Psychotic Disorders., Study notes of Abnormal Psychology

Download Psychotic Disorders. and more Study notes Abnormal Psychology in PDF only on Docsity! Psychotic Disorders Schizophrenia- • the startling disorder characterized by a broad spectrum of cognitive and emotional dysfunctions including delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions. • Schizophrenia is a complex syndrome that inevitably has a devastating effect on the lives of the person affected and on family members. This disorder can disrupt a person’s perception, thought, speech, and movement: almost every aspect of daily functioning. Society often devalues these individuals. People with these severe mental health problems are more likely to be stigmatized and discriminated against than those without schizophrenia • Schizophrenia affects one’s ability to express oneself clearly,To have close social relationships, to express positive emotions and to plan for their future. • The most common set of symptoms seen in individuals with schizophrenia with the past 100 years is a belief that others are out to get them and the hearing of voices that others do not hear. • Individuals schizophrenia can display problems in terms of cognitive process, emotion processes and motor processes. Cognitive problems can be seen as a disorganization of thinking and behavior. • the end of the 19th century, the German psychiatrist Emil Kraepelin (1899) built on the writings of Haslam, Pinel, and Morel (among others) to give us what stands today as the most enduring description and categorization of schizophrenia. • Two of Kraepelin’s accomplishments are especially important. First, he combined several symptoms of insanity that had usually been viewed as reflecting separate and distinct disorders: catatonia (alternating immobility and excited agitation), hebephrenia (silly and immature emotionality), and paranoia (delusions of grandeur or persecution). Kraepelin thought these symptoms shared similar underlying features and included them under the Latin term dementia praecox. Although the clinical manifestation might differ from person to person, Kraepelin believed an early onset at the heart of each disorder develops into “mental weakness.” • Kraeplin suggested there were four subtypes of dementia praecox. The first was the simple type which was characterized by a slow decline along with social withdrawal and apathy. The second was paranoid characterized by persecution.The third was hebephrenic characterized by mania like presentation. The fourth was catatonia – lack of movement. • In a second important contribution, Kraepelin (1898) distinguished dementia praecox from manic-depressive illness (now called bipolar disorder). For people with dementia praecox, an early age of onset and a poor outcome were characteristic; in contrast, these patterns were not essential to manic depression, Kraepelin also noted the numerous symptoms in people with dementia praecox, including hallucinations, delusions, negativism, and stereotyped behavior. • A second major figure in the history of schizophrenia was Kraepelin’s contemporary, Eugen Bleuler (1908), a Swiss psychiatrist who introduced the term schizophrenia. Schizophrenia, which comes from the combination of the Greek words for “split” (skhizein) and “mind” (phren), reflected Bleuler’s belief that underlying all the unusual behaviors shown by people with this disorder was an associative splitting of the basic functions of personality. This concept emphasized the “breaking of associative threads,” or the destruction of the forces that connect one function to the next. • Bleuler was critical of the term dementia praecox and suggested that here were was not a single schizophrenia but a number of different disorders with diff etiologies and prognoses. Characterisitcs described by him- • a) Affect- blunted or diminished emotional response • b)associations-loosening or inability to think in a logical manner • c)ambivalence-inability to make decisions • d)autism-social aloofness and an inablilty to remain in contact with the external world. STAGES OF SCHIZOPHRENIA • The course of Schizophrenia generally begins in adolescence or young adulthood • 1) Premorbid Phase During this phase , only subtle or nospecific problems with cognition, motor, or social functioning can be detected. They are accompanied by poor academic achievement and social functioning. • 2) Prodormal Phase: Normal individuals show some bizarre ideas as well as a thinking process. They are normally studying, doing business & socio-cultural activities, gradually they don’t like to participate in social activity. Their level of hygiene is disturbed, vigour is weakened & they do not complete important tasks in a stipulated period. Expressions of emotions become vague. All these symptoms are seen for up to one or two years. • 3) Active Phase: In this phase, the individual experiences hallucinations as well as delusions. They are unable to maintain contact with reality. The behaviour is disorganized. Thinking & emotions seem to be contradictory. • 4) Residual Phase: Symptoms of schizophrenia disappear for a long time but suddenly the patient may suffer a relapse & start showing