Treatment and management of schizophrenia — practice questions

(a) AO1 — CBT for psychosis (CBTp):

• Therapist works collaboratively to examine evidence for hallucinations/delusions.
• Patient develops coping strategies (e.g. distraction, reality testing) to reduce distress and dysfunction.

AO1 — Family intervention:

• Psychoeducation about schizophrenia for relatives.
• Training to reduce expressed emotion (criticism, hostility) — linked to lower relapse (Brown et al.).

(b) AO1 — Drug mechanisms:

• Typical antipsychotics block D2 receptors; atypical (risperidone) also affect 5-HT — reduce positive symptoms.

AO3 — Evaluation:

• Strengths: Meta-analyses show antipsychotics reduce positive symptoms and relapse; atypicals have fewer extrapyramidal effects than typicals.
• Limitations: Negative and cognitive symptoms often poorly treated; side effects (weight gain, metabolic syndrome, tardive dyskinesia) affect adherence.
• Ethical issues: Long-term use may feel coercive; cultural groups may prefer family/community approaches over medication.
• Determinism: Purely biological treatment is reductionist — combined CBT + family therapy addresses psychological and social maintenance.

Judgement: Drugs are essential for many patients but insufficient alone — best outcomes combine medication with CBTp and family intervention.

(a) Calculation of Relapse Rates:

Step 1: Identify the number of patients per group. Total patients = 80, so each group has 80 / 2 = 40 patients.

Step 2: Calculate the relapse rate for Group 1 (Standard Care). Formula: (Number of relapses / Total patients in group) x 100 Calculation: (20 / 40) x 100 = 0.5 x 100 = 50%

Step 3: Calculate the relapse rate for Group 2 (Standard Care + Family Therapy). Formula: (Number of relapses / Total patients in group) x 100 Calculation: (9 / 40) x 100 = 0.225 x 100 = 22.5%

(b) Explanation of Effectiveness:

The relapse rate for the group receiving only standard care (medication) was 50%. The relapse rate for the group that also received family therapy was significantly lower at 22.5%. This is a reduction of 27.5 percentage points. This suggests that adding family therapy to standard medication is highly effective in preventing relapse in patients with schizophrenia. The therapy likely achieves this by reducing levels of expressed emotion (EE) and improving communication within the family, creating a less stressful environment for the patient.