Schizophrenia - Psychological Therapies

Question 1

What is family therapy

Answer 1

range of interventions aimed at the family of someone with SZ.

Question 2

Why is family therapy important

Answer 2

SZ families that expressed high levels of criticism, hostility or over involvement had more frequent relapse than families who were less expressive than their emotions

Question 3

when is family therapy offered

Answer 3

offered for a period of between 3 and 12 months and at least ten sessions

Question 4

What does family therapy involve

Answer 4

providing family members with info on SZ,supporting someone with SZ and resolving any practical problems

Question 5

What does family therapy result in

Answer 5

improved relationships within the household because the therapist encourages family members to listen to each other and discuss problems and solutions

Question 6

Who looks at family therapy

Answer 6

Pharaoh et al (2010)

Question 7

what was Pharaoh et al (2010) procedure

Answer 7

reviewed 53 studies published between 2002 to 2010 to investigate the effectiveness of family intervention and compared the outcomes of therapy to standard care alone and concentrated on the studies that were randomised controlled trials

Question 8

In Pharaoh et al (2010) study where did they choose the studies from

Answer 8

Europe, Asia and North America

Question 9

what did Pharaoh et al (2010) compare the outcomes of family therapy to

Answer 9

standard care - antipsychotic medication

Question 10

what was Pharaoh et al (2010) main results comparing individuals receiving family therapy with those receiving standard care(no explanation)

Answer 10

mental state
compliance with medication
social functioning
reduction in relapse and readmission

Question 11

Pharaoh et al (2010) looked at mental state explain what he found comparing individuals receiving family therapy with those receiving standard care

Answer 11

Some studies reported an improvement in the overall mental state of patients compared to the ones receiving standard care but some did not

Question 12

Pharaoh et al (2010) looked at compliance with medication explain what he found comparing individuals receiving family therapy with those receiving standard care

Answer 12

the use of family intervention increased patients compliance with medication

Question 13

Pharaoh et al (2010) looked at social functioning explain what he found comparing individuals receiving family therapy with those receiving standard care

Answer 13

family intervention did not appear to have much of an effect on more concrete outcomes such as living independently or employment

Question 14

Pharaoh et al (2010) looked at reduction in relapse and readmission explain what he found comparing individuals receiving family therapy with those receiving standard care

Answer 14

there was a reduction in the risk relapse and a reduction in hospital admission during treatment in the 24 months after

Question 15

What study is used to look at the effectiveness of family therapy

Answer 15

Pharaoh et al (2010)

Question 16

Why can Pharaoh et al (2010) be used to look at the effectiveness of family therapy

Answer 16

that family therapy ca be used to improve clinical outcomes such as mental state and social functioning but this may be more due to the it increase medicine compliance as there more likely to reap the benefits if they keep up with their medication regime

Question 17

What are two methodological limitations of family therapy studies

Answer 17

the problem of random allocation

lack of blinding

Question 18

Explain the problem of random allocation as a methodological limitation of family therapy studies

Answer 18

although 53 studies claimed to have randomly allocated participants to treatment conditions but most of the studies were from the Peoples Republic of china and random allocation was stated but not used Wu et al 2006

Question 19

Explain lack of blinding as a methodological limitation of family therapy studies

Answer 19

raters were not bonded to the condition to which people were allocated
10 studies had not used blinding
and 26 did not mention whether or not blinding had been used

Question 20

What is an advantage of family therapy

Answer 20

It has considerable economic benefits associated with the treatments of schizophrenia

Question 21

Why is family therapy economically beneficial

Answer 21

Nice review (NCCMH,2009)The extra cost of therapy is an offset by the reduction in costs of hospitalisation as therapy comes with lower relapse rates the standard care and even after intervention there is reduced relapse rates meaning cost savings are even higher

Question 22

What did Lobban et al 2013 do

Answer 22

Lobban et al 2013

analysed the results from 50 therapy studies that had included intervention to support relatives

Question 23

Explain the impact on family members on family therapy with a study

Answer 23

60% of the studies reported a significant positive impact of the intervention on at least one outcome category for relatives such as family functioning

Question 24

What is a disadvantage of what Lobban et al 2013 did

Answer 24

found the methodological quality of the studies was generally poor making it difficult to distinguish from effective to ineffective intervention

Question 25

How does family therapy work?

Answer 25

reducing levels of expressed emotion and stress and increasing the capacity of relatives to solve related problems.

Question 26

What does family therapy aim to do

Answer 26

Reduce the incidence of relapse with the person with SZ

Question 27

Give some strategies used in family therapy (5)

Answer 27

psychoeducation

forming an alliance with caring relatives

reduce emotional climate and burden of care for family

enhancing families ability to solve and anticipate problems

reduce expressions of anger and guilt

Question 28

What should the patient do in family therapy sessions

Answer 28

talk to their family and explain what sort of support they find helpful and what things makes it worse for them

Question 29

Who looks at if family therapy is worth while

Answer 29

Garety et al 2008

Question 30

What did Garety et al 2008 do

Answer 30

failed to show any better outcomes for patients who had family therapy and those who had just had a carer , both had low relapse and carers showed low levels of expressed emotion

Question 31

What did Garety et al 2008 suggest

Answer 31

for many people family intervention may not improve outcomes further the a good standard of treatment as usual

Question 32

Explain what CBT does (2)

Answer 32

identify and change irrational thoughts

Helps patients understand their symptoms

Question 33

Explain how CBT identifies and changes irrational thoughts

Answer 33

may involve discussion of how likely the beliefs are to be true + consideration of less threatening possibilities

Question 34

Explain how CBT helps patients understand their symptoms

Answer 34

Help to make sense of the positive symptoms and offer an explanation which reduces anxiety and helps the patient realise their beliefs are not based on reality

Question 35

Give limitations of CBT as a psychological therapy using a study for one

Answer 35

Jauhar et al (2014)

ethical issues

Question 36

What did Jauhar et al (2014) do

Answer 36

found CBT had a significant but small effect on + and - symptoms

Question 37

Explain ethical issues as a limitation for CBT

Answer 37

CBT may challenge a persons paranoia but might that interfere with their freedom of thought?
E.g If a patient believes in a controlling government the CBT could stray them to modifying their politics

Question 38

What are the two sections of token economies

Answer 38

operant conditioning

classical conditioning

Question 39

Explain token economies as operant conditioning

Answer 39

TE are reward systems used to manage the behaviour of patient with SZ who spend long periods in psyc hospitals. Tokens are given to patients who carry out desirable behaviours which reinforces this behaviour + because they are given immediately it prevents ‘delay discounting’

Question 40

Explain token economies as classical conditioning

Answer 40

tokens have no value but can be swapped late for a tangible reward such as sweets they are secondary reinforcers because they only have learned association with innate primary reinforcers

Question 41

what is a limitation of token economies

Answer 41

Controversial as severely ill patients cannot get privileges as they are less able to comply with desirable behaviours than moderately ill patients and so they are discriminated against.

Question 42

What are 2 limitations of psychological therapies

Answer 42

quality of some evidence

alternative psychological therapies are under researched

Question 43

Explain quality of some evidence as a limitation

Answer 43

small-scale studies that compare patient before and after therapies have has positive results however these therapies lack a control group or lack random allocation to conditions this may mean the effectiveness of psychological therapies is overestimate by the evidence

Question 44

Explain alternative psychological therapies are under researched as a limitation

Answer 44

e.g. NICE recommends art therapy if a qualified art therapist is available who has experience working with SZ patients however these are not well researched and it is unclear how effective they are which questions whether they should be made available to patients