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Relapse Prevention: A Model for Psychosis?

Published online by Cambridge University Press:  22 February 2012

Alison Beck-Sander
Alison Beck-Sander*
Affiliation:
Forensic Services, South West London and St Georges' Mental Health NHS Trus
*
*Address for correspondence: Dr Alison Beck-Sander, Chartered Clinical Psychologist, Shaftesbury Clinic, Springfield Hospital, 61 Glenburnie Road, Tooting, London SW17 7DJ, United Kingdom.
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Abstract

Evidence suggests that there are substantial costs (in a variety of spheres: personal, social, financial, etc.) associated with psychotic relapse. Furthermore, relapse increases the likelihood of future relapses and increased costs. This paper explores the application of a model of relapse prevention (RP) outlined by Marlatt and Gordon (1985) to the field of psychosis. The original model was designed to help individuals who abuse substances to maintain control over their habit. The advantages and limitations of applying the original model to the prevention of psychotic relapse are explored in detail in the context of an amended model. One major advantage of the RP model is that it provides a framework for the coordination of treatment interventions. The complex intervention packages, which may be useful in the management of psychotic illnesses, are described. The RP framework may be used to coordinate treatments in a manner that maximises their potential and emphasises patient control.

Type
Research Article
Information
Behaviour Change , Volume 16 , Issue 3 , 01 September 1999 , pp. 191 - 202
Copyright
Copyright © Cambridge University Press 1999

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References

Amador, X.F., Strauss, D.H., Yale, S.A., & Gorman, J.M. (1991). Awareness of illness in schizophrenia. Schizophrenia Bulletin, 17,(1), 113–132.CrossRefGoogle Scholar
Beck-Sander, A., Griffiths, A., & Friel, C. (1998). A group-based intervention for forensic patients recovering from psychosis. Criminal Behaviour and Mental Health, 8, 193–201.CrossRefGoogle Scholar
Beisser, A.R. (1979). Denial and affirmation in illness and health. American Journal of Psychiatry, 136(8), 1026–1030.Google Scholar
Bentall, R.P., Higson, P., & Lowe, C.F. (1987). Teaching self-instruction to chronic schizophrenic patients: Efficacy and generalisation. Behavioural Psychotherapy, 15, 58–76.CrossRefGoogle Scholar
Bentall, R.P., & Kaney, S. (1989). Content specific processing and persecutory delusions: An investigation using the emotional Stroop test. British Journal of Medical Psychology, 62, 355–364.CrossRefGoogle ScholarPubMed
Bentall, R.P., Kaney, S., & Dewey, M.E. (1991). Paranoia and social reasoning: An attribution theory analysis. British Journal of Clinical Psychology, 30, 13–23.CrossRefGoogle ScholarPubMed
Birchwood, M. (1995). Early intervention in psychotic relapse: Cognitive approaches to detection and management. Behaviour Change, 12, 2–19.CrossRefGoogle Scholar
Birchwood, M., MacMillan, F., & Smith, J. (1992). Early signs of relapse in schizophrenia: Monitoring methodologyz. In D. Kavanagh (Ed.), Schizophrenia: An interdisciplinary handbook (pp. 24–41). London: Chapman & Hall.Google Scholar
Birchwood, M., Mason, R., & Macmillan, F. (1993). Depression, demoralisation and control over psychotic illness. Psychological Medicine, 23, 387–395.CrossRefGoogle ScholarPubMed
Birchwood, M., Smith, J., MacMillan, F., Hogg, B., Prasad, R., Harvey, C., & Bering, S. (1989). Predicting relapse in schizophrenia: The development and implementation of an early signs monitoring system using patients and families as observers: A preliminary investigation. Psychological Medicine, 19, 649–56.CrossRefGoogle ScholarPubMed
