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Psychoeducational family interventions for schizophrenia in the last decade: from explanatory to pragmatic trials

Part of: Special Articles

Published online by Cambridge University Press:  18 May 2011

Lorenza Magliano  and
Andrea Fiorillo
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Summary

A number of explanatory RCT studies published since the 1980s have demonstrated the clinical efficacy of Psychoeducational Family Interventions (PFI) for schizophrenia when provided in combination with drug therapy. In recent years, there has been a shift from efficacy to effectiveness studies and great attention by the researchers in developing training programmes in these interventions for ordinary staff. In this paper, we will provide an overview of the studies on PFI for schizophrenia which have been carried out in the last decade in routine clinical settings or with at least a partial involvement of ordinary staff. These studies have been grouped into: a) studies comparing PFI with standard care; b) studies comparing PFI with individual integrated interventions; c) studies comparing different PFI strategies; d) implementation studies. The results of these studies reveal that, when provided in clinical settings, PFI have positive middle-term effects on patients' clinical status and disability, and limited impact on family burden. From a methodological viewpoint, these studies had several similarities, such as homogeneity of PFI models and mid-term follow-up assessments, and several differences, mainly in the intensity and duration of the family exposure to the intervention. Future studies are needed to identify the “best dose” at which PFI can be provided in routine conditions at the most convenient cost-benefit ratio.

Keywords

psychoeducational family interventionschizophreniaeffectiveness studiesimplementation studies
Type
Special Article
Information
Epidemiology and Psychiatric Sciences , Volume 16 , Issue 1 , March 2007 , pp. 22 - 34
Copyright
Copyright © Cambridge University Press 2007

