Family Intervention in First-Episode Psychosis

Abstract

Family interventions have produced benefits on clinical and family outcomes in long standing psychosis. However, little is known about the efficacy of such interventions in the early stages of psychosis. This article reviews published research over the last two decades on family intervention in first-episode psychosis. Electronic databases, such as PubMed, PsycINFO, and ScienceDirect, have been systematically searched. In addition, an exhaustive Internet search was also carried out using Google and Google Scholar to identify the potential studies that evaluated family interventions in first-episode psychosis. We have identified seven reports of five randomized controlled trials (RCTs) and five non-randomized and uncontrolled studies of family intervention. Our review on 12 reports of family intervention studies has shown mixed effects on outcomes in first-episode psychosis. Most of the reports showed no added benefits or very short-term benefits on primary clinical or family outcome variables. There is a dearth of family intervention studies in first-episode psychosis. More RCTs are needed to reach reliable conclusions.

The effectiveness of a psycho-educational nursing intervention on illness perception, knowledge and expressed emotion of caregivers of patients with first episode psychosis

“…Results showed that there was a statistically significant difference between levels of income of the studied group regarding to the total expressed emotion. This result is consistent with sadath et al [4] who found that there was inverse correlation between monthly income and level of expressed emotion as many caregivers of psychosis were unable to afford their relatives' treatment expenses due to financial difficulties, which in turn increase level of expressed emotions. This relation explain the previous findings (level of expressed emotion did not improve to that significant level), because financial factors play a significant role in affecting on level of expressed emotion, and that factor cannot be controlled during the psycho educational intervention.…”

“…This result is matched with the preexisting literature review, Mertinez et al [13] found that expressed emotion (criticism and EOI) were strongly high especially in the early stage of psychosis. In the same line Sadath et al [4] found that nearly half of the caregivers of his sample showed high level of expressed emotion.…”

“…Unfortunately, the stress experienced by caregivers during the first episode can sometimes hamper recovery and even lead to a relapse. [4] Research evidence has demonstrated the clinical efficacy of a few approaches to family intervention, especially psychoeducation and behavioral or crisis management programs, in reducing patients' relapses from their psychotic disorders. [5] Mental healthcare or psychiatric treatment guide-lines in both the US and UK suggest that family-based (caregivers) intervention can be an integral of a community-based rehabilitation program to produce significant positive patients' outcomes in early psychosis whenever their family caregivers can improve in coping with their caregiving role and psychosocial functioning especially with the advent of deinstitualization where mentally ill patients are greatly stayed in the community and depend on their families in their care.…”

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

“…In a previous systematic review, Bird et al (2010) examined a small number of randomized controlled trials ( n = 3) within specialist early intervention for psychosis services and found that service users whose families received FIp were less likely to relapse or be admitted to hospital at the end of treatment, compared to those receiving standard care. All other reviews examining the efficacy of FIp in early psychosis report mixed findings (Penn et al, 2005; Askey et al, 2007; Sadath et al, 2015). However, there have been a number of limitations to previous reviews, including not using a systematic search strategy (Askey et al, 2007), only examining RCTs taking place within specialist early intervention for psychosis services (Bird et al, 2010), including mixed-length illness samples (Pharoah et al, 2010) and multi-element interventions (Penn et al, 2005) or limiting the review period to the last two decades (Sadath et al, 2015).…”

“…All other reviews examining the efficacy of FIp in early psychosis report mixed findings (Penn et al, 2005; Askey et al, 2007; Sadath et al, 2015). However, there have been a number of limitations to previous reviews, including not using a systematic search strategy (Askey et al, 2007), only examining RCTs taking place within specialist early intervention for psychosis services (Bird et al, 2010), including mixed-length illness samples (Pharoah et al, 2010) and multi-element interventions (Penn et al, 2005) or limiting the review period to the last two decades (Sadath et al, 2015). Further, with exception of Bird et al (2010), no previous reviews have employed a meta-analytic approach to provide quantitative synthesis of the evidence.…”