Schizophrenia

Question 1

Definition of schizophrenia

Answer 1

Schizophrenia is a long term psychotic disorder where an individual cannot differentiate between reality and fantasy. Most often diagnosed between the ages of 15 and 35, men and women equally affected.

Question 2

Who suggested characteristics for schizophrenia, what are they ?

Answer 2

Kurt Schneider, identified positive and negative symptoms

Positive (behaviours in addition to normal behaviours) :

. Hallucinations - false perceptions that are not real, usually auditory or visual but can occur in any sensory modality (individual may see, hear or feel something not there, see through the ceiling)

. Delusions - strongly held pathological beliefs that can’t be changed even when presented with conflicting evidence (feeling of being spied on, others watching, example of persecution bias)

. Disordered thinking - thoughts become jumbled, difficult to differentiate between reality and what is not (evident through persons speech, mumbling in between conversations)

Negative symptoms (absences lack of normal behaviour) :

. Alogia - A poverty of speech, a person may stop speaking altogether or speak in a way that does not make sense (may stop interacting or talking with others)

. Avolition - losing interest in things they used to enjoy, work hygiene, friends, become isolated (stop taking shower)

. Flatness of affect - lack of emotional expression through face, tone, body language (blank face, showing no emotion)

. Catatonic behaviour - lack of movement or useless repetitive movement (continuous tapping or fidgeting)

Question 3

How are patients diagnosed ?

Answer 3

Patient assessed against criteria set in DSM vol5, and must have experience two symptoms of schizophrenia, one must be a positive symptom (delusions, hallucinations, disordered thinking)
Must be continuous signs of disturbance for 6 months, at least one month of active symptoms

Question 4

Dopamine hypothesis (BIOLOGICAL 1)

Answer 4

• Link found between dopamine and schizophrenia when a drug called L-dopa was successful in reducing Parkinson’s symptoms.
• This hypothesis supported by lots of research including 1968 Griffiths et Al, induced psychosis in non schizophrenic volunteers with drug that increases the presence of dopamine in the brain.
• They found that volunteers demonstrated a generally abrupt onset of paranoid delusions and demonstrated a cold and detached emotional response
• At dopamine receptor sites, neurotransmitters such as dopamine are released at synapses, They enable neural messages to be sent from one neurone to another across the synapse. Too much or too little of a neurotransmitter at the synapse affects the message that is sent and as a result an individual’s behaviour.
• Several types of dopamine receptors sites, D1-D5 widely distributed in the cerebral cortex. D2 dopamine receptors was focused by Seeman and Lee who showed the impact of antipsychotic drugs on this particular receptor.
• Limbic system contains various sub cortical structures that are engaged in many functions, mostly emotion, memory formation, arousal
• The mesolimbic pathway carries signals from VTA to the nucleus accumbens, too much dopamine causes neurons to fire quickly, results in overstimulation and ultimately positive symptoms of schizophrenia such as hallucinations, delusions.
• The mesocortical pathway carries signals from the VTA to the frontal lobe. Davies et Al noted that too little dopamine is evident in the D1 dopamine receptor sites of the frontal lobe, which links to negative symptoms of schizophrenia

Question 5

Strength of dopamine hypothesis

Answer 5

• Strength is that the dopamine hypothesis makes good sense and possible to explain how dopamine imbalances. Genetic basis suggested through Gottesman et Al who looked at rates of schizophrenia in cousins, grandchildren, half siblings, parents, MZ and DZ twins and found that as genetic similarity increases, schizophrenia risk increases. However other research has shown there were 108 gene loci associated with schizophrenia so although there is a genetic component, involves more than few abnormal genes

Question 6

Weaknesses of dopamine hypothesis

Answer 6

• Contradictory evidence which weakens propositions. Dopamine not the only neurotransmitter implicated in Schizophrenia. Serotonin also identified as a potential influence. Newer atypical antipsychotics like clozapine block D2 receptor as well as serotonin receptor. Although hypothesis not wrong, not enough evidence to prove explanation on its own. So although successful treatments have been developed through dopamine hypothesis, still unanswered questions between neurotransmitters and schizophrenia
• Issues with establishing cause and effect. Although believers of this explanation suggest dopamine imbalances cause schizophrenia, could be suggested dopamine imbalances are an effect created by schizophrenia. Research using PET scans suggest not able to detect differences in dopamine activity of brains of schizophrenics and non schizophrenics. Suggests that still some way off of answering fundamental question of this biological explanation.
• Concerns over methodological processes adopted in exploring dopamine hypothesis, difficult to make direct measurements of neurotransmitters like dopamine, most research based on metabolites. These are what neurotransmitters get broken down into and their levels assessed in cerebrospinal fluid. Dopamine broken down into homovalinic acid and this measured in cbs fluid. However others factors can affect one’s metabolite levels such as diet, drugs so difficult to interpret even in controlled conditions. There caution should be adopted as there may be reduced validity if based on metabolite levels than dopamine

