Research Proposal: Schizophrenia Is a Heterogeneous Disorder

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[. . .] The symptoms are rated on 24 items and include depression, anxiety, hallucinations and unusual behaviors. Each symptom is rated 1-7 scale Likert type scale. It is the most used symptom scale in psychiatry and has demonstrated excellent reliability and validity.

The Social Functioning Scale (SFS; Birchwood et al., 1990) can be used as a self-report measure or be completed by an informant. It has 79 items and measures social functioning across multiple domains. The questions are answered in an interview format.

The Social Behavior Schedule (SBS; Wykes & Sturt, 1986) takes 15 minutes to be rated by a researcher or clinician, assessing the previous month's functioning. It assesses 21 areas of functioning that can be grouped in four areas of behavior and has demonstrated excellent reliability and validity.

Lab top computer; SPSS statistical program software.

Staffing

Supervising psychiatrist, two psychologists, and psychiatric nurse. Ten advanced clinical psychology graduate students or social work students.

A proposed budget for the materials and personal is presented in Appendix A.

Measures

The independent variables are the form of treatment. The dependent variables are the scores on the BPRS, SFS, SBS, number of relapses during the follow-up period, and review of the medical records for the patient. There will also be the potential to analyze group differences on the subscale scores of these measures and to look at group differences on item scores. Record review will be concerned with relapse which is defined as any record indicating a return of the schizophrenic symptoms or any psychiatric hospitalization.

Design

The design is essentially has a two level independent variable (treatment group) and four dependent measures that are measured over multiple time points (time can also be treated as a dependent measure). The study uses a quantitative design. Multivariate statistics will be used for their power. The use of SPSS procedures descriptive statistics, measures of reliability for the outcome measures (alpha), correlations, T-tests, MANOVA (with appropriate post hoc tests), ANOVA (with appropriate post hoc tests), multiple regression, and logistic regression will be used to analyze the data over multiple assessments. Trends and time series can also be considered. Alpha level will be set at .05 for the analyses.

Procedure

Participant recruitment

Following IRB approval persons with schizophrenia will recruited for the study from participating psychiatric facilities. Informed consent will be collected from the participant or in the case of participants with legal guardians from the guardian. All participants will have first episode schizophrenic diagnoses and exclusion criteria are listed in the participants section. The inclusion criteria ensure equivalence between the two treatment conditions. Participant recruiting will continue on an ongoing basis until the cells in the design are filled. Random assignment will be attempted, but certainly after a certain point in the recruitment processes it is possible that certain participants will be intentionally assigned to a condition to ensure a balanced design regarding the demographic characteristics of the groups.

Treatment groups and assessments

Participants in the medication treatment group will be followed by their treating psychiatrists. These patients should not receive any adjunctive psychotherapy, but this may not be practical. If they do receive adjunctive psychotherapy it will be noted. Participants will be assessed by research assistants on the three standardized measures at baseline, and at two, four, six, ten, and 12 weeks (the proposed length of the residential program). Participants will also be assessed at follow-up at six months, one year, 18 months, and two years.

Participants in the residential treatment will follow the same assessment procedure as those in the medication group. Residential treatment will consist of the procedures outlined by Mosher and associates used at the Soteria program (Mosher & Menn, 1977;1978) and Perry (1999) which allows for patients to vent, uses non-medical staffing, maintaining the patient's personal power, using social networks, and helping patients find meaning in the subjective experience of psychosis. Ten clinical psychology graduate students will be recruited from graduate programs in psychology and local graduate schools and trained in these methods by two supervising psychologists. Internship opportunities may be possible and it is also acceptable to recruit research assistants from social work programs. Research assistants will be assigned shift duties (two each in two day shifts). Midnight shifts will be covered by non-clinical paid staff who will be trained in crises management. No therapy will occur when the patients are sleeping. A supervising psychologist will be on the grounds during the day. The treatment programs will be standardized and manualized in line with the Diabasis and Soteria programs. Research assistants in the residential condition will be required to complete daily shift notes on each participant.

