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Psychology - PSYA4 > Schizophrenia - Psychological Therapies > Flashcards

Schizophrenia - Psychological Therapies Flashcards

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1
Q

Relationship between psychological and biological therapies?

A

Although the use of antipsychotic drugs is crucial in the treatment of SZ, additional psychological treatments are needed to sustain improvement

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2
Q

Types of psychological therapies?

A

CBT and family intervention

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3
Q

Assumption of CBT?

A

People have distorted beliefs which maladaptively influence behaviour, e.g. delusions result from faulty interpretations of events

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4
Q

CBT recommendations in NICE 2014 guidelines?

A

For 1st and subsequent acute episodes, delivered on a one-to-one basis over at least 16 planned sessions

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5
Q

Researcher on CBT?

A

Drury et al

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6
Q

Drury et al?

A

Benefits of CBT in terms of a reduction of positive symptoms and a 25-50% reduction in recovery time for patients given a combination of CBT and medication

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7
Q

How many stages in CBT?

A

4

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8
Q

1st stage of CBT?

A

ABC model is used to help patients organise confusing experiences

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9
Q

Example of using ABC model?

A

Rating intensity of distress in experiences on a scale of 1-10 and identifying what activating events seemed to cause the consequences

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10
Q

2nd stage of CBT?

A

Therapist uses methods to encourage the client to test the validity of their beliefs

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11
Q

Examples of methods used to test validity of beliefs?

A

Empirical disputing, logical disputing, pragmatic disputing and evaluating the content of their delusions/internal voices

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12
Q

Example of logical disputing?

A

“Does it make sense that the voices come from the radiator? In general do radiators talk?”

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13
Q

Example of empirical disputing?

A

“Can you think of any events that have happened which give you evidence that the shop keeper wants to kidnap you?”

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14
Q

Example of pragmatic disputing?

A

“How has believing that if you tell people about your visions that they will no longer speak to you helped you?”

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15
Q

3rd stage of CBT?

A

Develop own alternatives to maladaptive beliefs, looking for alternative explanations and coping strategies already present in mind, and setting goals

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16
Q

4th stage of CBT?

A

Replaces disordered or delusional thinking with rational thought processes

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17
Q

Strengths of effectiveness of CBT?

A

Reduces positive symptoms

Lots of benefits

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18
Q

Weaknesses of effectiveness of CBT?

A

Methodological

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19
Q

CBT reducing positive symptoms?

A

Gould et al

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20
Q

Gould et al?

A

Statistically significant decrease in positive symptoms of SZ after CBT (meta-analysis of 7 studies)

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21
Q

Research on benefits of CBT?

A

Tarrier et al

22
Q

Tarrier et al?

A

Persistent evidence of reduced symptoms (especially positive), lower relapse rates and speedier recovery of acutely ill patients (20 trials)

23
Q

Methodological problems with CBT?

A

NICE guidelines recommend CBT in combination with anti-psychoitcs, so its unsure whether effects are actually due to CBT

24
Q

Strengths of appropriateness of CBT?

A

Lower drop out rates than drugs

25
Q

Weaknesses of appropriateness of CBT?

A

Individual differences

26
Q

Research on drop out rates in CBT?

A

Kuipers et al

27
Q

Kuipers et al?

A

Lower drop out rates and greater satisfaction when CBT was used in addition to antipsychotics (instead of just antipsychotics)

28
Q

Individual differences with CBT?

A

Kingdon and Kirschen

29
Q

Kingdon and Kirschen?

A

Many patients (in particular older ones due to memory deficits, negative attitudes to change etc.) weren’t deemed suitable for CBT as psychiatrists believed they wouldn’t fully engage

30
Q

What does family intervention aim to do?

A

Doesn’t aim to ‘cure’ SZ but to prevent relapse by reducing EE and stress

31
Q

Research on EE?

A

Brown

32
Q

Brown?

A

SZs in families with high EE have more frequent relapses

33
Q

What does family intervention do?

A

Teaches coping and problem solving strategies, creating a warm and supportive atmosphere

34
Q

NICE recommendations on family intervention?

A

That it be carried out for between 3 months and 1 year and include at least 10 planned sessions in conjunction with antipsychotics

35
Q

How many stages in family intervention?

A

5

36
Q

First stage of family intervention?

A

Therapist establishes alliance and co-operative relationship with family and gives information about SZ (causes, course and treatment), patient discusses their symptoms

37
Q

Second stage of family intervention?

A

Relatives and patients told it’s normal to feel angry/impatient towards each other and discuss how they feel when certain events happen

38
Q

Third stage of family intervention?

A

Family learns more constructive ways of communicating and are encouraged to concentrate on good things rather than the negative events

39
Q

Fourth stage of family intervention?

A

Practical coping skills and problem solving skills are taught

40
Q

Fifth stage of family intervention?

A

Family and patients trained to recognise early signs of relapse (e.g. withdrawal, difficulty concentrating) so they can respond rapidly and reduce severity

41
Q

Strengths of effectiveness of family intervention?

A

Support
Effective with drugs
Long-term benefits

42
Q

Support for family intervention?

A

NCCMH

43
Q

NCCMH?

A

26% relapse in family intervention condition compared to 50% in the control standard-care condition (meta-analysis of 32 studies)

44
Q

Research on effectiveness of daily intervention with drugs?

A

Pharoah et al

45
Q

Pharoah et al?

A

53 studies from 2002-10 in Europe, Asia and N America - family intervention increased mental state, social functioning, and compliance with medication (so more likely to reap the benefits)

46
Q

LT benefits of family intervention?

A

Hogarty et al

47
Q

Hogarty et al?

A

At a 2 year follow up 25% of those who’d received family intervention had relapsed compare to 62% on medication alone (103 SZ patients in high EE households)

48
Q

Strengths of appropriateness of family intervention?

A

Economic benefits

49
Q

Weaknesses of appropriateness of family intervention?

A

Cultural limitations

50
Q

Economic benefits of family intervention?

A

NCCMH found the extra costs of family intervention is offset by a reduction in costs of hospitalisation because of lower relapse rates (26% v 50%)

51
Q

Cultural limitations of family intervention?

A

NCCMH found hospitalisation levels may differ significantly across countries depending on clinical practice (e.g. most of the evidence has come from studies outside the UK, principally in China)

Psychology - PSYA4 (16 decks)

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