the symptoms of schizophrenia. POSITIVE SYMPTOMS DELUSIONS • Positive symptoms generally refer to symptoms around distorted reality. Negative symptoms involve deficits in normal behavior in such areas as speech, blunted affect (or lack of emotional reactivity), and motivation. Disorganized symptoms include rambling speech, erratic behavior, and inappropriate affect (for example, smiling when you are upset). • A belief that would be seen by most members of a society as a misrepresentation of reality is called a disorder of thought content, or a delusion. These are fixed beliefs that are not amenable to change in light of conflicting evidence. In simple terms, these are false beliefs. Their content may include a variety of themes: • i. Persecutory: A most common belief that one is going be harmed or harassed & so forth by an individual or organization or another group. • ii. Referential: A belief that certain gestures or comments or environmental cues & so forth are directed at oneself. • iii. Grandiose: when an individual believes falsely that he/she has exceptional abilities/ wealth/fame. • iv. Erotomanic: when an individual believes falsely that another person is in love with them. • The expression of affect—or the lack of this expression—may be an important symptom of the development of schizophrenia. DISORGANIZED SYMPTOMS A) DISORGANIZED SPEECH • A conversation with someone who has schizophrenia can be particularly frustrating. For one thing, people with schizophrenia often lack insight, an awareness that they have a problem. In addition, they experience what Bleuler called “associative splitting” and what researcher Paul Meehl called “cognitive slippage” (Bleuler, 1908; Meehl, 1962). These phrases help describe the speech problems of people with schizophrenia: Sometimes they jump from topic to topic, and at other times they talk illogically. • tangentiality—that is, going off on a tangent instead of answering a specific question. Individuals also abruply change topic of conversations to unrelated areas, a behavior that has variously been called loose association or derailment • Rarely, speech may be so severely disorganized that it is nearly incomprehensible. The language used is disorganized (incoherence/word salad). Inventing new words (neologisms). Mildly disorganized speech is common. The symptoms are at times severe enough to impair communication. B) INAPPROPRIATE AFFECT AND DISORGANIZED BEHAVIOR • Occasionally, people with schizophrenia display inappropriate affect, laughing or crying at improper times. Sometimes they exhibit bizarre behaviors such as hoarding objects or acting in unusual ways in public • People with schizophrenia engage in a number of other “active” behaviors that are usually viewed as unusual. For example, catatonia is one of the most curious symptoms in some individuals with schizophrenia; it involves motor dysfunctions that range from wild agitation to immobility. • DSM 5 now includes catatonia as a separate schizophrenia spectrum disorder. On the active side of the continuum, some people pace excitedly or move their fingers or arms in stereotyped ways. At the other end of the extreme, people hold unusual postures, as if they were fearful of something terrible happening if they move (catatonic immobility). This manifestation can also involve waxy flexibility, or the tendency to keep their bodies and limbs in the position they are put in by someone else. Other Psychotic Disorders • the search for subtypes of schizophrenia began before Kraepelin described his concept of schizophrenia. Three divisions have historically been identified: paranoid (delusions of grandeur or persecution), disorganized (or hebephrenic; silly and immature emotionality), and catatonic (alternate immobility and excited agitation). Although these categories continued to be used in DSM-IV-TR, they were dropped from the diagnostic criteria for DSM-5 • Part of the rationale for omitting these subtypes was that they were not used frequently in clinical work and the nature of an individual’s symptoms can change over the course of his or her illness; so people could move from one category to another • The dimensional assessment of severity is now used instead of the three schizophrenia subtypes the disorders which are included under the broader heading of “Schizophrenia Spectrum and Other Psychotic Disorders.” Schizophreniform Disorder • }Schizophreniform disorder is a type of psychotic illness with symptoms similar to those of schizophrenia, but lasting for less than 6 months. • }Like schizophrenia, schizophreniform disorder is a type of "psychosis" in which a person cannot tell what is real from what is imagined. • }This type is distinguished by the difference in the duration: the total duratiion of the illness, including prodormal, active and residual phases is at least 1 month but less than 6 months. • The symptoms sometimes disappear as the result of successful treatment, but they often do so for reasons unknown. • It appears, however, that the lifetime prevalence is approximately 0.2% • The DSM-5 diagnostic criteria for schizophreniform disorder include onset of psychotic symptoms within 4 weeks of the first noticeable