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Questions and Answers
Cognitive behavioural therapy (CBT) aims to reduce the omnipotence and origin of auditory hallucinations.
Cognitive behavioural therapy (CBT) aims to reduce the omnipotence and origin of auditory hallucinations.
True
Family therapy for schizophrenia always guarantees a reduction in relapse rates.
Family therapy for schizophrenia always guarantees a reduction in relapse rates.
False
Cognitive remediation relies heavily on pharmacological strategies to treat cognitive impairments in schizophrenia.
Cognitive remediation relies heavily on pharmacological strategies to treat cognitive impairments in schizophrenia.
False
One aim of psychosocial interventions for schizophrenia is the attenuation of symptom severity and associated comorbidity.
One aim of psychosocial interventions for schizophrenia is the attenuation of symptom severity and associated comorbidity.
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Art therapy is one of the psychosocial interventions for schizophrenia mentioned in the content.
Art therapy is one of the psychosocial interventions for schizophrenia mentioned in the content.
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Family therapy for schizophrenia often excludes education about the illness.
Family therapy for schizophrenia often excludes education about the illness.
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Cognitive impairment has a significant impact on the outcomes in schizophrenia, and cognitive remediation aims to address this.
Cognitive impairment has a significant impact on the outcomes in schizophrenia, and cognitive remediation aims to address this.
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Psychosocial interventions for schizophrenia do not aim to enhance social functioning.
Psychosocial interventions for schizophrenia do not aim to enhance social functioning.
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Social skills training is recommended in current UK guidelines.
Social skills training is recommended in current UK guidelines.
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A recent meta-analysis indicated some efficacy of social skills training against negative symptoms.
A recent meta-analysis indicated some efficacy of social skills training against negative symptoms.
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There is strong evidence for the effectiveness of arts therapies in treating schizophrenia.
There is strong evidence for the effectiveness of arts therapies in treating schizophrenia.
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Dynamic psychotherapy is supported by clinical trials as an effective treatment for schizophrenia.
Dynamic psychotherapy is supported by clinical trials as an effective treatment for schizophrenia.
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Exercise is effective in improving a range of symptoms and quality of life in schizophrenia.
Exercise is effective in improving a range of symptoms and quality of life in schizophrenia.
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NICE guidelines recommend adherence therapy as a standard treatment option for schizophrenia.
NICE guidelines recommend adherence therapy as a standard treatment option for schizophrenia.
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Adherence therapy has been found to significantly improve adherence and alter attitudes to medication adherence.
Adherence therapy has been found to significantly improve adherence and alter attitudes to medication adherence.
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Dynamic psychotherapy was more commonly used in the treatment of schizophrenia in the USA and France than in the UK.
Dynamic psychotherapy was more commonly used in the treatment of schizophrenia in the USA and France than in the UK.
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Loading doses should be used for rapid neuroleptization during acute episodes of schizophrenia.
Loading doses should be used for rapid neuroleptization during acute episodes of schizophrenia.
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About two-thirds of patients with schizophrenia show a significant therapeutic response to antipsychotic medication.
About two-thirds of patients with schizophrenia show a significant therapeutic response to antipsychotic medication.
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Antipsychotic drugs treat both positive and negative symptoms of schizophrenia effectively.
Antipsychotic drugs treat both positive and negative symptoms of schizophrenia effectively.
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Continuous treatment of schizophrenia is more effective than intermittent treatment.
Continuous treatment of schizophrenia is more effective than intermittent treatment.
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Antipsychotics typically show improvement in psychotic symptoms within 2 weeks.
Antipsychotics typically show improvement in psychotic symptoms within 2 weeks.
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The choice of antipsychotic drug should be based solely on the drug’s efficacy.
The choice of antipsychotic drug should be based solely on the drug’s efficacy.
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Depot formulations of antipsychotic medications should be considered especially when adherence to medication is a problem.
Depot formulations of antipsychotic medications should be considered especially when adherence to medication is a problem.
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There are substantial differences in efficacy between typical and atypical antipsychotics.
There are substantial differences in efficacy between typical and atypical antipsychotics.
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Dosing adjustments of antipsychotic drugs should consider the results from PET and SPET studies that measure dopamine D₂ receptor occupancy.
Dosing adjustments of antipsychotic drugs should consider the results from PET and SPET studies that measure dopamine D₂ receptor occupancy.
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When changing antipsychotic medication, drug withdrawal should be abrupt to minimize patient discomfort.