Question 7

Biological method of modifying

Answer 7

• The dopamine explanation suggests that schizophrenics produce excessive amounts of the neurotransmitter dopamine
• Therefore in order to reduce suffering and the experience of symptoms such as hallucinations and delusions, it would be necessary to lower dopamine levels
• Anti psychotic drugs by work by binding to but not stimulating dopamine receptors preventing dopamine molecules from gaining access
• Dopamine levels reduces as a result, but this can cause side effects
• Newer atypical antipsychotics work by binding to receptors for a brief period, but rapidly dissociating. This allows for some dopamine transmission and side effects are lessened as a result.

Question 8

Structural abnormalities (BIOLOGICAL 2)

Answer 8

• Schizophrenia was first treated as a psychological illness however after looking at brain scans of schizophrenics, studies show structural differences between brains of schizophrenics and non schizophrenics
• Andreasen studied MRI scans of individuals with and without schizophrenia and found that those with schizophrenia had enlarged ventricles by about 20-50%
• Cortical atrophy is the loss of neurones in the cerebral cortex. It can occur all over the brain making it look shrunk. Vita et Al used CAT scans to assess 143 individuals with schizophrenia. They found that 33% of individuals with schizophrenia showed moderate to severe atrophy
• Reversed cerebral asymmetry in schizophrenics is where the right hemisphere is larger than the left different to a normal brain. As language function is located in the left hemisphere, this reversed asymmetry may account for symptoms of schizophrenia such as alogia
• Overall various structural differences can be seen in individuals with schizophrenia but more links need to made with the structural abnormalities and symptoms of schizophrenia.

Question 9

Strength of Structural abnormalities

Answer 9

• Huge strength of the theory relating schizophrenia to structural abnormalities in the brain is that studies conducted in the area are highly reliable. Same structural abnormalities found time after time when studies are replicated. McCarley et Al suggested that presence of enlarged ventricles is by far the most reliable finding in research that uses brain scans. However McCarley also suggests that age, gender and symptoms severity can exert a powerful influence on patterns of brain abnormalities, so cautious in determining actual cause of structural abnormality in brain

Question 10

Weaknesses of Structural abnormalities

Answer 10

• Some abnormalities not only linked with schizophrenia but also found in individuals suffering from conditions other than schizophrenia. Roy et al not that individuals diagnosed with bipolar disorder and schizoaffective disorder found to have enlarged ventricles. Disorders as such have many overlapping symptoms as a result of overlapping abnormalities in brain. Also these abnormalities not present in all schizophrenics and factors such as age, gender and severity affect prevalence. Therefore diagnoses may be more dependent on structural and functional abnormalities opposed to resultant behaviours

Question 11

Cognitive explanation (INDIVIDUAL 1)

