Nicholas Tarrier

Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS).

BACKGROUND Scales to measure the severity of different dimensions of auditory hallucinations and delusions are few. Biochemical and psychological treatments target dimensions of symptoms and valid and reliable measures are necessary to measure these. METHOD The inter-rater reliability and validity of the Psychotic Symptom Rating Scales (PSYRATS: auditory hallucination subscale and delusions subscale), which measure several dimensions of auditory hallucinations and delusions were examined in this study. RESULTS The two scales were found to have excellent inter-rater reliability. Their validity as compared with the KGV scale (Krawiecka et al. 1977) was explored. CONCLUSIONS It is concluded that the PSYRATS are useful assessment instruments and can complement existing measures.

A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder

A randomized trial was performed in which imaginal exposure (IE) and cognitive therapy (CT) were compared in the treatment of chronic posttraumatic stress disorder (PTSD). Patients who continued to meet PTSD caseness at the end of a 4-week symptom-monitoring baseline period (n = 72) were randomly allocated to either IE or CT. There was a significant improvement in all measures over treatment and at follow-up, although there were no significant differences between the 2 treatments at any assessment. A significantly greater number of patients who showed worsening over treatment received IE, although this effect was not found at follow-up. Patients who worsened showed a greater tendency to miss treatment sessions, rated therapy as less credible, and were rated as less motivated by the therapist. It was concluded that either exposure or a challenge to cognition can result in symptom reduction, although neither resulted in complete improvement.

Social functioning in schizophrenic patients: I. The effects of expressed emotion and family intervention

SummaryThe relationship between the social functioning of schizophrenic patients and the EE levels of their relatives is examined. Patients living with a high EE relative function significantly worse than those living with low EE relatives. This appeared to be due to a poorer social functioning in patients who lived with hostile relatives. Patients who participated in a nine month behavioural family intervention showed greater improvements in social functioning than control groups. The improvements could not be explained as being due to medication since high neuroleptic dosage over nine months was associated with poorer social functioning.

Coping strategy enhancement (CSE) : a method of treating residual schizophrenic symptoms

A method of teaching coping skills to patients with schizophrenia who experience unremitting psychotic symptoms is described. This method (Coping Strategy Enhancement CSE) is based on a thorough behaviour analysis of each symptom and the assessment of any coping strategy the subject may already employ. The subject is then systematically trained in the use of appropriate coping strategies in response to the occurrence of their psychotic symptoms. Two case studies are described in which CSE was used. Both patients showed considerable improvements over treatment. In one patient improvement continued at 6 month follow-up, in the other there was some deterioration at follow-up. Possible reasons for these results were discussed.

A trial of two cognitive behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients. II: Treatment-specific changes in coping and problem-solving skills

SummaryChanges in coping skills and problem-solving skills were examined in two groups of schizophrenic patients. The groups received either coping skills enhancement or problem-solving treatments to reduce their drugresistant residual psychotic symptoms. The coping skills group showed significant increases both in the number of positive coping strategies used and in their efficacy, whereas the problem-solving group showed a decrease in these measures during treatment. Both groups showed significant improvements in problem-solving skills. Changes in coping but not problem solving were significantly related to decreases in psychotic symptoms during treatment. It was concluded that treatment involving the teaching of coping skills had a specific treatment effect.

Prodromal signs of relapse in schizophrenia

SummaryFifty-six patients who were hospitalised for a schizophrenic episode were followed up for nine months after discharge. The Psychiatric Assessment Scale (PAS, Krawiecka et al., 1977) was administered at monthly intervals during this period. Twenty-three patients relapsed of which data were available for sixteen. In these sixteen patients who relapsed comparisons were made of the PAS symptoms between the month prior to relapse and the month preceding this. Sixteen patients who did not relapse were randomly matched with the relapsing patients and an index point comparable in time to relapse onset in the matched relapsed patient was identified. Comparisons were made on the PAS symptoms using a repeated measures ANOVA to compare relapsers and non relapsers on the month prior to relapse and the month which preceded this. Discriminant function analysis was used to predict relapse by analysis of those PAS symptoms which showed an increase in the month before relapse. This suggested that the measures of depression and hallucinations significantly increased in the month prior to relapse compared to the preceding month in relapsers but not non-relapsers. The results of this study closely agree with previous published results even though there were some differences between studies in the patient samples.

Family Interventions for Schizophrenia

Studies that have attempted to reduce schizophrenic relapse by the use of family interventions are described. Results from studies that implemented behavioral family interventions with patients who were identified as high risk because of the expressed emotion status of their relatives have demonstrated that relapse rates can be significantly reduced over a 2-year postdischarge follow-up period. A number of ongoing studies, especially those that are investigating the interaction of family interventions and different medication regimes, are also discussed. Areas for further investigation are identified, for example: the use of multiple outcome measures, the use of single-case studies and the development of ideographic assessment measures, the interaction of biological and environmental influences, the alleviation of the burden of care, the involvement of the consumer in services, the development of behavioral formulations and analysis of family engagement and compliance, staff training in intervention methods, and the translation of research results into clinical practice.

Treatment of psychological distress following mastectomy: an initial report

Abstract A behavioural programme to treat psychological distress following mastectomy for breast cancer is described. The first 10 patients to be treated were randomly allocated to two treatment groups: Behavioural Programme Only or Behavioural Programme + Drugs (antidepressant medication). Both groups showed improvement over treatment, but the Behavioural Programme + Drugs group appeared to maintain their improvement better.

A Behavioural Family Intervention with a Schizophrenic Patient: A Case Study

A schizophrenic patient and his family were provided with a nine month multi-component behavioural intervention programme as part of a controlled study. The patient was at high risk of relapse according to the High EE status of his parents. Multiple outcome measures were used to assess the efficacy of the programme. The components of the intervention are described in detail, and the specificity of component effects in this case are examined. Given the methodological limitations of this type of study, it is not possible to demonstrate conclusively intervention effects in the case reported. However, following the intervention the relapse rate of the patient was reduced, his social functioning improved and the EE status of his parents changed from High to Low.

A longitudinal psychophysiological assessment of a schizophrenic patient in relation to the expressed emotion of his relatives

This article reports a longitudinal study of the psychophysiological responses of a schizophrenic patient towards his parents, in relation to their Expressed Emotion status. Recordings were taken during periods of relapse and remission. The results are discussed in the context of environmental and vulnerability factors affecting the illness.