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The Management of Difficult to Treat Patients with Schizophrenia, Using Non-drug Therapies

Published online by Cambridge University Press:  06 August 2018

Elizabeth Kuipers
Elizabeth Kuipers*
Affiliation:
Institute of Psychiatry, London SE5 8AF
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Extract

When we consider what defines a person with schizophrenia as ‘difficult to treat’, a number of questions are raised. These concern some fundamental assumptions about patients, therapy and the sick role in society (Parsons, 1951).

Type
Research Article
Information
The British Journal of Psychiatry , Volume 169 , Issue S31: Management of Difficult to Treat Patients with Schizophrenia , December 1996 , pp. 41 - 51
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Anderson, C., Reiss, D. & Hogarty, G. E. (1986) Schizophrenia in the Family: a Practical Guide. New York: Guilford Press.Google Scholar
Anderson, J. & Adams, C. (1996) Family intervention in schizophrenia. British Medical Journal, 313, 232–236.Google Scholar
Ball, R. A., Moore, E. & Kuipers, L. (1992) EE in community care facilities: a comparison of patient outcome in a 9 month follow-up of two residential hostels. Social Psychiatry and Psychiatric Epidemiology, 27, 35–39.CrossRefGoogle Scholar
Barrowclough, C. & Tarrier, N. (1992) Families of Schizophrenic Patients: Cognitive Behavioural Interventions. London: Chapman & Hall.Google Scholar
Bebbington, P. E. & Kuipers, L. (1994a) The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychological Medicine, 24, 707–718.CrossRefGoogle ScholarPubMed
Bebbington, P. E. & Kuipers, L. (1994b) The social management of long-standing schizophrenia. I. The deployment of service resources. Clinician, 12, 17–29.Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. F., et al (1979) Cognitive Therapy of Depression. Chichester: Wiley.Google Scholar
Beltz, J., Bertrando, P., Clerici, M., et al (1991) Emotiva Espresso e schizophrenia: dai familiari agli operatori psychiatrici. Symposium on Expressed Emotion in Latin based languages. Barcelona, Spain.Google Scholar
Berkowitz, R., Eberlein-Friess, R., Kuipers, L., et al (1984) Educating relatives about schizophrenia. Schizophrenia Bulletin, 10, 418–429.Google Scholar
Birchwood, M. & Smith, J. (1987) Schizophrenia and the family. In Coping with Disorder in the Family (ed. Orford, J.), pp. 7–38. London: Croom Helm.Google Scholar
Birchwood, M. & Smith, J. (1990) Relatives and patients as partners in the management of schizophrenia. Psychosocial Rehabilitation Journal, 13, 27–30.Google Scholar
Birley, J. & Hudson, B. (1983) The family, the social network and rehabilitation. In Theory and Practice of Psychiatric Rehabilitation (eds Watts, F. N. & Bennett, D. H.), pp. 171–188. New York: Wiley.Google Scholar
Bledin, K., MacCarthy, B., Kuipers, L., et al (1990) Daughters of people with dementia: EE, strain and coping. British Journal of Psychiatry, 157, 221–227.Google Scholar
Brewin, C. R., MacCarthy, B., Duda, R., et al (1991) Attribution and Expressed Emotion in the relatives of patients with schizophrenia. Journal of Abnormal Psychology, 100, 546–554.Google Scholar
Brugha, T., Wing, J., Brewin, C., et al (1988) The problems of people in long-term psychiatric day care. An introduction to the Camberwell High Contact Study. Psychological Medicine, 18, 443–456.Google Scholar
Chadwick, P. & Lowe, F. (1990) The measurement and modification of delusional beliefs. Journal of Consulting Clinical Psychology, 58, 225–232.Google Scholar
Creer, C., Sturt, E. & Wykes, T. (1982) The role of relatives. In Long term community care: experience in a London borough (ed. J. K. Wing), pp. 29–39. Psychological Medicine, Monograph, Suppl. 2.CrossRefGoogle Scholar