change in usual behavior, confusion at the height of the psychotic episode, good premorbid (before the psychotic episode) social and occupational functioning, and the absence of blunted or flat affect A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition). B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.” C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms; or 2) if mood episodes have occurred during activephase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness. D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. Specify if: With good prognostic features: This specifier requires the presence of at least two of the following features: onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning; confusion or perplexity; good premorbid social and occupational functioning; and absence of blunted or flat affect. Without good prognostic features: This specifier is applied if two or more of the above features have not been present. Specify if: With catatonia Schizoaffective Disorder • }Schizoaffective disorder is characterized by abnormal thought processes and dysregulated emotions. • }A person with this disorder has features of both schizophrenia and a mood disorder (either bipolar disorder or depression) but does not strictly meet the diagnostic criteria for either. • }Schizoaffective disorder symptoms may vary from person to person. • }People with the condition experience psychotic symptoms, such as hallucinations or delusions, as well as symptoms of a mood disorder — either bipolar type (episodes of mania and sometimes depression) or depressive type (episodes of depression). • }Although the development and course of schizoaffective disorder may vary, defining features include a major mood episode (depressed or manic mood) and at least a two-week period of psychotic symptoms when a major mood episode is not present. • }Signs and symptoms of schizoaffective disorder depend on the type — bipolar or depressive type — and may include, among others: • }Delusions — having false, fixed beliefs, despite evidence to the contrary • }Hallucinations, such as hearing voices or seeing things that aren't there • }Impaired communication and speech, such as being incoherent • }Bizarre or unusual behavior • }Symptoms of depression, such as feeling empty, sad or worthless • }Periods of manic mood, with an increase in energy and a decreased need for sleep over several days, and behaviors that are out of character • }Impaired occupational, academic and social functioning • }Problems with managing personal care, including cleanliness and physical appearance A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia . Note: The major depressive episode must include Criterion A1: Depressed mood. B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness. symptoms become most disruptive. Delusional disorder seems to afflict more females than males A. The presence of one (or more) delusions with a duration of 1 month or longer. B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation). C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd . D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods. E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder. Specify whether: Causes of Schizophrenia GENETIC • Schizophrenia tends to run in families, but no single gene is thought to be responsible. It's more likely that different combinations of genes make people more vulnerable to the condition. However, having these genes does not necessarily mean you'll develop schizophrenia • According to major study of families by Franz Kallman the severity of the parent’s disorder influenced the likelihood of the child’s having schizophrenia: The more severe the parent’s schizophrenia, the more likely the children were to develop it. • All forms of schizophrenia (for example, the historic categories such as catatonic and paranoid) were seen within the families. In other words, it does not appear that you inherit a predisposition for what was previously diagnosed as paranoid schizophrenia. Instead, you may inherit a general predisposition for schizophrenia that manifests in the same form or differently from that of your parent • More recent research confirms this observation and suggests that families that have a member with schizophrenia are at risk not just for schizophrenia alone or for all psychological disorders; instead, there appears to be some familial risk for a spectrum of psychotic disorders related to schizophrenia. • In a classic analysis, Gottesman (1991) summarized the data from about 40 studies of schizophrenia, as shown in ● Figure 13.3. The most striking feature of this graph is its orderly demonstration that the risk of having schizophrenia varies according to how many genes an individual shares with someone who has the disorder. For example, you have the greatest chance (approximately 48%) of having schizophrenia if it has affected your identical (monozygotic) twin, a person who shares 100% of your genetic information. Your risk drops to about 17% with a fraternal (dizygotic) twin, who shares about 50% of your genetic information. And having any relative with schizophrenia makes you more likely to have the