Answer 11

• The cognitive approach views behaviour and thoughts as being a product of internal mental processes. The brain is seen as a computer with inter mental processes acting as software. These mental processes help us to make sense of the world
• Mental illness is therefore explained in terms of problems with these internal mental processes . Symptoms of schizophrenia can be explained through problems with processes that govern perception, language
• It appears that some of positive and negative symptoms of schizophrenia might have a cognitive basis. Hallucinations are a common symptom of schizophrenia and one of its defining characteristics. It can be any modality (sight, sound, touch). One of the most common types of schizophrenia is hearing voices
• However not only schizophrenics hear voices, occurs in mental illnesses such as bipolar, Parkinson’s or Alzheimer’s. mentally healthy people can experience hallucinations from time to time, around 2.5-4% of the general population have experienced hallucinations once in their lifetime.
• Morrison proposed that hallucinations can be onset by a variety of triggers including stress, lack of sleep and certain drugs. Migraines and vision problems are less common causes. The individuals experiencing hallucinations may appraise these voices inappropriately as belonging to the devil therefore eliciting behaviours like self harm and withdrawal.
• An additional theory to why schizophrenics hear voices comes from Frith and is that we all have a voice in our head. When a person hears voices, its actually their inner speech being misinterpreted
• Theory is supported by McGuire et Al who found schizophrenics have reduced activity in parts of brain involved in monitoring inner speech and under activity in the frontal lobe
• Less research has been conducted into the negative, symptoms of schizophrenia. However Beck applied his cognitive triad to this. Problems with one’s self, the world and the future could lead to symptoms like alogia, avolition and flatness of affect
• A lack of precocious filters have also been linked as Frith proposes that unlike a normal brain, the filters that inhibit sensory background information that would usually be filtered out within the environment are defective in schizophrenics. suggested to be caused by abnormalities in areas of brain that use dopamine. Reduced blood flow to these areas also been shown.
• Bentall argued that schizophrenics have attentional bias towards stimuli of a threatening and emotional, nature particularly stimuli associated with pain, violence. They are more likely to perceive stimuli as threatening when it isn’t due to an attentional bias, which could explain paranoid delusions

Question 12

Strength of the cognitive explanation

Answer 12

• Theories produced by Frith and Beck have stimulated a lot of scientific investigation, thus research evidence to support explanations. Barch et Al compare performance on a stroop test of people with and without schizophrenia. Found that those with schizophrenia couldn’t filter information effectively. Suggest that evidence has been proposed to support proposed accounts of schizophrenia as that of Friths idea attentional filters in schizophrenics are defective

Question 13

Weaknesses of the cognitive explanation

Answer 13

• Described the explanation as reductionist as it takes a highly complex condition and simplifying it down to action of one simple factor. Frith proposed faulty operation of cognitive mechanism is due to impairment with frontal cortex and posterior areas of brain. Frith also produced supportive evidence by detecting cerebral blood flow changes in schizophrenic brains when completing cognitive tasks. Impossible to suggest however complex experience of schizophrenics come down to brain circuits.
• Weakness is that proposed theories can only account for the cognitive based symptoms of schizophrenia, runs into difficulty when trying to justify other characteristics of schizophrenia such as issues with movement. Cognitive explanation fails to account sufficiently for origins of cognitive deficits which result in schizophrenic symptoms. Also the explanation can only explain proximal causes ( cause for symptoms ) for schizophrenia and not distal causes (origin of condition). Suggests that caution should be be exercised as no single explanation for cause of schizophrenia
• However, cognitive component is relevant of investigation, psychologists starting to appreciate schizophrenia needs to be considered holistically, including cognitive factors. Howes and Murray described integrated model of schizophrenia where genes or early life complications combined with difficult life events or social stressors (poverty) provoke dopamine system into releasing dopamine. Increased dopamine secretion causes problems with cognitive processing specifically positive symptoms lie hallucinations, delusions. This continues in a circle for individual. Proposal therefore demonstrates that alone cognitive explanation of schizophrenia is insufficient but adds value to integrated theories.

Question 14

Cognitive method of modifying

Answer 14

• Major symptom of Schizophrenia is seen in disordered thinking of the individual, possibly caused because of faulty processing of information received from one’s environment.
• The purpose of CBT therefore is to help an individual consider and organise their disordered thoughts in a more rational way
• CBT will help individual to realise their disordered thinking is likely the cause of their illness.
• CBT session will be collaborative between a client and therapist over a number of sessions where therapist will use disputing techniques to challenge perceptions of schizophrenic, asking them for evidence for their delusional beliefs
• They will work on relapse prevention strategies whereby early warning indicators of relapse are identified so plans can be developed for when triggers arise

Question 15

Schizophrenogenic mother (Psychodynamic explanation) (INDIVIDUAL 2)

Answer 15

• Number of studies had suggested that the mother child relationship was disordered in cases of childhood schizophrenia
• Links made between Freuds ideas on schizophrenia by a neo-freudian psychoanalyst called Fromm-Reichman
• She blamed mothers of schizophrenics and suggested trigger came from mothers who were overly dominant in interacting with child
• While being controlling, also cold and distant therefore distancing each other leaving child feel emotionally insecure