Curzon, D. A., Barnes, T. R. E., Bamber, R. W., et al (1985) Long-term depot maintenance of chronic schizophrenic outpatients. British Journal of Psychiatry, 146, 464–480.Google Scholar
De Jesus Mari, J. & Streiner, D. L. (1994) An overview of family interventions and relapse in schizophrenia: meta-analysis of research findings. Psychological Medicine, 24, 565–578.Google Scholar
Fadden, G. B., Bebbington, P. E. & Kuipers, L. (1987a) The burden of care: the impact of functional psychiatric illness on the patient's family. British Journal of Psychiatry, 150, 285–292.CrossRefGoogle ScholarPubMed
Fadden, G. B., Kuipers, L. & Bebbington, P. E. (1987) Caring and its burdens: a study of the relatives of depressed patients. British Journal of Psychiatry, 151, 660–667.Google Scholar
Falloon, I. R. H. (1985) Family Management of Schizophrenia. Baltimore: Johns Hopkins University Press.Google ScholarPubMed
Falloon, I. R. H. & Talbot, R. E. (1981) Persistent auditory hallucinations: coping mechanisms and implications for management. Psychological Medicine, 11, 329–339.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Boyd, J. L., McGill, C. W., et al (1982) Family management in the prevention of exacerbations of schizophrenia. A controlled study. New England Journal of Medicine, 306, 1437–1440.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Boyd, J. L., McGill, C. W., et al (1985) Family management in the prevention of morbidity of schizophrenia. Clinical outcome of a two year longitudinal study. Archives of General Psychiatry, 42, 887–896.CrossRefGoogle ScholarPubMed
Falloon, I. R. H. & Pederson, J. (1985) Family management in the prevention of morbidity of schizophrenia. Adjustment of the family unit. British Journal of Psychiatry, 147, 156–163.CrossRefGoogle ScholarPubMed
Fowler, D. (1992b) Cognitive behaviour therapy in the management of patients with schizophrenia: preliminary studies. In Psychotherapy of Schizophrenia: Facilitating and Obstructive Factors (eds Werbart, A. & Cullberg, J.). Oslo: Scandinavian University Press.Google Scholar
Fowler, D. & Morley, S. (1989) The cognitive behavioural treatment of hallucinations and delusions: a preliminary study. Behavioural Psychotherapy, 17, 267–282.Google Scholar
Fowler, D., Garety, P. A. & Kuipers, L. (1995) Cognitive Behaviour Therapy for People with Psychosis: A Clinical Handbook. Chichester: Wiley.Google Scholar
Fowler, L. (1992a) Family psychoeducation: Chronic psychiatrically ill Caribbean patients. Journal of Psychosocial Nursing and Mental Health Services, 30, 27–32.Google Scholar
Frank, A. F. & Gunderson, J. G. (1990) The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Archives of General Psychiatry, 47, 228–236.CrossRefGoogle ScholarPubMed
Gamble, C., Midence, K. & Leff, J. (1994) The effects of family work training on mental health nurses’ attitudes to and knowledge of schizophrenia: a replication. Journal of Advanced Nursing, 19, 893–896.Google Scholar
Gantt, A. B., Goldstein, G. & Pinky, S. (1989) Family understanding of psychiatric illness. Community Mental Health Journal, 25, 101–108.Google Scholar
Garety, P. A. (1992) Making sense of delusions. Psychiatry, 55, 282–291.Google Scholar
Garety, P. A., Kuipers, L., Fowler, D., et al (1994) Cognitive behaviour therapy for drug resistant psychosis. British Journal of Medical Psychology, 67, 259–271.Google Scholar
Gibbons, J. S., Horn, S. H., Powell, J. M., et al (1984) Schizophrenic patients and their families. A survey in a psychiatric service based on a district general hospital. British Journal of Psychiatry, 144, 70–77.Google Scholar
Hatfield, A., Spaniol, L. & Zipple, A. M. (1987) Expressed Emotion: a family perspective. Schizophrenia Bulletin, 13, 221–226.CrossRefGoogle ScholarPubMed
Hawton, K., Salkovskis, P., Kirk, J., et al (1989) Cognitive Behaviour Therapy for Psychiatric Problems. Oxford: Oxford University Press.Google Scholar