disorder than someone without such a relative (about 1% if you have no relative with schizophrenia). • In one of the most fascinating of “nature’s experiments,” identical quadruplets, all of whom have schizophrenia, have been studied extensively. Nicknamed the “Genain” quadruplets (from the Greek, meaning “dreadful gene”), these women have been followed by David Rosenthal and his colleagues at the National Institute of Mental Health for a number of years (Rosenthal, 1963). The fictitious names of the girls reported in studies of their lives—Nora, Iris, Myra, and Hester—represent the letters NIMH for the National Institute of Mental Health. In a sense, the women represent the complex interaction between genetics and environment. • All four shared the same genetic predisposition, and all were brought up in the same particularly dysfunctional household; yet the time of onset for schizophrenia, the symptoms and diagnoses, the course of the disorder, and, ultimately, their outcomes, differed significantly from sister to sister. • The case of the Genain quadruplets also reveals an important consideration in studying genetic influences on behavior—unshared environments Even identical siblings can have different prenatal and family experiences and can therefore be exposed to varying degrees of biological and environmental stress • The largest adoption study was conducted in Finland The data from this study support the idea that schizophrenia represents a spectrum of related disorders, all of which overlap genetically • If an adopted child had a biological mother with schizophrenia, that child had about a 5% chance of having the disorder (compared to about only 1% in the general population). However, if the biological mother had schizophrenia or one of the related psychotic disorders (for example, delusional disorder or schizophreniform disorder), the risk that the adopted child would have one of these disorders rose to about 22% • Even when raised away from their biological parents, children of parents with schizophrenia have a much higher chance of having the disorder themselves. At the same time, there appears to be a protective factor if these children are brought up in healthy supportive homes. In other words, a gene–environment interaction was observed in this study, with a good home environment reducing the risk of schizophrenia • Researchers in a study begun in 1971 by Margit Fischer and later continued by Irving Gottesman and Aksel Bertelsen wanted to determine the relative likelihood that a child would have schizophrenia if her parent did and if the parent’s twin had schizophrenia but the parent did not. • If your parent is the twin with schizophrenia, you have about a 17% chance of having schizophrenia yourself. If your parent does not have schizophrenia but your parent’s fraternal twin does, your risk is only about 2%. The data clearly indicate that you can have genes that predispose you to schizophrenia, not show the disorder yourself, but still pass on the genes to your children. In other words, you can be a “carrier” for schizophrenia • Evidence that the disorder is partly inherited comes from studies of twins. Identical twins share the same genes. In identical twins, if a twin develops schizophrenia, the other twin has a 1 in 2 chance of developing it, too. This is true even if they're raised separately. • In non-identical twins, who have different genetic make-ups, when a twin develops schizophrenia, the other only has a 1 in 8 chance of developing the condition. While this is higher than in the general population, where the chance is about 1 in 100, it suggests genes are not the only factor influencing the development of schizophrenia. DOPAMINE HYPOTHESIS • It has been suggested that dopamine neurons are overactive in schizophrenia. These activations can in turn influence other brain areas with dopamine projections. This is referred to as the dopamine imbalance hypothesis. • Supporting this hypothesis is the findiing that there is a direct relationship between drugs that treat schzophrenia and their ability to bind to dopamine receptors in brain. • In schizophrenia, attention has focused on several dopamine sites, in particular those referred to simply as D1 and D2 . In a story that resembles a mystery plot, several pieces of “circumstantial evidence” are clues to the role of dopamine in schizophrenia: • 1. Antipsychotic drugs (neuroleptics) often effective in treating people with schizophrenia are dopamine antagonists, partially blocking the brain’s use of dopamine (Creese, Burt, & Snyder, 1976; Seeman, Lee, Chau Wong, & Wong, 1976). • 2. These neuroleptic drugs can produce negative side effects similar to those in Parkinson’s disease, a disorder known to be caused by insufficient dopamine. • 3. The drug L-dopa, a dopamine agonist used to treat people with Parkinson’s disease, produces schizophrenia-like symptoms in some people (Davidson et al., 1987). • 4. Amphetamines, which also activate dopamine, can make psychotic symptoms worse in some people with schizophrenia (van Kammen, Docherty, & Bunney, 1982). Taking these observations together, researchers theorized that schizophrenia in some people was attributable