Breier, A., & Strauss, J.S. (1982). Self-control in psychotic disorders. Archives of General Psychiatry, 40, 1141–1145.CrossRefGoogle Scholar
Brown, C.S., Wright, R.G., & Christensen, D.B. (1987). Association between type of medication instruction and patients’ knowledge, side-effects and compliance. Hospital and Community Psychiatry, 38, 55–60.Google ScholarPubMed
Burns, T., Creed, F., Fahy, T., Thompson, S., Tyrer, P., & White, I. (1999). Intensive vs standard case management for severe psychotic illness: A randomised trial. The Lancet, 353, 2185–2189.CrossRefGoogle ScholarPubMed
Chadwick, P., & Birchwood, M. (1994). The omnipotence of voices: A cognitive approach to auditory hallucinations. British Journal of Psychiatry, 164, 190–201.CrossRefGoogle ScholarPubMed
Chadwick, P., & Lowe, F.L. (1991). The measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology, 58, 225–32.CrossRefGoogle Scholar
Curson, D.A., Barnes, T.R.E., Bamber, R.W., Platt, S.D., Hirsch, S.R., & Duffy, J.D. (1985). Long-term depot maintenance of chronic schizophrenic outpatients. British Journal of Psychiatry, 146, 464–480.CrossRefGoogle Scholar
Davey, G.C. (1993). A comparison of three cognitive appraisal strategies: The role of threat devaluations in problem-focused coping. Personality and Individuals Differences, 14(4), 535–546.CrossRefGoogle Scholar
Davidson, L., & Strauss, J.S. (1992). Sense of self and recovery from severe mental illness. British Journal of Medical Psychology, 65, 131–145.CrossRefGoogle ScholarPubMed
Estroff, S. (1989). Self, identity and subjective experiences of schizophrenia: In search of the subject. Schizophrenia Bulletin, 15(2), 189–196.CrossRefGoogle Scholar
Farina, A., Gliha, D., Boudreau, L.A., Allen, J.G., & Sherman, M. (1971). Mental illness and the impact of believing others know about it. Journal of Abnormal Psychology, 77(1), 1–5.Google Scholar
Farina, A., Fisher, J.D., Getter, H., & Fischer, E.H. (1978). Some consequences of changing people's views regarding the nature of mental illness. Journal of Abnormal Psychology, 87, 272–279.CrossRefGoogle ScholarPubMed
Fisher, J.D., & Farina, A. (1979). Consequences of beliefs about the nature of mental disorders. Journal of Abnormal Psychology, 88, 320–327.CrossRefGoogle ScholarPubMed
Gaebel, V., Frick, W., & Kopcke, M. (1994). Early neuroleptic intervention in schizophrenia. British Journal of Psychiatry, 163, 8–12.CrossRefGoogle Scholar
Garfield, D.S. (1995). Unbearable affect: A guide to the psychotherapy of psychosis. New York: Wiley. Google Scholar
Gaebel, V., Frick, W., & Kopcke, M. (1994). Early neuroleptic intervention in schizophrenia. British Journal of Psychiatry, 163, 8–12.CrossRefGoogle Scholar
Greer, S., Morris, T., & Pettingale, K.W. (1979, October 13). Psychological response to breast cancer: Effect on outcome. The Lancet, pp. 785–787.Google Scholar
Herz, M., & Melville, C. (1980). Relapse in schizophrenia. American Journal of Psychiatry, 137, 801–12.Google ScholarPubMed
Hirsch, S.R., & Jolley, A.G. (1989). The dysphoric syndrome in schizophrenia and its implications for relapse. British Journal of Psychiatry, 155(Suppl. 5), 46–50.CrossRefGoogle ScholarPubMed
Hogarty, G.E., McEvoy, J.P., & Munetz, M. (1988). Dose of fluphenazine, familial expressed emotion and outcome in schizophrenia. Archives of General Psychiatry, 45, 797–805.CrossRefGoogle ScholarPubMed
Hughes, I., Hill, B., & Budd, R. (1997). Compliance with antipsychotic medication: From theory to practice. Journal of Mental Health, 6(5), 473–489.CrossRefGoogle Scholar