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References

Anderson, J. & Adams, L. 1996. Family interventions in schizophrenia. An effective but underused treatment. British Medical Journal 313, 505–506.CrossRefGoogle Scholar
Barbato, A. & D'Avanzo, B. 2000. Family interventions in schizophrenia and related disorders: a critical review of clinical trials. Ada Psychiatrica Scandinavica 102, 81–97.CrossRefGoogle ScholarPubMed
Barrowclough, C., Tarrier, N., Lewis, S., Sellwood, W., Mainwaring, J., Quinn, J. & Hamlin, C. 1999. Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia. British Journal of Psychiatry 174, 505–511.CrossRefGoogle ScholarPubMed
Bellack, A.S., Haas, G.L., Schooler, N.R. & Flory, J.D. 2000. Effects of behavioural family management on family communication and patient outcomes in schizophrenia. British Journal of Psychiatry 111, 434–439.CrossRefGoogle Scholar
Berglund, N., Vahlne, J.O. & Edman, A. 2003. Family intervention in schizophrenia. Impact on family burden and attitude. Social Psychiatry and Psychiatric Epidemiology 38, 116–121.CrossRefGoogle ScholarPubMed
Bradley, G.M., Couchman, G.M., Perlesz, A., Nguyen, A.T., Singh, B. & Riess, C. 2006. Multiple-family group treatment for English- and Vietnamese-speaking families living with schizophrenia. Psychiatric Services 57, 521–530.CrossRefGoogle ScholarPubMed
Buchkremer, G., Klingberg, S., Holle, R., Schulze Monking, H. & Hornung, W.P. 1997. Psychoeducational psychotherapy for schizophrenic patients and their key relatives or care-givers: results of a 2-year follow-up. Acta Psychiatrica Scandinavica 96, 483–491.CrossRefGoogle ScholarPubMed
Canive, J.M., Sanz-Fuentenebro, J., Vazquez, C., Quails, C., Fuentenebro, F., Perez, I.G. & Tuason, V.B. 1996. Family psychoeducational support groups in Spain: parents' distress and burden at nine-month follow-up. Annals of Clinical Psychiatry 8, 71–79.CrossRefGoogle Scholar
Cardin, V.A., McGill, C.W. & Falloon, I.R.H. 1985. An economic analysis: costs, benefits, and effectiveness. In Family Management of Schizophrenia (ed. Falloon, I.R.H.), pp. 115–123. John Hopkins University Press: Baltimore.Google Scholar
Chien, W.-T. & Chan, S.W.C. 2004. One-year follow-up of a multiple family-group intervention for Chinese families of patients with schizophrenia. Psychiatric Services 55, 1276–1284.CrossRefGoogle ScholarPubMed
Dixon, L. & Lehman, A.F. 1995. Family interventions for schizophrenia. Schizophrenia Bulletin 21, 631–643.CrossRefGoogle ScholarPubMed
Dixon, L., Adams, C. & Lucksted, A. 2000. Update on family psychoeducation for schizophrenia. Schizophrenia Bulletin 26, 5–30.CrossRefGoogle ScholarPubMed
Dixon, L., McFarlane, W.R., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., Mueser, K., Miklowitz, D., Solomon, P. & Sondheimer, D. 2001. Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services 52, 903–910.CrossRefGoogle ScholarPubMed
Dyck, D.G., Short, R.A., Hendryx, M.S., Norell, D., Myers, M., Patterson, T., McDonell, M.G., Voss, W.D. & McFarlane, W.R. 2000. Management of negative symptoms among patients with schizophrenia attending multiple-family groups. Psychiatric Services 51, 513–519.CrossRefGoogle ScholarPubMed
Dyck, D.G., Hendryx, M.S., Short, R.A., Voss, W.D. & McFarlane, W.R. 2002. Service use among patients with schizophrenia in psychoeducational multiple-family group treatment. Psychiatric Services 53, 749–754.CrossRefGoogle ScholarPubMed
Fadden, G. 1997. Implementation of family interventions in routine clinical practice following staff training programs: a major cause for concern. Journal of Mental Health 6, 599–612.CrossRefGoogle Scholar
Fadden, G. 1998. Research update: psychoeducational family interventions. Journal of Family Therapy 20, 293–310.CrossRefGoogle Scholar
Falloon, I.R.H. 1985. Family Management of Schizophrenia: A Controlled Study of Clinical, Social, Family and Economic Benefits. John Hopkins University Press: Baltimore.Google Scholar
Falloon, I.R.H. 2003. Family interventions for mental disorders: efficacy and effectiveness. World Psychiatry 2, 20–28.Google ScholarPubMed
Falloon, I.R., Boyd, J.L., McGill, C.W., Razani, J., Moss, H.B. & Gilderman, A.M. 1982. Family management in the prevention of exacerbations of schizophrenia: a controlled study. New England Journal of Medicine 17, 1437–1440.CrossRefGoogle Scholar
Falloon, I.R.H., Montero, I., Sungur, M., Mastroeni, A., Malm, U., Economou, M., Grawe, R., Harangozo, J., Mizuno, M., Murakami, M., Hager, B., Held, T., Veltro, F., Gedye, R., & the OTP collaborative group 2004. Implementation of evidence-based treatment for schizophrenic disorders: two-year outcome of an international field trial of optimal treatment. World Psychiatry 3, 104–109.Google ScholarPubMed
Gaebel, W., Weinmann, S., Sartorius, N., Rutz, W. & Mclntyre, J.S. 2005. Schizophrenia practice guidelines: international survey and comparison. British Journal of Psychiatry 187, 248–255.CrossRefGoogle ScholarPubMed
Glick, I., Spencer, J., Clarkin, J., Haas, G., Lewis, A., Peyser, J., DeMane, N., Good-Ellis, M., Harris, E. & Lestelle, V. 1990. A randomized trial of inpatient family intervention, IV: follow-up results for subjects with schizophrenia. Schizophrenia Research 3, 187–200.CrossRefGoogle ScholarPubMed
Goldstein, M.J. & Miklowitz, D.J. 1995. The effectiveness of psychoeducational family therapy in the treatment of schizophrenic disorders. Journal of Marital and Family Therapy 21, 361–376.CrossRefGoogle Scholar
Goldstein, M.J., Rodnick, E.H., Evans, J.R., May, P.R.A. & Steinberg, M.R. 1978. Drugs and family therapy in the aftercare of acute schizophrenics. Archives of General Psychiatry 35, 1169–1177.CrossRefGoogle Scholar
