Data Bases • Custom Term Papers • Free Term Papers • Free Research Papers • Free Essays • Free Book Reports • Plagiarism? Links • Top 100 Term Paper Sites • Top 25 Essay Sites • Top 50 Essay Sites • Search 97,000 Papers @ DirectEssays.com • Search 101,000 Papers @ ExampleEssays.com • Search 90,000 Papers @ MegaEssays.com Free Essays • Term Paper Sites • Chuck III's Free Essays • Free College Essays • TermPaperSites.com • My Term Papers • Get Free Essays • Essay World • Planet Papers	Search Lots of Essays Back to Subjects - Psychology NonDrug Treatments of Schizophrenia NonDrug Treatments of Schizophrenia Non-Drug Treatments of Schizophrenia There has been a lot of research in the area of treatments of schizophrenia. However, most of the research has been focused on medication. This paper focuses on various non-drug treatments for schizophrenia. Schizophrenia is a disorder that affects approximately two percent of the population. Since it is highly debilitating various treatments are available. The most common treatments are pharmacological, as it is biologically based. Cognitive behavior and other therapies are often used alongside medication to lower relapse rates. In addition to this family interventions, which attempt to teach families of patients techniques to better care for their loved ones are used. Interventions have shown to significantly reduce relapse rates for at least the first nine months after the families are educated (Kuipers, 1996) . They also improve social function of patients (Tarrier et al. 1988) , and ease the burden on those who care for the patient (Falloon & Pederson, 1985) . Unfortunately, patients with schizophrenia can be difficult to deal with and hospital staff may dislike them and thus act in a negative manner toward them. As they are the people who are mainly taking care of the patient at the time, hostile attitudes toward a patient are not conducive to his or her well-being. In addition to this, families of the patient may make relapse more likely. In order to find out which families have a greater likelihood of having a patient relapse, the Expressed Emotion (EE) measure was developed. It has been found that patients with high EE families have higher relapse rates. In terms of treatment options, most of the emphasis has been on medication. However, some patients are drug-resistant and some do not wish to take medication. For these cases, a greater emphasis on non-drug treatments is necessary. The advantages of non-drug therapies are that they are usually low risk, have not physical side effects, are not physically intrusive, and may be more acceptable to the patient. The disadvantages are that these therapies are not very effective without medication, can make the patient worse if they are too demanding, are time consuming, and therapists often need extra training to carry them out (Kuipers, 1996). With these factors in mind, we can see that non-drug treatments for schizophrenia should be utilized whenever possible, though not as a replacement for medication. In the past, families were seen as a problem or annoyance to be dealt with when dealing with schizophrenic patients. However, with the advent of interventions, relatives are now seen as a resource and their needs are being acknowledged. One thing that relatives often require is information about schizophrenia and whatever medication(s) are being administered. However, one must be careful that the information provided is not misunderstood. This is especially likely to happen with very critical relatives as they have a tendency to blame the patient for problem behavior and negative symptoms rather than realizing that the problem is the disorder. Since it is difficult to effectively transmit the necessary information, this process often takes more than one session. Another necessary part of in interventions with high EE families is helping them communicate and solve problems better. High EE families often poor communication and tend to avoid trying solutions to problems, tending to avoid them or become angry instead. Families of patients with schizophrenia have a strong range of emotional responses. These range from shock, denial, guilt, and grief to fear, worry, anger, and a loss of confidence (Kuipers, 1996). It is very important to allow these emotions to be aired and dealt with rather than leaving them to gnaw away at the relatives’ psyches. A study of high EE families showed that after successful interventions, relapse rates went from fifty percent to ten percent for the first nine months. Unfortunately two years after the fact, the relapse rates were not significantly different whether there was an intervention or not (Kuipers, 1996). However, Tarrier et al. (1994) found that after five and eight years patients who had a nine month family intervention still had a significantly lower relapse rate though relapses did accumulate. Interventions suffer from a few problems. While they help, they are time consuming, their effects are reduced over time, and finally, it is very difficult to recruit families while the patient is in remission and the family has a fairly stable situation. Non-engagement rates at these times are over fifty percent (Smith 1992) . As already noted, many ‘difficult to treat’ schizophrenic patients are disliked by hospital