Schizophrenia symposium Flashcards
Why not just treat schizophrenia with medication?
- Treatment resistant symptoms
- Partially resistant symptoms
- Where side effects limit doses of medication
- Service user choice
- Comorbidity…anxiety, depression, PTSD
- Psychologically informed case management- relapse prevention
Overarching ethos of Early Intervention services
Hopeful
Collaborative
Empowering
Social recovery prioritised… achieving work, relationships
CBT informed case management/ Good practice
timeline of events leading to psychosis relapse signature early warning signs crisis plan problem solving psychoeducation about illness and possible treatment options self management, advance directives
NICE reccomended psychological treatment in schizophrenia
Offer cognitive behavioural therapy for psychosis
offer family inteventions for fmilies
consider art therapy
assess for ptsd and follow ptsd guidelines
Psychological therapies for comorbidities
Depression-behavioural activation Bipolar- mood management Trauma- trauma related work EMDR Anger management Anxiety- relaxation, graded exposure work Medication concordance
Cognitive behavioural therapy for psychosis (CBTp)
12-20 sessions
Treatment resistant symptoms
Alternative to medication for distressing symptoms
Aim is to relieve distress and increase function rather than treat delusions or get rid of hallucinations
CBT model
involves tackling thoughts, feelings or behaviour and it is thought if you change any one of these the rest will also change
CBT 1 Working on a delusional belief
CBT 2 Knock on effects
CBT 1 Belief: I am being followed so I am in danger
What happens; anxious, looking for danger so checking cars as they go by, keep seeing red cars, this reinforces belieg that I am being followed.
Possibly selective attention and jumping to conclusions playing a part
Challenge: sit and record colours cars going past and their registration plate for period of time
Are there more red cars than other cars? Is it the same car or different cars?
SO how does that then influence belief that being followed by a red car
CBT 2: If I am less convinced I am being followed I might be able to go out more…effect on behaviour from changing thoughts
I would feel less lonely and depressed… effect on feelings form changing thoughts
CBT
Change appraisal of experiences
Change appraisal of voices (voices are thoughts, change their perception of the degree of control voices have by experiments testing their power to do things)
Change appraisal of visual hallucinations..may be visual tricks. Morrison fake arm
Work on reasoning biases
Jumping to conclusions, external attribution bias, selective attention, theory of mind
Behavioural experiments
- counting number of red cards in given time and comparing to figures of percentage of cars that are red that are made each year
- Surveying other people about their fears about being watched to show it is a common fear
- offering alternative conclusions where they jump to conclusions
Work on self esteem and negative schemas
Thinking errors…everything always goes wrong for me, if its not perfect its worthless
Nobody likes me and I am an outside so people will not trust me and think I am a terrorist
Work on appraisal of meaning of having psychosis
“It means im weak and a failure I am not in control and cannot do anything to change that”
Ill never get a job, partner, have a meaningful life…therefore there is no point even trying
Family interventions
- Psychoeducation for families
- Support for families, friends and family groups
- Specific coping strategies
- Specific psychosis based family intervention
Behavioural family therapy
Highly structured therapy
Based on work on expressed emotion and risk of relapse
12-16 sessions
2 therapists
Ideally patients who have relapsed and are in close contact with family
Some of the sessions of behavioural family therapy
Sharing information about mental health problems and treatment
Problem solving
crisis management
managing medication compliance
demonstrating and working on good communication between family members
encouraging family members to refocus on own lives rather than the individual with the psychosis
