Psychological Therapies

Family Intervention
1. Effectiveness
  1. NICE (2009) - Meta-analysis of 32 studies, nearly 2500 participants. Found significant evidence for effectiveness of family interventions. When compared with standard care alone, a reduction in hospital admissions during treatment, and severe symptoms during and up to 24 months following. Relapse rate with family intervention 26% and standard care 50%.
  2. Pharoah et al (2012) - Meta-analysis found family intervention may be effective in improving clinical outcomes. Authors suggest reason for effectiveness may have less to do with any improvements in clinical markers and more to do with increases in medication compliance. more benefits of medication as they are more likely to comply with the medication regime.
2. Appropriateness
  1. NICE (2009) - Family intervention is associated with significant cost savings when offered to schizophrenics in addition to standard care. Treatment cost is offset by reduction in costs of hospitalisation due to lower relapse rates. ~ Higher cost savings due to lower relapse rates over long period.
  2. NICE (2009) - Hospitalisation levels may differ across countries, depending on their clinical practice. Hospitalisation rate from non-UK countries may not be applicable to UK. Most evidence comes from China.
3. Family environment can influence the course of schizohrenia.
4. Attempt to make family life less stressful and reduce re-hospitalisation.
5. Brown et al (1972) - Schizophrenics in families with high levels of criticism, hostility or over involvement had more frequent relapses, than those with less expressive emotion families.
6. 1) Form an alliance with caring relatives of schizophrenic. 2) Reduce emotion climate in family and the burden of care for family members. 3) Enhance relatives' ability to anticipate and solve problems. 4) Reduce expressions of anger and guilt by family. 5) Maintain reasonable expectations of patient's behaviour among family. 6) Encourage relatives to set appropriate limits ad maintain a degree of separation when needed.
Behaviour Therapy
1. Effectiveness
  1. Paul & Lentz (1977) - Chronic schizophrenics put into 3 groups, a learning group, milieu therapy group and how they would normally treat a patient. Around 90% received drug therapy at the start of the research. 4 years later those in general mental institute group, the number receiving drug treatment rose to 100%, milieu group dropped to 18% and token economy fell to 11%. Members from all groups returned to communities with supervision. token economy did better in society.
  2. Allyon & Azrin (1968) - Token economy significantly reduced bizarre behaviour and increased their helping behaviour.
  3. Gripp & Magaro (1971) - Symptoms of schizophrenics treated with token economy improved more than those treated with other methods.
  4. Gershone et al (1977) - Schizophrenics treated with token economy spent time doing activities, spent less time in bed and made fewer disturbing comments to other patients than those treated traditionally.
2. Appropriateness
  1. Proven useful in institutions, as schizophrenics in isolation were given more freedom.
  2. Paul & Lentz (1977) - as been effective on the behaviour of schizophrenics, clinicians need to be careful not to say they are cured. It is a way to manage behaviour.
3. To help sufferers with their behaviour, can be used in conjunction with drug therapy.
4. Token Economy - Uses principles of operant conditioning, schizohrenics are rewarded for displaying "normal" behaviour, they progressed and are rewarded for performing actions with society
5. Ayllon & Azrin (1968) - Studied a wing of a mental institute to assess the technique in practice. 45 female patients were rewarded for not showing psychotic behaviour and for being helpful, they were given tokens in exchange for benefits.
CBT
1. Therapy that aims to address anc change a sufferer's dysfunctional emotions, thought processes and behaviour.
2. Meichenbaum (1977) - Majority of mental disorders re products of abnormal thoughts and feelings. Our behaviour is the product of our thoughts and feelings, it would be logical to find a way to adapt or change the thoughts and feelings to alter the behaviour.
3. REBT Ellis (1962) - Dysfunctional behaivour and emotional distress are the result of irrational thoughts. These lead to "irrational dialogue" and will impact the behaviour, should be replaced with more rational thoughts and cognition.
4. Effectiveness
  1. Zimmermann et al (2005) - CBT was better at training the positive symptoms that having no treatment. Proposed the effect was long lasting, helping sufferers for up to 12 months.
  2. Turkington et al (1998) - CBT was effective in trating the symptoms in the short-term, occasionally long-term.
  3. Sensky et al (2000) - Effective in reducing symptoms, even 9 months after treatment had been stopped.
  4. Tarrier et al (2000) - Found no benefits of CBT a year after it had stopped, even less after 2 years.
  5. Kopelowicz & Liberman (1998) - CBT moderately improved symptoms of schizophrenia in 50-60% of sufferers. Only when used in conjunction with drug therapy. Relapse rate was moderate and treatment was deemed moderately expensive.
5. Approppriateness
  1. Morrison et al (2003) - CBT can be adapted to challenge the dysfunctional beliefs that sufferers experience, could reduce their symptoms and distress. Possibly leading to a lasting decrease in symptoms.
  2. Garrett (2008) - Successfully used CBT to change a patient's mind about taking the drugs she was prescribed, therefore reducing her symptoms.
6. Beck - Mental disorders are due to errors of logic, addressing these will effect the behaviour.
7. Helps sufferers understand the hallucinations, Coping Strategy Enhancement (CSE) IS USED. They can develop ways of managing specific symptoms.

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	Criado por Daisy T mais de 9 anos atrás