Herzog, T. (1988) Nurses, patients and relatives: a study of family patterns on psychiatric wards. In Family Intervention in Schizophrenia: Experiences and Orientations in Europe (eds Cazzullo, C. L. & Invernizzi, G.). Milan: ARS.Google Scholar
Hogarty, G. E., Anderson, C. M., Reiss, D. J., et al (1986) Family psycho-education, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia. I. One year effects of a controlled study on relapse and Expressed Emotion. Archives of General Psychiatry, 43, 633–642.Google Scholar
Hogarty, G. E., Anderson, C. M. & Reiss, D. J. (1987) Family psycho-education, social skills training, and medication in schizophrenia: the long and the short of it. Psychopharmacology Bulletin, 23, 12–13.Google Scholar
Hogarty, G. E., McEvoy, J. P., Munetz, M., et al (1988) Dose of fluphenazine, familial expression of emotion, and outcome in schizophrenia: results of a two-year controlled study. Archives of General Psychiatry, 45, 797–805.CrossRefGoogle ScholarPubMed
Jaspers, K. (1963) General Psychopathology (Trans. Hoenig, J. & Hamilton, M. W.). Manchester: Manchester University Press.Google Scholar
Johnson, W. G., Ross, J. M. & Mastria, M. A. (1977) Delusional behaviour: an attributional analysis of development and modification. Journal of Abnormal Psychology, 86, 421–426.Google Scholar
Johnstone, E. C., Owens, D. G. C., Frith, C. D., et al (1991) Clinical findings: abnormalities of mental state and their correlates. The Northwick Park follow-up study. British Journal of Psychiatry, 159 (Suppl. 13), 21–25.Google Scholar
Kapur, S., Ganguili, R., Ulrich, R., et al (1991) Use of random-sequence riboflavin as a marker of medication compliance in chronic schizophrenics. Schizophrenia Research, 6, 49–53.Google Scholar
Kavanagh, D. H. (1992) Recent developments in Expressed Emotion and schizophrenia. British Journal of Psychiatry, 160, 601–620.Google Scholar
Keith, S. J., Matthews, S. M. & Schooler, N. R. (1991) A review of psychoeducational family approaches. In Schizophrenia Research. Advances in Neuropsychiatry and Psychopharmacology, Vol. 1 (eds Tamminga, C. A. & Schulz, S. C.), pp. 247–254. New York: Raven Press.Google Scholar
Kemp, R., Hayward, P., Applewhaite, G., et al (1996) Compliance therapy in psychotic patients: random controlled trial. British Medical Journal, 312, 345–349.Google Scholar
Kingdon, D. G. & Turkington, D. (1991) Preliminary report: the use of cognitive behaviour therapy with a normalizing rationale in schizophrenia. Journal of Nervous and Mental Disease, 179, 207–211.CrossRefGoogle ScholarPubMed
Köttgen, C., Sonnichsen, I., Mollenhauer, K., et al (1984) Group therapy with the families of schizophrenic patients: results of the Hamburg Camberwell Family Interview Study: III. International Journal of Family Psychiatry, 5, 84–94.Google Scholar
Kuipers, E. & Moore, E. (1995) Expressed Emotion and staff–client relationships. International Journal of Mental Health, 24, 13–26.Google Scholar
Kuipers, L. (1991) Schizophrenia in the family: the needs of long-term psychiatric carers. International Review of Psychiatry, 3, 105–117.Google Scholar
Kuipers, L. (1992) Expressed Emotion research in Europe. British Journal of Clinical Psychology, 31, 429–443.CrossRefGoogle ScholarPubMed
Kuipers, L. (1994) The measurement of expressed emotion: its influence on research and clinical practice. International Review of Psychiatry, 6, 187–199.Google Scholar
Kuipers, L. & Bebbington, P. E. (1985) Relatives as a resource in the management of functional illness. British Journal of Psychiatry, 147, 465–471.Google Scholar
Kuipers, L. & Bebbington, P. E. (1988) Expressed Emotion research in schizophrenia: theoretical and clinical implications. Psychological Medicine, 18, 893–910.Google Scholar
Kuipers, L. & Moore, E. (1995) Expressed emotion and staff–client relationships. International Journal of Mental Health, 24, 13–26.Google Scholar