When changing antipsychotic medication, drug withdrawal should be abrupt to minimize patient discomfort.
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Olanzapine has the greatest effect on weight gain among antipsychotic drugs.
Olanzapine has the greatest effect on weight gain among antipsychotic drugs.
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Lurasidone has the smallest effect on efficacy among antipsychotic drugs.
Lurasidone has the smallest effect on efficacy among antipsychotic drugs.
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Haloperidol is most likely to continue on the drug compared to the other antipsychotics listed.
Haloperidol is most likely to continue on the drug compared to the other antipsychotics listed.
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Paliperidone results in the lowest increase in prolactin levels among the antipsychotic drugs.
Paliperidone results in the lowest increase in prolactin levels among the antipsychotic drugs.
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Sedation is least likely with the use of Amisulpride.
Sedation is least likely with the use of Amisulpride.
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Depot injections of antipsychotics reflect a 30% reduction in the risk of relapse.
Depot injections of antipsychotics reflect a 30% reduction in the risk of relapse.
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The recurrence rate for those who stopped medication after one year is 77% while it is only 3% for those who continued medication.
The recurrence rate for those who stopped medication after one year is 77% while it is only 3% for those who continued medication.
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Risperidone is most likely to cause QTc prolongation among the antipsychotic drugs listed.
Risperidone is most likely to cause QTc prolongation among the antipsychotic drugs listed.
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Chlorpromazine is least likely to result in extrapyramidal side effects among the antipsychotic drugs.
Chlorpromazine is least likely to result in extrapyramidal side effects among the antipsychotic drugs.
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Partial or non-adherence to antipsychotic treatment is reported to be as high as 52% in a recent meta-analysis.
Partial or non-adherence to antipsychotic treatment is reported to be as high as 52% in a recent meta-analysis.
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The NICE guidelines for the management of schizophrenia in adults place a strong emphasis on psychological and psychosocial interventions.
The NICE guidelines for the management of schizophrenia in adults place a strong emphasis on psychological and psychosocial interventions.
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Scottish guidelines for the management of schizophrenia prioritize pharmacological treatment for first-episode psychosis over all other recommendations.
Scottish guidelines for the management of schizophrenia prioritize pharmacological treatment for first-episode psychosis over all other recommendations.
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The Australasian guidelines for schizophrenia include considerations for older patients and those with comorbid substance abuse.
The Australasian guidelines for schizophrenia include considerations for older patients and those with comorbid substance abuse.
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Antipsychotic drugs have no significant side effects according to the evidence provided.
Antipsychotic drugs have no significant side effects according to the evidence provided.
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The primary treatment for schizophrenia involves the use of antipsychotic drugs complemented by psychological and psychosocial interventions.
The primary treatment for schizophrenia involves the use of antipsychotic drugs complemented by psychological and psychosocial interventions.
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NICE guidelines for schizophrenia in children and adolescents were updated in 2016.
NICE guidelines for schizophrenia in children and adolescents were updated in 2016.
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The Scottish guidelines focus more on perinatal issues than the NICE guidelines.
The Scottish guidelines focus more on perinatal issues than the NICE guidelines.
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The Scottish guidelines for schizophrenia are relatively short on details compared to the NICE guidelines.
The Scottish guidelines for schizophrenia are relatively short on details compared to the NICE guidelines.
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At least 30% of patients respond well to antipsychotics without any issues.
At least 30% of patients respond well to antipsychotics without any issues.
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Clozapine is the only proven drug intervention for patients who do not respond to other antipsychotics.
Clozapine is the only proven drug intervention for patients who do not respond to other antipsychotics.
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Other atypical antipsychotic drugs share the greater efficacy of clozapine.
Other atypical antipsychotic drugs share the greater efficacy of clozapine.
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The beneficial properties of clozapine may include reduction in suicide risk, aggression, and substance misuse.
The beneficial properties of clozapine may include reduction in suicide risk, aggression, and substance misuse.
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Antidepressants have been proven highly effective in treating depression in schizophrenia.
Antidepressants have been proven highly effective in treating depression in schizophrenia.
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Mood stabilizers have a proven antipsychotic effect in treating schizophrenia.
Mood stabilizers have a proven antipsychotic effect in treating schizophrenia.
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Benzodiazepines are useful for augmenting antipsychotic drugs.
Benzodiazepines are useful for augmenting antipsychotic drugs.
