych treatments -methodological flaws with Leff’s work
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.
Evaluating psych treatments -Vaughn and Leff
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.
What did Vaughn and Leff investigate
Looked at schizophrenic patients returning to either high or low EE in the household.
In high EE households, relapse of schizophrenic symptoms increased with more face-to face contact, and with no medication relapse rate rose to __%
92
Evaluating psych treatments -Anderson et al
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.
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.
40 20 5
Evaluating psych treatments -Xiong et al
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.
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.
636136