Jaspers, K. (1963). General psychopathology. (J. Hoenig & M.W. Hamilton, Trans.). Manchester: Manchester University Press. (Original work published 1913).Google Scholar
Johnson, D.A.W., Ludlow, J.M., Street, K., & Taylor, R.D.W. (1987). Double-blind comparison of halfdose and standard dose flupenthixol deconate in the maintenance treatment of stabilized outpatient schizophrenics. British Journal of Psychiatry, 151, 634–638.CrossRefGoogle Scholar
Johnson, S., & Orrell, M. (1995). Insight and psychosis: A social persepective. Psychological Medicine, 25, 515–520.CrossRefGoogle Scholar
Jolley, A.G., Hirsch, S.R., Morrison, G., McRink, A., & Wilson, L. (1990). Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenia outpatients: Clinical and social outcome at two years. British Medical Journal, 301, 847–42.CrossRefGoogle ScholarPubMed
Kaney, S., & Bentall, R.P. (1992). Persecutory delusions and the self-serving bias: Evidence from a contingency judgement task. Journal of Nervous and Mental Disease, 180, 773–780.CrossRefGoogle Scholar
Kaney, S., Wolfenden, M., Dewey, M.E., & Bentall, R.P. (1992). Persecutory delusions and the recall of threatening propositions. British Journal of Clinical Psychology, 31, 85–87.CrossRefGoogle ScholarPubMed
Kavanagh, D.J. (1992). Recent developments in expressed emotion and schizophrenia. British Journal of Psychiatry, 160, 601–620.CrossRefGoogle ScholarPubMed
Kelly, G.R., & Scott, J.E. (1990). Medication compliance and health education among out-patients with chronic mental disorders. Medical Care, 28, 1181–1197.CrossRefGoogle ScholarPubMed
Kemp, R., Hayward, P., Applewhaite, G., Everitt, B., & David, A. (1996). Compliance therapy in psychotic patients: Randomised controlled trial. British Medical Journal, 312, 345–349.CrossRefGoogle ScholarPubMed
Lally, S.J. (1989). Does being in here mean there is something wrong with me? Schizophrenia Bulletin, 15, 253–265.CrossRefGoogle ScholarPubMed
Lieberman, J.A., Jody, D., Geisler, S., Vital-Herne, J., Alvir, J.M.J., Walsleben, J., & Woerner, M.G. (1989). Treatment outcome in first episode schizophrenia. Psychopharmacology Bulletin, 25, 92–96.Google ScholarPubMed
Lyon, H.M., Kaney, S., & Bentall R.P. (1994). The defensive function of persecutory delusions: Evidence from attribution tasks. British Journal of Psychiatry, 164, 637–646.CrossRefGoogle ScholarPubMed
Macmillan, J.F., Crow, T.J., Johnson, A.L., & Johnstone, E.C. (1986). The Northwick Park first episodes of schizophrenia study. British Journal of Psychiatry, 148, 128–33.CrossRefGoogle Scholar
Marder, S.R., Mintz, J., Van Putten, T., Lebell, M., McKenzie, J., Wirsching, W., & Johnstone-Cronk, K. (1991). Psychopharmacology Bulletin, 27, 79–82.Google Scholar
Marlatt, G.A., & Gordon, J.R. (Eds.). (1985). Relapse prevention. London: Guilford.Google Scholar
McGlashan, T.H., Docherty, J.P., & Siris, S. (1976). Integrative and sealing-over recoveries from schizophrenia: Distinguishing case studies. Psychiatry, 39, 325–338.CrossRefGoogle ScholarPubMed
McGlashan, T.H., & Carpenter, W.T. (1981). Does attitude toward psychosis relate to outcome? American Journal of Psychiatry, 138, 797–801.Google ScholarPubMed
McGorry, P.D., Chanen, A., McCarthy, E., Van Riel, R., McKenzie, D., & Singh, B. (1991). Posttraumatic stress disorder following recent-onset psychosis: An unrecognized postpsychotic syndrome. The Journal of Nervous and Mental Disease, 179(5), 253–258.CrossRefGoogle Scholar
Meichenbaum, D., & Cameron, R. (1973). Training schizophrenics to talk to themselves: A means of developing attentional control. Behaviour Therapy, 4, 515–534.CrossRefGoogle Scholar
