Family Interventions for Schizophrenia and the Psychoses: A Review

Abstract

Family psychoeducation as a treatment for schizophrenia was developed 40 years ago almost simultaneously and independently by investigators who at the time were not family therapists. Although the original goal was to decrease high expressed emotion as a means of preventing relapse, later variations have gone beyond to focus on social and role functioning and family well-being. Explicitly disavowing the earlier assumptions that family pathology caused relapse and deterioration, family psychoeducation seeks to engage family members as more sophisticated partners, complementing interventions by clinicians with specialized interactions and coping skills that counter the neurologic deficits inherent to the disorder. It has proved to be one of the most consistently effective treatments available. Reports on outcome studies now number more than 100, while meta-analyses put relapse rate reduction at 50-60% over treatment as usual. The most recent application in first episode and prodromal psychosis, combined with other evidence-based interventions, is yielding perhaps the most promising results yet achieved-substantial return of functioning and avoidance of psychosis altogether. Reviewed here are its scientific, theoretical, and clinical sources, a description of the most commonly applied version-the multifamily group format, selected clinical trials spanning those four decades, international and ethnic adaptations, and studies on mechanisms of efficacy.

Emerging behavioral and psychotherapeutic interventions for schizophrenia

“…Considering these findings, authors recommended that family interventions should be offered to families of those with schizophrenia. Several studies and subsequent reviews reported similar results (55,83,92,94,95). Support for family intervention also resulted in some national guideline recommendation that treatment would be offered to caregivers (49,73).…”

“…There are several variations of family interventions, but most commonly family psychoeducation consists of strategies to effectively work with a relative with schizophrenia, and to increase collaboration between family members and clinical care providers. Family psychoeducation typically reviews content about illness, medication and treatment management, coordination of services, problem solving, coping and rehabilitative services, and crisis planning, as well as discussion about expectations and distress, as well as social support (92).…”

Grupo De Suporte À Família Da Pessoa Com Doença Mental Grave: Espaço De Partilha Na Adversidade

“…E se ao doente é dado apoio e orientação antes e depois da alta o mesmo não acontece às famílias. A inexistência de programas estruturados com vista a preparar uma alta responsável e segura, cria dinâmicas de grande stresse no seio da família, sendo o grupo de suporte um recurso utilíssimo, mas de efeito escasso para a amplitude do problema de cuidar de uma pessoa com DMG em casa (Mcfarlane, 2016). Assim, importa mudar as conceções de cuidados à família ainda existentes, mais centrados na satisfação das necessidades do cliente e se avance para uma conceção de cuidados centrada no doente e família e no seu potencial de desenvolvimento.…”

“…A evidência em outras realidades semelhantes sugere a efetividade deste tipo de intervenção para os familiares das pessoas doentes (Grácio, Gonçalves-Pereira, & Leff, 2015;McFarlane, 2016 (Strauss e Corbin, 1998).…”

Psychoeducation as an Opportunity for Patients, Psychiatrists, and Psychiatric Educators: Why Do We Ignore It?

“…Family interventions, including psychoeducation for schizophrenia, have proved to be one of the most consistently effective treatment modalities available, with relapse rate reduction at 50-60% over treatment as usual [1,2]. Besides relapse severity reduction, psychoeducation leads to less frequent relapses, better treatment adherence, lower self-stigma, better quality of life, improvement of social competencies, active engagement in rehabilitation, and lower cost of care, either alone or as a part of complex treatment regimen [3][4][5][6][7].…”