CLINICAL HANDBOOK OF SCHIZOPHRENIA

8. Psychosocial Factors 81KEY POINTS• Positive symptoms of schizophrenia seem to be related to emotional and social reactivity.• There is good evidence that life events trigger episodes of schizophrenia, a link that is alsoseen in other disorders.• Social networks are often restricted in schizophrenia; lacking a confidant seems particularlyrelated to increased symptoms.• Medication, the first line of treatment, is often not fully effective. Adjunctive psychological interventionssuch as CBT and FI have been shown to improve outcomes.• Psychological interventions seem to work by improving both disturbed affect and cognitiveappraisals.REFERENCES AND RECOMMENDED READINGSBebbington, P., & Kuipers, L. (1994). The predictive utility of EE in schizophrenia: An aggregate analysis.Psychological Medicine, 24, 707–718.Bebbington, P., & Kuipers, E. (2003). Schizophrenia and psychosocial stresses. In S. R. Hirsch & D. R.Weinberger (Eds.), Schizophrenia (2nd ed.). Malden, MA: Blackwell Scientific.Bebbington, P. E., Bhugra, D., Brugha, T., Singleton, N., Farrell, M., Jenkins, et al. (2004). Psychosis,victimisation and childhood disadvantage: Evidence from the second British National Survey ofPsychiatric Morbidity. British Journal of Psychiatry, 185, 220–226.Birchwood, M., & Jackson, C. (2001). Schizophrenia. Sussex, UK: Psychology Press.Broome, M. R., Wooley, J. B., Tabraham, P., Johns, L. C., Bramon, E., Murray, G. K., et al. (2005).What causes the onset of psychosis? Schizophrenia Research, 79, 23–34.Brown, G. W., & Birley, J. L. T. (1968). Crises and life changes and the onset of schizophrenia. Journalof Health and Social Behavior, 9, 203–214.Fowler, D., Garety, P., & Kuipers, E. (1995). Cognitive behaviour therapy for people with psychosis.East Sussex, UK: Wiley.Freeman, D., & Garety, P. A. (2004). A cognitive model of persecutory delusions. In Paranoia: Thepsychology of persecutory delusions (Maudsley Monograph No. 45, pp. 115–135). Hove, UK:Psychology Press.Garety, P. A., Kuipers, E. A., Fowler, D., Freeman, D., & Bebbington, P. (2001). A cognitive model ofthe positive symptoms of psychosis. Psychological Medicine, 31, 189–195.Kapur, S. (2003). Psychosis as a state of aberrant salience: A framework linking biology, phenomenology,and pharmacology in schizophrenia. American Journal of Psychiatry, 160(1), 13–23.Kuipers, E., Bebbington, P., Dunn, G., Fowler, D., Freeman, D., Watson, P., et al. (2006). Influence ofcarer expressed emotion and affect on relapse in non-affective psychosis. British Journal of Psychiatry,188, 173–179.Kuipers, E., Leff, J., & Lam, D. (2002). Family work for schizophrenia: A practical guide (2nd ed.).London: Gaskell Press.Myin-Germeys, I., van Os, J., Schwartz, J., Stone, A., & Delespaul, P. (2001). Emotional reactivity indaily life stress in psychosis. Archives of General Psychiatry, 58, 1137–1144.Steinberg, H. R., & Durell, J. (1968). A stressful situation as a precipitant of schizophrenic symptoms:An epidemiological study. British Journal of Psychiatry, 114, 1097–1105.Wing, J. K., & Brown, G. W. (1970). Institutionalism and schizophrenia: A comparative study of threemental hospitals 1960–68. Cambridge, UK: Cambridge University Press.