Proposed time frame

There will be a maximum of five participants in the residential treatment condition at a time. The residential treatment is designed to last 10 weeks. So the expected length of the residential treatment center is about 30 weeks, but recruiting complications may extend this to 50 weeks. The research program is expected to run the full 50 weeks.

Additional staff

In addition to psychological staff the residential program will have an on-call psychiatrist and psychiatric nurse that will be available for consultation in the event of emergencies. Although the residential treatment program is considered to be medication-free the potential for some patients to need minimal medication treatment is very real, and this is consistent with the Soteria program (Mosher & Menn, 1978). In the event that medications are needed for some residential treatment participants this information will be documented and could potentially be compared to medication treatment participants with regards to dosage needed, time on medications, etc. The supervising psychiatrist can also remove a residential participant from the program if it is deemed that this is in the best interest of the patient.

Assessments will be performed by volunteer research assistants that are not involved in the treatment of the participants, are blind as to the aim of the study, and are assigned to assess only one condition (e.g., the participants in either the medication or residential group). This will partially control for experimenter bias. Assessment research assistants will be fully trained in the use of the standardized measures and in how to read the progress charts by the supervising psychologists. Assessment research assistants will also be trained to enter data into the SPSS program for later analysis. Research assistants will check the data of their counterpart for errors. In order to maintain confidentiality each study participant will be assigned a number for identification.

Discussion

This study will test the effects of residential and essentially non-medication treatment on schizophrenia. There is sufficient research to question the effectiveness of antipsychotic medications in the management of schizophrenia, the long-term prognoses for patients on these medications, and the effectiveness of residential treatment (e.g., Hegarty et al., 1994). Such medication use also results in significant risk for health complications and mortality in these patients. In addition, past studies investigating a Jungian approach to the treatment of psychosis demonstrated promise (e.g., Perry, 1999), but ran out of funding in the 1980s when the development of many psychiatric medications began to dominate the treatment of psychotic disorders. The application of the Jungian notion of psychosis is best exemplified by the practices of the late psychiatrist, John W. Perry.

John Perry's work as a model for the current proposed residential program

Perry's work in with schizophrenics in traditional psychiatric surroundings and using traditional treatments for psychosis was not satisfying for him and contradicted much of his understanding of the mind that he had learned in his analytic training. He came to believe that schizophrenics in modern treatment were never or rarely if ever heard or experienced on the level of their state of visionary consciousness (Perry, 1974). Instead, modern treatments (medication, isolation) go to every means possible to ignore or to silence the patients during these times. Modern treatments for schizophrenia are based on the notion that the content of hallucinations and delusions in psychosis is insignificant and idiosyncratic; therefore, clinicians are encouraged to ignore and to reject the seemingly irrational language and experience of the schizophrenic as having any meaning. This only leads to an increased sense of alienation, isolation, and labeling these patients as incapable. Moreover, he strongly disagreed with the commonly held view based on Kraepeilnan ideas that schizophrenia is a chronic life-long condition (Perry, 1974; 1999).

Perry considered the development of psychosis to be a natural problem-solving process that occurs because of the individual's breakdown in their view of the world. Perry (1974) investigated the nature of psychosis from a Jungian context and believed that at least some of the psychotic breaks he investigated were had a spiritual basis as their nature. He often found that hallucinations and delusions were similar in different schizophrenics and considered them to consist of archetypal or mythical type themes that expressed meaning through their imagery and imaginary power. Perry (1974; 1999) spent a great deal of his time documenting how these… [END OF PREVIEW]

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Schizophrenia Is a Heterogeneous Disorder.  (2012, June 8).  Retrieved April 22, 2019, from https://www.essaytown.com/subjects/paper/schizophrenia-heterogeneous-disorder/9280465

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"Schizophrenia Is a Heterogeneous Disorder."  Essaytown.com.  June 8, 2012.  Accessed April 22, 2019.
https://www.essaytown.com/subjects/paper/schizophrenia-heterogeneous-disorder/9280465.