Questions and Answers
High rates of relapse (92%) are associated with high expressed emotion (EE), intense contact, and no medication.
True
Studies by Leff et al. (1985) showed an increase in relapse rates in high EE families through behavioural programmes involving family sessions.
False
Training in intervention programmes for reducing relapse has not yet become a part of the Thorn Course for psychiatric nurses.
False
Despite the strong evidence base, behavioural programmes aimed at reducing relapse rates have struggled to be adopted in routine practice.
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Relatives of patients with schizophrenia may experience increased feelings of anxiety, depression, guilt, or bewilderment.
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Families of patients with schizophrenia primarily face issues related to social withdrawal and episodes of disturbed behaviour.
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Improving community services and support for patients with schizophrenia and their relatives is not a priority in many countries.
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In the UK, all carers of patients with schizophrenia are now entitled to an annual assessment of their needs.
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The neurodevelopmental model of schizophrenia was proposed by Clouston in 1892.
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Kraepelin proposed that schizophrenia is a disorder of neurodevelopment in the 21st century.
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The neurodevelopmental model implicates the second trimester in utero or adolescence.
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There are serious challenges to the neurodevelopmental model as a hypothesis of schizophrenia pathogenesis.
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The neurodevelopmental model's vagueness allows most findings to be interpreted as consistent with it.
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The neurodevelopmental model easily explains the variable course of schizophrenia.
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Increased frequency of large cavum septum pellucidum is a finding that supports the neurodevelopmental hypothesis of schizophrenia.
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Limited progression of brain changes after onset supports the neurodevelopmental hypothesis of schizophrenia.
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'Soft' neurological signs at presentation are not associated with the neurodevelopmental hypothesis of schizophrenia.
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Neuropathological changes with gliosis imply a prenatal timing for schizophrenia.
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Younger age at onset is considered a poor prognostic factor in schizophrenia.
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The International Pilot Study of Schizophrenia found the 2-year outcome was worse in India, Colombia, and Nigeria than in Western countries.
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High expressed emotion in families is associated with a higher risk of relapse in schizophrenia patients.
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Patients with schizophrenia who have high levels of contact with family members always have better outcomes.
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Overstimulation in family environments is related to poor outcomes in schizophrenia patients.
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Insidious onset of schizophrenia is linked to better prognosis.
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Wing and Brown's research found that an active rehabilitation program improved outcomes in patients with schizophrenia.
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Male sex is one of the poor prognostic factors identified in schizophrenia.
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The International Pilot Study of Schizophrenia suggested a difference in the severity of illness at first presentation could be an important factor in geographical differences in outcomes.
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Patients in traditional institutions had better outcomes than those in active rehabilitation programs according to Wing and Brown's research.
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Kraepelin initially believed that dementia praecox had an invariably poor outcome.
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Manfred Bleuler concluded that 45% of patients exhibited complete remission 20 years after admission.
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Bleuler's conclusions were supported by Ciompi.
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A recent 15- and 25-year follow-up study found that one-fourth of the patients had achieved full recovery.
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In the UK AESOP study, 45% of patients had been free of psychotic symptoms for at least 3 years.
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Hegarty et al. (1994) found that the 'recovery rate' for schizophrenia fell back to 36% between 1986 and 1992.
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The lifetime risk of suicide in schizophrenia is typically around 10%.
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Patients with schizophrenia have a threefold increase in the risk of death from all causes according to recent studies.
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Approximately 5% of patients meet the criterion of recovery requiring improvement in both symptoms and social/functional roles, persisting for at least 2 years.
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Expressed another way, men with schizophrenia die approximately 20 years prematurely.
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Study Notes
Effects of Schizophrenia on the Family
- High rates of relapse (92%) are associated with high expressed emotion (EE), intense contact, and no medication.
- Relapse rates can be reduced in high EE families through behavioral programs involving family sessions.
- Training in these intervention programs has become an integral part of the Thorn Course for psychiatric nurses.
How Schizophrenia Affects Family Members
- Relatives of patients with schizophrenia may experience anxiety, depression, guilt, or bewilderment.
- They may struggle to deal with difficult and unusual behavior.
- Anticipatory anxiety and sense of stigma is often more difficult to manage than the practical burden of caring for a family member.
Popular Support for Discredited Theories
- Although few mental health professionals support theories that families cause schizophrenia, there is still considerable popular support for these ideas.
- Families often feel blamed for the illness.
Support Services for Families
- Community services and support for patients with schizophrenia and their relatives are often less than adequate.
- Improving services for carers is a priority in many countries.
- In the UK, all carers are now entitled to an annual assessment of their needs.
Relatives' Experiences of Interacting with Patients
- Families describe two main problems: social withdrawal and episodes of disturbed behavior.
- Patients often avoid interacting with other family members, appear slow, lack conversational skills, have few interests, and neglect themselves.
Neurodevelopmental Model
- The neurodevelopmental model of schizophrenia proposes that the disorder is related to abnormalities in brain development.
- Evidence in favor of the model has accrued from several sources, including structural brain changes, limited progression of brain changes after onset, and neuropsychological impairments.
- The model has weaknesses, including a failure to readily explain the variable course of the disorder or provide a convincing explanation for late-onset schizophrenia.
Predictors of Outcome
- The outcome of schizophrenia is heterogeneous and still largely unpredictable.
- Poor prognostic factors include younger age of onset, male sex, poor pre-morbid functioning, prolonged duration of untreated psychosis, and early negative symptoms and cognitive impairment.
- These factors have modest predictive value, and caution should be exercised when predicting outcomes for individual cases.
International Studies
- International studies suggest that the course and outcome of schizophrenia may differ between countries.
- The International Pilot Study of Schizophrenia found that the 2-year outcome was better in India, Colombia, and Nigeria than in Western countries.
Social Stimulation
- Clinicians recognized in the 1940s and 1950s that many clinical features were associated with an unstimulating environment among people with schizophrenia living in institutions.
- Poverty of social milieu was found to be closely related to three aspects of the patients' clinical condition: social withdrawal, blunting of affect, and poverty of speech.
Course and Prognosis
- The course and long-term outcome of schizophrenia has been a fiercely debated issue.
- Kraepelin initially believed that dementia praecox had an invariably poor outcome, although later reported that 17% of his patients eventually were socially well-adjusted.
- Manfred Bleuler found that 20% of his patients exhibited complete remission, 35% had good social adjustment, and 24% remained severely disturbed 20 years after admission.
- A more recent 15- and 25-year follow-up study found that one-sixth of the patients had achieved full recovery.
- A 10-year follow-up of first-episode psychosis found that 23% had had an unremitting illness, and 45% had been free of psychotic symptoms for at least 2 years.
- A recent meta-analysis reported that about 14% of patients met the criterion for recovery.
Physical Health, Mortality, and Suicide in Schizophrenia
- There is an increased mortality in patients with schizophrenia, with a risk of death from all causes increased 1.6-fold to threefold.
- This "mortality gap" is increasing, and subsequent studies have found a higher figure than the original report.
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Description
This quiz explores the relationship between expressed emotion and relapse in families affected by schizophrenia, including the impact of behavioural programmes and interventions.
