SCHIZOPHRENIA - Family therapy as a psychological treatment of schizophrenia

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  • Psychological treatment of schizophrenia (sch) - Family Therapy
    • interventions based on families with a sch sufferer
    • recommended that it should be a priority available to every person diagnosed or in contact with a sch person
    • research ~ schs in critical or hostile families suffered more relapses than schs in families with less EE
    • aimed at reducing EE in family
    • GARETY (2008) - relapse for individs that received family therapy was 25% compared to 50% for those who received standard care
    • provides family members with info about sch, ways to help schs and resolving practical probs
    • characteristics of psychosis - schs are more suspicious of treatment. Involving person solves problem
    • Research
      • PHAROAH (2010) - 53 randomised controlled trail studies from 2002-2010 on family intervention. Studies compared fam.ther to 'standard' treatment (antipsych med)
        • FOUND:
          • overall mental state = mixed. Some reported improvements and some didn't
          • family intervention increased patients compliance with medication
          • fam.int not shown to have much of an effect on social functioning (eg. employment etc.)
          • reduction in relapse and reduction of hospital admission during treatment and 24 months after
    • Evaluation (A03)
      • nature of treatment informed by relevant explanation
      • Pharoah's research - fam.ther = effective in improving clinical outcomes (eg. mental state and social functioning)
        • but argued that effectiveness due to the fact that it increases medication compliance
      • problem of random allocation - some Chinese studies claimed to have used ran.all but did not
      • lack of blinding - possibility of observer bias- not 'blinded to condition'
      • NICE review of family studies said that fam.ther has cost savings when given to schs in addition to standard care
        • reduction of hospitalisation costs
      • shown to improve outcomes for individs with sch
      • shown to have good outcomes for family members (60%)
      • no better outcomes for patients given sessions of fam.ther compared to those who had a carer but no fam.ther
    • How does it work?
      • offered in 3-12 months and at least 10 sessions
      • therapist encourages family members to listen to each other and openly discuss probs and solutions together
      • person with sch has to be present as sessions with family (if practical)

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