Family intervention for schizophrenia

Abstract

Background People with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of emotions. Forms of psychosocial intervention, designed to reduce these levels of expressed emotions within families, are now widely used. Objectives To estimate the effects of family psychosocial interventions in community settings for people with schizophrenia or schizophrenia-like conditions compared with standard care. Search strategy We updated previous searches by searching the Cochrane Schizophrenia Group Trials Register (September 2008). Selection criteria We selected randomised or quasi-randomised studies focusing primarily on families of people with schizophrenia or schizoaffective disorder that compared community-orientated family-based psychosocial intervention with standard care. Data collection and analysis We independently extracted data and calculated fixed-effect relative risk (RR), the 95% confidence intervals (CI) for binary data, and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). Main results This 2009-10 update adds 21 additional studies, with a total of 53 randomised controlled trials included. Family intervention may decrease the frequency of relapse (n = 2981, 32 RCTs, RR 0.55 CI 0.5 to 0.6, NNT 7 CI 6 to 8), although some small but negative studies might not have been identified by the search. Family intervention may also reduce hospital admission (n = 481, 8 RCTs, RR 0.78 CI 0.6 to 1.0, NNT 8 CI 6 to 13) and encourage compliance with medication (n = 695, 10 RCTs, RR 0.60 CI 0.5 to 0.7, NNT 6 CI 5 to 9) but it does not obviously affect the tendency of individuals/families to leave care (n = 733, 10 RCTs, RR 0.74 CI 0.5 to 1.0). Family intervention also seems to improve general social impairment and the levels of expressed emotion within the family. We did not find data to suggest that family intervention either prevents or promotes suicide. Authors’ conclusions Family intervention may reduce the number of relapse events and hospitalisations and would therefore be of interest to people with schizophrenia, clinicians and policy makers. However, the treatment effects of these trials may be overestimated due to the poor methodological quality. Further data from trials that describe the methods of randomisation, test the blindness of the study evaluators, and implement the CONSORT guidelines would enable greater confidence in these findings.

Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II)

“…2 The SEI teams combine assertive community treatment,3 4 psychoeducation,5 and family involvement,6 7 with a low case load of patients for case managers. The early intervention paradigm from which the SEI teams grew is based on the hypothesis of a critical period in the disorder 8…”

The Influence of Causal Explanations and Diagnostic Labeling on Psychology Students’ Beliefs About Treatments, Prognosis, Dangerousness and Unpredictability in Schizophrenia

“…Another study, of 19 Italian Mental Health Services (MHS) comparing routine practices and the evidence-based NICE guidelines to promote recovery in schizophrenia (Semisa et al 2008) found that in 60% of MHS no PWS received even three sessions of cognitive therapy per year, while in 40% of MHS less than 10% of PWS received this psychological treatment. As far as family psychoeducation is concerned, the efficacy of this cognitive-behavioral approach -aimed at educating PWS and their relatives about this disorder and improving their communication and problem solving skills -has been demonstrated by more than 50 RCTs and meta-analyses (Pharoah et al 2010). In particular, family psychoeducation has found to have positive impact on the recovery of PWS, with a significant reduction of relapse rates, and improvement in social functioning.…”

The effectiveness and active ingredients of mutual support groups for family caregivers of people with psychotic disorders: A literature review

“…With the current emphasis on community care for mentally ill patients, family intervention, particularly in a group format using a diverse range of modalities, is thought to effectively satisfy the informational needs of families (Cuijpers, 1999) and enhance their coping abilities to care for their relatives with mental illness (Chien and Wong, 2007), thus reducing patient relapses (Pharoah, Mari and Streiner, 2001). Although there have been a few psychological models of commonly used family group interventions, studies seeking to explain which model is most effective have been inconsistent.…”