to excessive dopamine activity • Despite these observations, some evidence contradicts the dopamine theory (Javitt & Laruelle, 2006): 1. A significant number of people with schizophrenia are not helped by the use of dopamine antagonists. • 2. Although the neuroleptics block the reception of dopamine quite quickly, the relevant symptoms subside only after several days or weeks, more slowly than we would expect. • 3. These drugs are only partly helpful in reducing the negative symptoms (for example, flat affect or anhedonia) of schizophrenia. • Strong evidence now leads us to believe that schizophrenia is partially the result of excessive stimulation of striatal dopamine D2 receptors , striatum is part of the basal ganglia found deep within the brain. These cells control movement, balance, and walking, and they rely on dopamine to function. • One clue is that the most effective antipsychotic drugs all share dopamine D2 receptor antagonism—meaning they help block the stimulation of the D2 receptors BRAIN DEVELOPMENT • Evidence for neurological damage in people with schizophrenia comes from a number of observations. One of the most reliable observations about the brain in people with schizophrenia involves the size of the ventricles • During this time, psychosurgery, including prefrontal lobotomies, was introduced, and in the late 1930s, electroconvulsive therapy (ECT) was advanced as a treatment for schizophrenia ANTIPSYCHOTIC MEDICATIONS • A breakthrough in the treatment of schizophrenia came during the 1950s with the introduction of several drugs that relieved symptoms in many people • Called neuroleptics (meaning “taking hold of the nerves”), these medications provided the first real hope that help was available for people with schizophrenia. When they are effective, neuroleptics help people think more clearly and reduce hallucinations and delusions. They work by affecting the positive symptoms and to a lesser extent the negative and disorganized ones • neuroleptics are dopamine antagonists. One of their major actions in the brain is to interfere with the dopamine neurotransmitter system. They can also affect other systems, however, such as the serotonergic and glutamate system. • Each drug is effective with some people and not with others. Clinicians and patients often must go through a trial-and-error process to find the medication that works best, and some individuals do not benefit significantly from any of them • The earliest neuroleptic drugs, called conventional or firstgeneration antipsychotics (such as Haldol and Thorazine), are effective for approximately 60%270% of people who try them. • Chlorpromazine • Fluphenazine • Haloperidol • Perphenazine • Many people are not helped by antipsychotics, however, or they experience unpleasant side effects. Fortunately, some people respond well to newer medications—sometimes called atypical or second-generation antipsychotics; the most common are risperidone and olanzapine. Cariprazine (Vraylar),Clozapine (Clozaril, Versacloz) Ziprasidone (Geodon) • These newer drugs hold promise for helping patients who were previously unresponsive to medications (Leucht et al., 2009); also, it was initially thought that these drugs had fewer serious side effects than the conventional antipsychotics. However, two large-scale studies found that the second-generation drugs were no more effective or better tolerated than the older drugs. • Despite the optimism generated by the effectiveness of antipsychotics, they work only when they are taken properly, and many people with schizophrenia do not routinely take their medication. • A number of factors seem to be related to patients’ noncompliance with a medication regimen, including negative doctor–patient relationships, cost of the medication, and poor social support • Not surprisingly, negative side effects are a major factor in patient refusal. Antipsychotics can produce a number of unwanted physical symptoms, such as grogginess, blurred vision, and dryness of the mouth. • Because the drugs affect neurotransmitter systems, more serious side effects, called extrapyramidal symptoms, can also result (Cunningham Owens & Johnstone, 2012). These symptoms include the motor difficulties similar to those experienced by people with Parkinson’s disease, sometimes called parkinsonian symptoms • Akinesia is one of the most common; it includes an expressionless face, slow motor activity, and monotonous speech. Another extrapyramidal symptom is tardive dyskinesia, which involves involuntary movements of the tongue, face, mouth, or jaw and can include protrusions of the tongue, puffing of the cheeks, puckering of the mouth, and chewing movements. • Tardive dyskinesia seems to result from long-term use of high doses of antipsychotic medication and is often irreversible • An interesting treatment for the hallucinations experienced by many people with schizophrenia involves exposing the individual to magnetic fields. Called transcranial magnetic stimulation, • this technique uses wire coils to repeatedly generate magnetic fields—up to 50 times per second—that pass through the skull to the brain. This input seems to interrupt temporarily the normal communication