staff treating them. This hampers the therapeutic alliance greatly. Frank & Gunderson (1990) found that although even after six months only thirty percent of patients in treatment for schizophrenia were in good alliances, those that were were less likely to drop out and made more gains over the next two years. Good alliances led to greater acceptance of psychotherapy and pharmacotherapy (though less medication use). It has been found that the things that most lead carers to dislike a patient were repetition of inappropriate behavior and attention seeking. However apathy, slowness and poor self-care also lead to criticism from carers (Moore et al. 1992b). It was also found that those of the staff who criticize a lot are more likely to attribute patients’ difficulties to being under the patients’ control, and to have negative expectations of the patient. However, nothing suggests that patients with challenging behavior necessarily are disliked. The group which receives the most criticism and be disliked are those patients who are withdrawn and seemed to be cold and not very responsive to therapy. From this we can see that there are several things that staff needs to do to deal with challenging patients. Be persistent, as good therapeutic alliances can form even six months after the beginning of treatment; keeping patient load for staff fairly low so as to allow staff to not get overworked and frustrated; finding at least one aspect of the patient which can be viewed positively; and, finally, staff should work together and take time to vent anger or frustration. An additional aspect of keeping staff from disliking certain patients is training in attributing blame for disliked behavior to the illness rather than the patient. So far the treatments I have spoken of deal with non-drug treatments of schizophrenia that are used in conjunction with medication, but what happens when a patient is resistant to the antipsychotic which they are prescribed? Besides altering the dose and trying an atypical antipsychotic such as clozapine, electroconvulsive therapy (ECT) has been found to be a useful treatment. A response to ECT is more likely if there are affective symptoms. Unilateral electrodes over the non-dominant hemisphere seem to be as effective as bilateral placement (Jalenques, 1996). While many kinds of therapy can be useful, the most helpful seem to be: body awareness therapy, communication-oriented group therapy, family therapy, hospital-based social skills training, cognitive behavioral therapy, and vocational rehabilitation. Body awareness therapy and communication-oriented therapy are both aimed at increasing the patient’s communication skills. Hospital-based social skills training focuses on improving the patient’s ability to survive and function on his or her own. Vocational rehabilitation attempts to help the patient organize his or her external structure. Cognitive behavior therapy alleviates psychotic symptoms (Jalenques, 1996). Cognitive behavior therapy seems to be the most effective non-drug option. In a study of patients treated with it compared to patients who received supportive counseling and those who simply received routine care a significant benefit was shown. Patients treated with cognitive behavior therapy were eight times more likely to show reduction of fifty percent or more in psychotic symptoms than subjects receiving routine care alone. They also had shorter duration of psychotic episodes and less sever symptoms. In terms of relapse, patients treated with cognitive behavior therapy were much less likely to relapse than those who received routine care, and when they did they spent much less time in the hospital. (Tarrier et al. 1998) The different methods of such therapy that are used are cognitive therapy with a normalizing rationale; coping strategy enhancement; and comprehensive cognitive-behavioral therapy. Another effective technique is early intervention. Clinical interventions are implemented when signs of a coming relapse are detected in an attempt to prevent it. This has, along with prophylactic medication, proven to be successful fairly regularly. As we have seen, while non-drug treatments and techniques for helping those with schizophrenia exist, some are not utilized as much as they could and should be. These techniques should be implemented more as patients often neglect to take medication. While it would be difficult to change so many things at once, focusing training staff, lightening the staff’s caseload, making sure to hold interventions for high risk families, and learning to not be put off by ECT to use it even in times when it would be the best treatment for the patient, if it is taken bit by bit, these changes can be accomplished. It is unfortunate that better treatment for patients with schizophrenia is not used because of monetary issues, but that is the main reason for most hospitals ignoring the staff training guidelines mentioned here. Family interventions as well as additional cognitive behavioral therapy and other kinds of therapy are also limited by the patient’s ability to pay and thus many of our nation’s severely psychologically disturbed individuals are homeless and without any sort of support at all. Bibliography: Word Count: 1566
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