schizophrenia eval

Question 1

eval drug therapy

Answer 1

1. extrapyramidal side effects - typical antipsychotic drugs produce movement problems for the patient. most common are the parkinsonian and related symptoms. más que 50% taking typ antipsychotics experience this + tardive dyskinesia( i,e involuntary movement of the face and jaw).
2. ethical problems with typical antipsychotics - US - a large out-of court settlement was awarded to a tardive dyskinesia sufferer on the basis of Article 3 of the human rights act that states no one shall be subjected to inhuman and degrading treatment.
3. atypical vs typical : atypical has fewer extrapyramidal side effects, patients more likely to continue with their medications and see a reduction in symptoms

Question 2

eval CBTp

Answer 2

1. (Nice) 2014 review, cbtp advantages: shown to be effective in reducing symptom severity and, when compared with patients receiving standard care, some evidence for improvements in social functioning. (pero same time as antipsychotics so hard to gauge the effectiveness
2. lack of availability: 1/10 who could benefit get access to cbtp.
   even lower in some areas of the country. survey carried out by haddock et al. (2013) in the NW england found that of 187 randomly selected patients diagnosed with SZ only 13 had been offered CBTp.
3. effectiveness of CBTp is dependent on the stage of the disorder: self - reflection is not appropriate for initial acute phase of SZ (addington x2, 2005). following stabilisation of the psychotic symptoms with antipsychotic medication, however, individuals can benefit from group based CBTp. research has shown that it’s individuals with more experience of their sz and a greater realisation of their problems that benefit from cbtp

Question 3

eval - family therapy

Answer 3

1. economic benefits - NICE review of family therapy studies showed that ft is associated with significant cost savings when offered to people with sz in addition to standard care. extra cost of ft is offset by a reduction in costs of hospitalisation because of the lower relapse rates associated with this form of intervention. also evidence that ft reduces relapses after a sig period the completion of the intervention.
2. why is ft effective: improvements in mental state and social functioning found in pharoah et al study may not be directly due to ft. the authors suggest its due to the increase in compliance with medication.
3. is family therapy worthwhile: garety et al. (2008) failed to show any better outcomes for patients given sessions of ft compared to those who simply had carers but no family therapy. individs in both groups had unexpectedly low rates of relapse, contrasting markedly with the rates found in the “no carer” group.