Kuipers, L., MacCarthy, B., Hurry, J., et al (1989) A low cost supportive model for relatives of the long term adult mentally ill. British Journal of Psychiatry, 154, 775–782.Google Scholar
Kuipers, L. & Bebbington, P. E. (1990) Working in Partnership: Clinicians and Carers in the Management of Long-standing Mental Illness. Oxford: Heinemann Medical.Google Scholar
Kuipers, L., Leff, J. P. & Lam, D. H. (1992) Family Work for Schizophrenia: A Practical Guide. London: Gaskell.Google Scholar
Kuipers, L., Garety, P. & Fowler, D. (1996) An outcome study of cognitive behavioural treatment for psychoses. In Cognitive Behavioural Interventions with Psychotic Disorders (eds Haddock, C. & Slade, P.), pp. 116–136. London: Routledge.Google Scholar
Lam, D. H. (1991) Psychosocial family intervention in schizophrenia: a review of empirical studies. Psychological Medicine, 21, 423–441.Google Scholar
Leff, J. P., Kuipers, L., Berkowitz, R., et al (1982) A controlled trial of social intervention in schizophrenic families. British Journal of Psychiatry, 141, 121–134.Google Scholar
Leff, J. P., Kuipers, L. & Berkowitz, R. (1985) A controlled trial of social intervention in the families of schizophrenic patients: two year follow up. British Journal of Psychiatry, 146, 594–600.Google Scholar
Leff, J. P. & Vaughn, C. (1985) Expressed Emotion in Families. New York: Guilford Press.Google Scholar
Leff, J. P., Berkowitz, R., Shavit, N., et al (1989) A trial of family therapy v. a relatives’ group for schizophrenia. British Journal of Psychiatry, 154, 58–66.Google Scholar
Leff, J. P., Berkowitz, R., Shavit, N., et al (1990) A trial of family therapy versus a relatives’ group for schizophrenia: a two year follow-up. British Journal of Psychiatry, 157, 571–577.CrossRefGoogle Scholar
MacCarthy, B. (1988) The role of relatives. In Community Care in Practice (eds Lavender, A. & Holloway, F.). Chichester: Wiley.Google Scholar
MacCarthy, B., Kuipers, L., Hurry, J., et al (1989a) Evaluation of counselling for relatives of the long term adult mentally ill. British Journal of Psychiatry, 154, 767–775.Google Scholar
MacCarthy, B., Lesage, A., Brewin, C. R., et al (1989b) Needs for care among the relatives of long term users of day care. Psychological Medicine, 19, 725–736.Google Scholar
McCreadie, R. G., Phillips, K., Harvey, J. A., et al (1991) The Nithsdale Schizophrenia Surveys VIII. Do relatives want family intervention and does it help? British Journal of Psychiatry, 158, 110–113.Google Scholar
McCrone, P., Beecham, J. & Knapp, M. (1994) Community psychiatric nurse teams: cost effectiveness of intensive support versus generic care. British Journal of Psychiatry, 165, 218–221.Google Scholar
Meichenbaum, D. (1977) Cognitive Behaviour Modification. New York: Plenum.Google Scholar
Moore, E. (1992) Care of the long-term adult mentally ill: expressed emotion in staff–patient relationships. PhD Thesis, London University.Google Scholar
Moore, E., Ball, R. A., & Kuipers, L. (1992a) Expressed Emotion in staff working with the long-term adult mentally ill. British Journal of Psychiatry, 161, 802–808.Google Scholar
Moore, E., Kuipers, L. & Ball, R. (1992b) Staff patient relationships in the case of the long-term mentally ill: a content analysis of EE interviews. Social Psychiatry and Psychiatric Epidemiology, 27, 28–34.Google Scholar
Muijen, M., Cooney, M., Strathdee, G., et al (1994) Community Psychiatric Nurse Teams: intensive support versus generic care. British Journal of Psychiatry, 165, 211–217.Google Scholar
Noh, S. & Turner, R. J. (1987) Living with psychiatric patients: implications for the mental health of family members. Social Science and Medicine, 25, 263–272.Google Scholar
Oliver, N. & Kuipers, E. (1996) Stress and its relationship to EE in community mental health workers. International Journal of Social Psychiatry, 42, 150–159.Google Scholar