Question 16

Strength of psychodynamic explanation

Answer 16

A strength of the psychodynamic approach to explaining schizophrenia can be seen in the explanatory power of Freuds theories. The model provides explanation as to why schizophrenics lose touch with reality as Freud argues schizophrenia is a regression to an infant like state. However this explanation not able to account for all symptoms of schizophrenia. Therefore suggests that Freud may have had some insight into why schizophrenia may develop but only able to offer a partial explanation

Question 17

Weakness of psychodynamic explanation

Answer 17

Big problem faced is Freudian concepts are out of date and widely discredited by practising psychologists today. Psychodynamic approach unable to produce testable hypotheses so little evidence available. Not being able to verify the existence of the id, ego, superego and defence mechanisms such as regression makes it impossible to trust the explanation. As a result, if concepts that freuds theory of schizophrenia have no basis, reduces validity of whole explanation

Question 18

Dysfunctional families (SOCIAL 1)

Answer 18

• Bateson proposed that symptoms see in individuals with schizophrenia were the result of communication difficulties within family. It may develop when a child is repeatedly exposed to social interactions in which there are two conflicting messages
• For example if a father tells his young daughter that he’d love to hear what they did in school while focusing on the tv, the daughter receives two conflicting messages. The verbal component of communication offered by the father implies care and interest in daughter however non verbal suggests something different, that daughter is less important
• Parents who often make these double bind statements may not be aware they are doing so, words are only a part of communication and tone of voice, body language can betray an individuals true feelings. These non verbal cues are known as paralanguage
• Mother asks should I read story however if true underlying feeling is I don’t want to spend time with you, will come across in her paralanguage. Child therefore gets conflicting messages, if the say yes mother may read to her but will be unhappy while doing so which is unpleasant for child, if no then they are rejecting which may be punished by parent as not showing how loving they are
• Children who grew up encountering these double bind statements on regular basis have no idea how to respond on reasonable way as a result. As these interactions are with a role model (family) may believe this is how normal relationships are life in future so may struggle to establish relationships
• Bateson et Al believed this eventually led to manifestation of symptoms of schizophrenia such as hallucinations and delusions to escape contradictions of double bind statements

Question 19

Strength of dysfunctional families

Answer 19

• Supportive evidence available for expressed emotion explanation of schizophrenia. Vaughn and leff offered clear support for role of expressed emotions in relapse rates. Found that 53% of individuals with schizophrenia who had high EE relapsed within nine months compared to 12% with low EE who relapsed. However not all research has supported EE as predictor of relapse, Mcreadie and Phillips failed to find subsequent relapse rates among individuals with schizophrenia living in high EE homes. Therefore EE doesn’t provide complete explanation of schizophrenia but still may be a relevant factor in schizophrenia, just not the only factor

Question 20

Weaknesses of dysfunctional families

Answer 20

• Findings have been inconclusive with regards to double bind theory, not all studies found a significant difference in quality of communications within families that have schizophrenia. Liem found communication offered in a structured task by parents of 11 sons with schizophrenia were no more disordered than communications offered by 11 parents of sons who didn’t have schizophrenia. Suggests that communication difficulties on which double bind theory is based on are more an effect than cause of schizophrenia
• Determining what classifies as double bind statement is very subjective. Study done by Kennedy had experts in the double bind theory and non experts make judgements about letters written to schizophrenics. These letters were either written by family member or hospital staff. The results demonstrated that the so called experts were no better at indentifying double bind statements than non experts. Suggests that little headway made into relevance of double bind communication on schizophrenia
• Although schizophrenia may be due to communication difficulties within shared family environment, it could equally be a product of the families shared genes which is a big challenge for explaining schizophrenia through family relationships. Gottesman looked at instance of schizophrenia in cousins, grandchildren, half children, parents, siblings and identical/non identical twins. It was found as genetic similarity increased, probability of getting schizophrenia increased. However applying the diathesis stress model suggests that genetics predispose individual to schizophrenia and family relationships may act as at trigger. Suggests that number of factors may be working together to cause schizophrenia behaviours

Question 21

Social method of modifying

Answer 21

• The dysfunctional families explanation of schizophrenia suggests that disorder is caused by disturbed communication within the family home
• Therefore it is suggested that a significant reduction in relapse rates can be achieved through family based interventions rather than working in isolation with the individual who has received the diagnosis
• Pharoah et Al in a review of 53 randomised control trials concluded that family intervention decreased both the frequency of relapse and reduced hospital admissions
• Family based intervention could include increasing the ability of family members to solve and anticipate problems, reduce expressions of anger and guilty by family members, maintaining reasonable expectations for how the ill family member should perform