to that part of the brain. Hoffman and colleagues (2000, 2003) used this technique to stimulate the area of the brain involved in hallucinations for individuals with schizophrenia who experienced auditory hallucinations. PSYCHOSOCIAL INTERVENTIONS • Today, few believe that psychological factors cause people to have schizophrenia or that traditional psychotherapeutic approaches will cure them. Nevertheless, you will see that psychological methods have an important role. • Despite the great promise of drug treatment, the problems with ineffectiveness, inconsistent use, and relapse suggest that by themselves drugs may not be effective with many people • Psychological treatment (talking therapy) helps you live with schizophrenia and have the best possible quality of life. • For psychological treatment to work well, you need a good working relationship with your doctor or other therapist. You need to be able to trust them and stay hopeful about your recovery • Types of psychological treatment for schizophrenia include cognitive behavioural therapy (usually called CBT), psychoeducation and family psychoeducation. • It also involves social skills training. This type of instruction focuses on improving communication and social interactions • CBT aims to help you identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and learn to change this thinking with more realistic and useful thoughts. • For example, you may be taught to recognise examples of delusional thinking. You may then receive help and advice about how to avoid acting on these thoughts. • CBT helps you: • Feel less distressed the psychotic experiences • Feel less depressed and anxious • Reduce alcohol and drug abuse • Deal with suicidal thoughts • Overcome feelings of hopelessness • During the 19th century, inpatient care involved “moral treatment,” which emphasized improving patients’ socialization, helping them establish routines for self-control, and showing them the value of work and religion • Gordon Paul and Robert Lentz conducted pioneering work in the 1970s at a mental health center in Illinois (Paul & Lentz, 1977). Borrowing from the behavioral approaches used by Ted Ayllon and Nate Azrin (1968), Paul and Lentz designed an environment for inpatients that encouraged appropriate socialization, participation in group sessions, and self-care such as bed making while discouraging violent outbursts • They set up an elaborate token economy, in which residents could earn access to meals and small luxuries by behaving appropriately • This incentive system was combined with a full schedule of daily activities. Paul and Lentz compared the effectiveness of applied behavioral (or social learning) principles with traditional inpatient environments. In general, they found that patients who went through their program did better than others on social, self-care, and vocational skills, and more of them could be discharged from the hospital. • One of the more insidious effects of schizophrenia is its negative impact on a person’s ability to relate to other people. Although not as dramatic as hallucinations and delusions, problems with social skills can be the most visible impairment displayed by people with schizophrenia and can prevent them from getting and keeping jobs and making friends. Clinicians attempt to reteach social skills such as basic conversation, assertiveness, and relationship building to people with schizophrenia. • In addition to social skills, programs often teach a range of ways people can adapt to their disorder yet live in the community • Preliminary evidence indicates that this type of training may help prevent relapses by people with schizophrenia, although longer-term outcome research is needed to see how long the effects last • To address some obstacles to this much-desired maintenance, such programs combine skills training with the support of a multidisciplinary team that provides services directly in the community, which seems to reduce hospitalization FAMILY INTERVENTIONS • Your knowledge of psychosis and schizophrenia can help a friend or family member who has it. • Research shows that people with schizophrenia who have a strong support system do better than those without the encouragement of friends and family. • Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, caring for somebody with schizophrenia can place a strain on any family. • Family therapy is a way of helping you and your family cope better with your condition. It involves a series of informal meetings over a period of around 6 months. • Meetings may include: • discussing information about schizophrenia • exploring ways of supporting somebody with schizophrenia • deciding how to solve practical problems that can be caused by the symptoms of schizophrenia • families could be helped by learning to reduce their level of expressed emotion and whether this would result in fewer relapses and better overall functioning for people with schizophrenia. Several studies have addressed these issues in a variety of ways (Falloon et al., 1985; Hogarty et al., 1986, 1991), and behavioral family therapy has been used to teach the families of people with schizophrenia to be more supportive