Parkes, C. M. (1972) Bereavement: Studies of Grief in Adult Life. Harmondsworth: Penguin.Google Scholar
Parsons, T. (1951) The Social System. Chicago: Free Press.Google Scholar
Penn, D. & Mueser, K. (1996) Research update on the psychosocial treatment of schizophrenia. American Journal of Psychiatry, 153, 607–617.Google ScholarPubMed
Sellwood, W., Haddock, G., Tarrier, N., et al (1994) Advances in the psychological management of positive symptoms of schizophrenia. International Review of Psychiatry, 6, 201–215.Google Scholar
Shapiro, M. B. & Ravenette, A. T. (1959) A preliminary experiment on paranoid delusions. Journal of Mental Science, 105, 295–313.Google Scholar
Slade, P. D. & Bentall, R. P. (1988) Treatment of hallucinations. In Sensory Deception: Toward a Scientific Analysis of Hallucinations (eds Slade, P. D. & Bentall, R. P.). London: Croom Helm.Google Scholar
Smith, J. & Birchwood, M. J. (1987) Specific and nonspecific effects of educational intervention with families living with a schizophrenic relative. British Journal of Psychiatry, 150, 645–652.Google Scholar
Tarrier, N., Barrowclough, C., Vaughn, C., et al (1988) The community management of schizophrenia: a controlled trial of a behavioural intervention with families to reduce relapse. British Journal of Psychiatry, 153, 532–542.Google Scholar
Tarrier, N., Barrowclough, C., Vaughn, C., et al (1989) Community management of schizophrenia in a two year follow-up of a behavioural intervention with families. British Journal of Psychiatry, 154, 625–628.Google Scholar
Tarrier, N. & Barrowclough, C. (1990) Family interventions for schizophrenia. Special issue: recent developments in the behavioral treatment of chronic psychiatric illness. Behavior Modification, 14, 408–440.Google Scholar
Tarrier, N., Harwood, S., Yusopoff, L., et al (1990) Coping Strategy Enhancement (CSE): a method of treating residual schizophrenic symptoms. Behavioural Psychotherapy, 18, 283–293.Google Scholar
Tarrier, N., Lowson, K. & Barrowclough, C. (1991) Some aspects of family interventions in schizophrenia. II: Financial considerations. British Journal of Psychiatry, 159, 481–484.Google Scholar
Tarrier, N., Sharpe, L., Beckett, R., et al (1993) A trial of two cognitive behavioural methods treating drug-resistant residual psychotic symptoms in schizophrenic patients: II treatment specific changes in coping and problem solving skills. Social Psychiatry and Psychiatric Epidemiology, 28, 5–10.Google Scholar
Vaughn, K., Doyle, M. McConathy, N., et al (1992) The Sydney intervention trial: a controlled trial of relatives’ counselling to reduce schizophrenic relapse. Social Psychiatry and Psychiatric Epidemiology, 27, 16–21.Google Scholar
Watts, F. N., Powell, G. E. & Austin, S. V. (1973) The modification of abnormal beliefs. British Journal of Medical Psychology, 46, 359–363.Google Scholar
Watts, F. N. & Bennett, D. H. (1983) Theory and Practice of Psychiatric Rehabilitation. Chichester: Wiley.Google Scholar
Williams, J. M. G. (1992) The Psychological Treatment of Depression: A Guide to the Theory and Practice of Cognitive Behaviour Therapy. London: Routledge.Google Scholar
Wing, J. K. & Brown, G. W. (1970) Institutionalism and Schizophrenia. Cambridge: Cambridge University Press.Google Scholar
Wing, J. K., Brewin, C. R. & Thornicroft, G. (eds) (1992) Defining mental health needs. In Measuring Mental Health Needs, pp. 1–17. London: Gaskell.Google Scholar
Wykes, T. (1982) A hostel ward for new long-stay patients. In Long-term Community Care (ed. J. K. Wing). Psychological Medicine Monograph Supplement 2, 59–97.Google Scholar
Young, J. L., Zonana, H. V. & Shepler, L. (1986) Medication noncompliance in schizophrenia: codification and update. Bulletin of the American Academy of Psychiatry and the Law, 14, 105–122.Google Scholar
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