Question 22

Sociocultural factors (SOCIAL 2)

Answer 22

• Since 1939 it has been apparent that there is a higher prevalence of schizophrenia in people living in urban areas compared with rural areas. Faris and Dunham amongst the first to discover this relationship. Findings from their investigation of schizophrenia in Chicago demonstrated that not only was there a higher incidence of schizophrenia in the densely populated centre of the city rather than in the less densely populated suburbs
• They also found that the highest levels of schizophrenia were in the areas that had a high level of ethnic conflict and a high degree of social mobility
• Another theory explains schizophrenia being related to social isolation. Schizophrenics are often socially isolated from others. They have few friends, may be estranged from family, and are more likely to live alone. Faris suggested that the schizophrenic finds interaction with others to be stressful and confusing, and so they retreat and withdraw from society. This means that urbanicity and overcrowding may add to this sense of isolation.
• Since the 1970s, statistics have demonstrated that higher than expected numbers of individuals of Afro-Caribbean decent are diagnosed with schizophrenia. The explanation cannot be genetic, as the increased risk is not found in studies conducted in the Caribbean. Therefore, the additional stress that comes with migration to a different culture was suggested as being a reasonable interpretation of these statistics.
• However, the increased risk in diagnosis rates were not only found in first generation immigrants, but higher rates of schizophrenia diagnosis were also found in the children of Afro- Caribbean migrants in the UK (Harrison et al)

Question 23

Strength of sociocultural factors

Answer 23

• May be beneficial to consider social isolation and its links to schizophrenia as a means of tacking condition. May lend itself to early intervention. Unlike ethnicity, discrimination or urban city, interventions can be put in place to help develop the social skills of children who are socially isolated to reduce the risk of schizophrenia. Suggests there are practical applications that come with social isolation based theory so could reduce suffering experienced by real people

Question 24

Weakness of sociocultural factors

Answer 24

• Difficulty in establishing cause and effect of sociocultural explanation of schizophrenia. It’s unclear as to whether living in an urban environment leads to greater risk of schizophrenia or does having schizophrenia mean you are more likely to live in an urban area. Social drift theory proposes that individuals with schizophrenia may experience a decline in socioeconomic status and thus move to less salubrious areas in inner city. So gives false impression of urbanity being caused by of schizophrenia

Question 25

Method of modifying 1
Antipsychotic drugs

Answer 25

• Derived from biological explanation of schizophrenia where suffering created by addiction is relieve by altering physiological mechanisms of body
• Conventional anti-psychotics, chlorpromazine were first developed in 1950s, work by lowering levels of dopamine, believed to be produced in excess by schizophrenics, resulting in positive symptoms (hallucinations)
• Chlorpromazine works primarily as antagonist (blocking effect) on D2 dopamine receptors, binding with but not stimulating the cell. It also blocks other dopamine receptors, D1, D2, D3, D4, D5. Due to blockage, dopamine unable to gain access
• Lower levels of dopamine in synapse as a result of presence of chlorpromazine, leads to substantial reduction in neural activity. Reduction in activity in Mesolimbic pathway thought to benefit reduction in positive symptoms (hallucinations, delusions)
• Atypical antipsychotics (Clozapine) have been used since 1990s, second generation of antipsychotic drug
• Atypical like conventional work as dopamine antagonist, prevents ability of dopamine from gaining access to receptor sites
• Key difference is atypical bind to fewer dopamine D2 receptors and more D1, D4, also seratonin receptors.
• Another difference is fast off theory meaning atypical antipsychotics bind to receptor sites for only a brief moment of time
• This short term effect means antipsychotic binds long enough for symptoms to be relieved but not so long that side effects are caused like Parkinson’s, dyskinesia that are common in conventional
• With atypical, occupancy of D2 receptors falls off within 24 hours, however with conventional fall off longer than 24 hours