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New medications such as minocycline and polyunsaturated fatty acids are ready for routine clinical use in schizophrenia.
New medications such as minocycline and polyunsaturated fatty acids are ready for routine clinical use in schizophrenia.
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Electroconvulsive therapy is frequently used in the treatment of schizophrenia in the UK.
Electroconvulsive therapy is frequently used in the treatment of schizophrenia in the UK.
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A recent network meta-analysis suggested clozapine is not more effective than olanzapine or risperidone for treatment-resistant schizophrenia.
A recent network meta-analysis suggested clozapine is not more effective than olanzapine or risperidone for treatment-resistant schizophrenia.
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Study Notes
Psychosocial Interventions for Schizophrenia
- Family therapy (psychoeducation)
- Cognitive behaviour therapy
- Cognitive remediation
- Art therapy
- Social skills training
- Illness management skills
- Supported employment
- Integrated treatment for comorbid substance misuse
Aims of Psychosocial Interventions
- Enhance interpersonal and social functioning
- Attenuate symptom severity and associated comorbidity
Family Therapy
- Reduces rates of relapse and improves medication compliance
- Psychoeducation alone is effective in improving coping and knowledge of family members
- Focuses on education about schizophrenia, improving communication, lowering expressed emotion, expanding social networks, adjusting expectations, and reducing daily contact
Cognitive Behavioral Therapy (CBT)
- Effective in treating schizophrenia
- Focuses on structured reasoning and behavioral modification
- Aims to trace the origins of delusional beliefs and explore alternative explanations
- Can modify patients' beliefs about the origin of auditory hallucinations
- Often used as an adjunct to medication, but effective even without antipsychotics
Cognitive Remediation
- Effective in improving cognitive performance and functional outcomes
- Involves mental exercises and training to improve performance through practice
- Addresses important determinants of poor outcomes in schizophrenia
Antipsychotic Drugs Ranked by Effect
- 15 antipsychotic drugs ranked by efficacy, side effects, and tolerability
- Greatest effect: Amisulpride, Olanzapine, Risperidone
- Smallest effect: Lurasidone, Asenapine, Chlorpromazine
Maintenance Treatment and Prevention of Relapse
- Continued antipsychotic medication prevents relapse
- Meta-analysis found 65% relapse rate for those who stopped medication after 1 year, compared to 27% for those who continued treatment
- Continued treatment associated with better quality of life
- Systematic review showed 77% recurrence rate after 1 year for those who stopped medication, but only 3% for those who continued treatment
Treatment Adherence
- Partial or non-adherence to antipsychotic treatment is common (up to 52%)
- Associated with adverse outcomes
- Factors influencing adherence include severity of illness, side effects, and frequency of administration
Depot Antipsychotics (Long-Acting Injectables)
- Introduced to address non-adherence to treatment
- More successful than oral medication in preventing relapse due to improved compliance
- Meta-analysis showed 30% relative risk reduction
Key Points in the Pharmacological Treatment of Schizophrenia
- Initiate antipsychotic medication at the lower end of the licensed dose range
- Titrate dose within licensed range, monitoring for effects and side effects
- Aim to achieve optimum dose with good adherence for 2 weeks
- Consider psychological interventions whenever medication is being introduced or changed
Effectiveness and Side Effects of Antipsychotic Drugs
- Well-established effectiveness in treating acute schizophrenia
- Median effect size compared to placebo is 0.44
- Two-thirds of patients show significant therapeutic response
- No clinically useful ways of predicting individual patient response
- Antipsychotic drugs only treat positive symptoms, with little or no effect on negative or cognitive symptoms
Onset of Action
- Antipsychotics do not have a delayed onset of action
- Improvement in psychotic symptoms and sedation can be detected within 24 hours
- If no 20% improvement in symptom score after 2 weeks, chances of later response to that drug and dose are small
Dosage
- Studies using PET and SPET provide a rationale for dosing of antipsychotic drugs
- Evidence complements clinical guidelines
Clozapine
- Only proven drug intervention for treatment-resistant schizophrenia
- Effective in about one-third of patients
- Has benefits regarding suicide risk, aggression, and substance misuse
- Unique place in treatment of schizophrenia despite risks and side effects
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Description
Learn about various psychosocial interventions for schizophrenia, including family therapy, cognitive behavior therapy, and social skills training, with the aim of enhancing interpersonal and social functioning and attenuating symptom severity.