Morley, S. (1987). Modification of auditory hallucinations: Experimental studies of headphones and earplugs. Behavioural Psychotherapy, 15, 240–251.CrossRefGoogle Scholar
Mueser, K.T., Bellack, A.S., Wade, J.H., Sayers, S.Z., & Rosenthal, L.K. (1992). An assessment of the educational needs of chronic psychiatric patients and their relatives. British Journal of Psychiatry, 160, 668–673.CrossRefGoogle ScholarPubMed
O’Mahony, P.D. (1982). Psychiatric patient denial of mental illness as a normal process. British Journal of Medical Psychology, 55, 109–118.CrossRefGoogle ScholarPubMed
Perkins, R., & Moodley, P. (1993). The arrogance of insight? Psychiatric Bulletin, 17, 233–234.CrossRefGoogle Scholar
Rogers, R., & Dickey, R. (1994). Denial and minimization among sex offenders: A review of competing models of deception. Annals of Sex Research, 4, 49–63.Google Scholar
Schneider, S.J., & Pope, A.T. (1982). Neuroleptic-like electroencephalographic changes in schizophrenics through biofeedback. Biofeedback and Self-regulation, 7, 479–490.CrossRefGoogle ScholarPubMed
Siris, S.G. (1991). Diagnosis of secondary depression in schizophrenia: Implications for DSM-IV. Schizophrenia Bulletin, 17(1), 75–98.CrossRefGoogle Scholar
Slade, P.D. (1972). The effects of systematic desensitisation on auditory hallucinations. Behaviour, Research and Therapy, 10, 85–91.CrossRefGoogle ScholarPubMed
Strauss, D.H., Spitzer, R.L., & Muskin, P.R. (1990). Maladaptive denial of physical illness: A proposal for DSM-IV. American Journal of Psychiatry, 147, 1168–1172.Google ScholarPubMed
Subotnik, K.L., & Nuechterlein, K.H. (1988). Prodromal signs and symptoms of schizophrenic relapses. Journal of Abnormal Psychology, 97, 405–412.CrossRefGoogle Scholar
Tarrier, N. (1992). Management and modification of residual positive psychotic symptoms. In M. Birchwood & N. Tarrier (Eds.), Innovations in the psychological management of schizophrenia: Assessment, treatment and services. London: Wiley.Google Scholar
Tarrier, N., Barrowclough, C., Vaughn, C., Bamrah, J.S., Porceddu, K., Watts, S., & Freeman, H. (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.CrossRefGoogle ScholarPubMed
Tarrier, N., Beckett, R., Harwood, S., Baker, A., Yusupoff, L., & Ugarteburu, I. (1993). A trial of cognitive-behavioural methods of treating residual psychotic symptoms in schizophrenia patients: 1. Outcome. British Journal of Psychiatry, 162, 524–532.CrossRefGoogle Scholar
Tarrier, N., Harwood, S., Yusopoff, L., Beckett, R., & Baker, A. (1990). Coping strategy enhancement (CSE): A method of treating residual schizophrenic symptoms. Behavioural Psychotherapy, 18, 283–93.CrossRefGoogle Scholar
Thornton, D. (1997). When they don't change: Techniques for relapse prevention intervention with reluctant or rebellious clients. Paper presented at ATSA 16th Annual Research and Treatment Conference, Washington, DC.Google Scholar
Vaughn, C.E., & Leff, J.P. (1976). Influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry, 129, 125–137.CrossRefGoogle ScholarPubMed
Warner, R., Taylor, D., Powers, M., & Hyman, J. (1989). Acceptance of the mental illness label by psychotic patients: Effects on functioning. American Journal of Orthopsychiatry, 59(3), 398–409.CrossRefGoogle Scholar
World Health Organisation. (1979). The International Pilot Study of Schizophrenia. London: Wiley.Google Scholar
Zigler, E., & Glick, M. (1988). Is paranoid schizophrenia really camouflaged depression? American Psychologist, 43, 284–290.CrossRefGoogle ScholarPubMed
Zubin, J., & Spring, B. (1977). Vulnerability: A new view of schizophrenia. Journal of Abnormal Psychology, 86, 102–126.CrossRefGoogle ScholarPubMed