Question 26

Effectiveness of antipsychotic drugs

Answer 26

• Jonathan Cole et Al conducted earliest study into effectiveness of conventional antipsychotic drugs. Findings proves drugs could treat mental disorders as well as physical disorders. He found 75% of those given a conventional antipsychotic were considered to be much improved compared with only 25% of those given a placebo. Cole also noted those who took antipsychotics did not get worse compared to those given a placebo. This was revolutionary at the time as schizophrenia was seemed to be untreatable
• Atyipical antipsychotics considers to be more effective than conventional antipsychotics. Ravanic et Al compared the effectiveness of clozapine, chlorpromazine and haloperidol in 325 individuals. Reasearch over five years found there were significant psychometric scores favouring clozapine, and found fewer adverse effects. Suggests atypical antipsychotics are a more effective and preferable option when treating schizophrenia. However some individuals may respond better to conventional

Question 27

Ethical implications of antipsychotic drugs

Answer 27

• One major problem with both conventional and atypical antipsychotics is that they have side effects such as dyskinesia as well as tremors and seizures. Therefore psychiatrists must assess benefits against side effects. Also when schizophrenia is first diagnosed, atypical antipsychotics may be administered without valid consent meaning resulting side effects are not there choice so informed consent must be granted

Question 28

Social implication of antipsychotics

Answer 28

• One very serious consequence of individuals with schizophrenia who don’t follow daily drug therapy is they might pose a threat to public or to themselves. Tiihonen et al noted a 37 fold increase in suicide in patients who stopped taking medication. The NCISh reported 346 homicides in England by people with schizophrenia history and was 29% were non adherent to drug treatment. Therefore a risk factor present due to level of compliance

Question 29

Method of Modifying 2
CBT

Answer 29

• CBT is a therapy that combines both cognitive and behaviours techniques to help clients relieve symptoms of their condition
• It is based on the assumption that much abnormal behaviour occurs as a result of disordered cognitions or thinking. Aim of CBT is to challenge those irrational thoughts
• A major symptom of schizophrenia is disordered thinking. CBT helps to identify, organise and consider their thoughts rationally
• CBT helps schizophrenic to appreciate the connections between their disordered thoughts and their illness. It challenges schizophrenics interpretation of events by asking for evidence. These techniques largely help to deal with positive symptoms of suchlike delusions
• Smith et Al has identifies the key treatment components when using CBT for schizophrenia. Firstly engagement strategies, which is where the therapist attempts to build a rapport with the patient. This helps with the paranoia that the individual may be experiencing.
• Psychoeducation is where the client is educated about their condition by normalising the experience of psychotic symptoms and increasing the clients understanding of the situations under which their symptoms occur
• Cognitive strategies are where a client will engage in traditional CBT techniques such as thought diaries, reality testing. Homework task may be used as well. Behavioural skills training is where skills such as relaxation, problem solving and activity scheduling are taught, these may help manage symptoms of schizophrenia
• Relapse prevention strategies are where the client and the therapist will work together to identify early warning indicators of relapse. They will develop plans that can be actioned when warning sights are observed

Question 30

Effectiveness of CBT

Answer 30

• Kuipers et Al conducted a study on sixty individuals with schizophrenia who had symptoms that were medically resistant. After nine months of CBT therapy, researchers found a change in psychotic symptoms experienced in CBT plus standard care condition, 50% considered to have improved, 31% not improved with 3 becoming worse and 1 committing suicide. This suggests that although improvement offered with addition of CBT is marginal, it is significantly better than standard care alone
• Not all research suggest CBT is effective in schizophrenia treatment. Jauhar et Al reported only a small therapeutic effect from using CBT with clients with schizophrenia. However a month later, Morrison et Al reported that CBT significantly reduced psychiatric symptoms in individuals with schizophrenia. The lack of consistent findings may initially seem to suggest CBT is ineffective, however results may have been down to a confounding variable

Question 31

Ethical implication of CBT

Answer 31

• It can be suggested that suffering from symptoms, being assessed and diagnosed and then prescribed strong medication for schizophrenia can be scary. So question arises whether CBT is a burden. Kuipers et Al reported that clients were generally satisfied with their experiences of CBT and they thought it was an appropriate way to deal with problems. It also focuses on developing a rapport between the therapist and client, making it comfortable for them

Question 32

Social implication of CBT

Answer 32

• Kuipers et Al analysed the economic impact of offering CBT to schizophrenics, in addition to antipsychotics used. Researchers reported although initially CBT may be costly, in the long term those costs are more likely to be recouped because individuals would be less likely to need emergency psychiatric services. This benefits everyone as that money can be used for other healthcare services. However budgets assigned to healthcare trusts only allow them to deal with immediate care requirements rather than long term.