Haas, G.L., Glick, I.D., Clarkin, J.F., Spencer, J.H., Lewis, A.B., Peyser, J., DeMane, M., Good-Ellis, M., Harris, E. & Lestelle, V. 1988. Inpatient family intervention: a randomized clinical trial. II: Results at hospital discharge. Archives of General Psychiatry 45, 217–224.CrossRefGoogle ScholarPubMed
Hazel, N.A., McDonell, M.G., Short, R.A., Berry, C.M., Voss, W.D., Rodgers, M.L. & Dyck, D.G. 2004. Impact of multiple-family groups for outpatients with schizophrenia on caregivers' distress and resources. Psychiatric Services 55, 35–41.CrossRefGoogle ScholarPubMed
Hogarty, G.E., Anderson, C.M., Reiss, D.J., Kornblith, S.J., Greenwald, D.P., Javna, C.D. & Madonia, M.J. 1986. Family education, social skills training, and maintenance chemotherapy in the aftercare of schizophrenia. Archives of General Psychiatry 43, 633–642.CrossRefGoogle Scholar
Hogarty, G.E., Anderson, C., Reiss, D., Kornblith, S., Greenwald, D., Ulrich, R. & Carter, M. 1991. Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia, II: two year effects of a controlled study on relapse and adjustment. Archives of General Psychiatry 48, 340–347.CrossRefGoogle Scholar
Hornung, W.P., Feldmann, R., Klingberg, S., Buchkremer, G. & Reker, T. 1999. Long-term effects of a psychoeducational psychotherapeutic intervention for schizophrenic outpatients and their key-persons - results of a five-year follow-up. European Archives of Psychiatry and Clinical Neuroscience 249, 162–167.CrossRefGoogle ScholarPubMed
Hotopf, M. 2002. The pragmatic randomised controlled trial. Advances in Psychiatric Treatment 8, 326–333.CrossRefGoogle Scholar
Jeppesen, P., Petersen, L., Thorup, A., Abel, M.-B., Oehlenschlaeger, J., Christensen, T.O., Krarup, G., Hemmingsen, R., Jorgensen, P. & Nordentoft, M. 2005. Integrated treatment of first-episode psychosis: effect of treatment on family burden. OPUS trial. British Journal of Psychiatry 187, Suppl. 48, 85–90.CrossRefGoogle ScholarPubMed
Leff, J. 2000. Family work for schizophrenia: practical application. Acta Psychiatrica Scandinavica 102, Suppl. 407, 78–82.CrossRefGoogle Scholar
Leff, J., Berkowitz, R., Shavit, N., Strachan, A., Glass, I. & Vaughn, C. 1990. A trial of family therapy versus a relatives' group for schizophrenia: two-year follow-up. British Journal of Psychiatry 157, 571–577.CrossRefGoogle Scholar
Lehman, A.F., Kreyenbuhl, J., Buchanan, R.W., Dickerson, F.B., Dixon, L.B., Goldberg, R., Green-Paden, L.D., Tenhula, W.N., Boerescu, D., Tek, C., Sandson, N. & Steinwachs, D.M. 2004. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophrenia Bulletin 30, 193–217.CrossRefGoogle ScholarPubMed
Linszen, D., Dingemans, P., Van Der Does, J.W., Nugter, A., Scholte, P., Senior, R. & Goldstein, M.J. 1996. Treatment, expressed emotion and relapse in recent onset schizophrenic disorders. Psychological Medicine 26, 333–342.CrossRefGoogle ScholarPubMed
Magliano, L., Fadden, G., Madianos, M., de Almeida, J.M., Held, T., Guarneri, M., Marasco, C., Tosini, P. & Maj, M. 1998. Burden on the families of patients with schizophrenia: results of the BIOMED I study. Social Psychiatry and Psychiatric Epidemiology 33, 405-412.Google ScholarPubMed
Magliano, L., Fadden, G., Economou, M., Held, T., Xavier, M., Guarneri, M., Malangone, C., Marasco, C. & Maj, M. 2000. Family burden and coping strategies in schizophrenia: one-year follow-up data from the BIOMED I study. Social Psychiatry and Psychiatric Epidemiology 35, 109.–115Google Scholar
Magliano, L., Marasco, C., Fiorillo, A., Malangone, C., Guarneri, M., Maj, M. & Working Group of the Italian National Study on Families of Persons with Schizophrenia. 2002. The impact of professional and social support on the burden of families of patients with schizophrenia in Italy. Acta Psychiatrica Scandinavica 106, 291–298.CrossRefGoogle ScholarPubMed
Magliano, L., Fiorillo, A., Malangone, C., De Rosa, C., Favata, G., Sasso, A.R., Prezioso, M., Pezzenati, L., Gentile, F., Casale, L., Bondi, E., Robustelli Test, G., Di Leila, M., Biscussi, E., Degl'innocenti, F., Bellini, R., Di Nunzio, R., Matrella, L., Salmeri, R., Cantone, R., Gargiulo, L., Esposito, A., Delcuratolo, V., Giannini, M., Maresca, L., Cavaliere, G., Scandone, B., Folia, M., Raffaeli, M., Innocente, P., Dagianti, F., Lucania, S., Scorsino, A., Bardicchia, F., Cerullo, G., Curreli, R., Miscali, S., Scordato, M., Campo, G., Mameli, C., Sodde, C., D'Ambra, L., Malacarne, A., Maj, M. & Gruppo di Lavoro (2005a). Aspetti positivi e difficoltá nella diffusione degli interventi psicoeducativi familiari nella pratica clinica: uno studio multicentrico in 23 CSM italiani. Epidemiologia e Psichiatria Sociale 14, 235–242.CrossRefGoogle Scholar
Magliano, L., Fiorillo, A., Fadden, G., Gair, F., Economou, M., Kallert, T., Schellong, J., Xavier, M., Pereira, M.G., Torres-Gonzales, F., Palma-Crespo, A. & Maj, M. (2005b). Effectiveness of a psychoeducational intervention for families of patients with schizophrenia: preliminary results of a study funded by the European Commission. World Psychiatry 4, 45–49.Google Scholar
Magliano, L., Fiorillo, A., Malangone, C., De Rosa, C., Maj, M. & the Family Intervention Working Group 2006. A pragmatic randomised controlled trial of a psychoeducational family intervention for schizophrenia on patients' personal/social functioning and relatives' burden and perceived support. Psychiatric Services 57, 1784–1791.CrossRefGoogle Scholar
Malm, U., Ivarsson, B., Allebeck, P. & Falloon, I.R.H. 2003. Integrated care in schizophrenia: a 2-year randomized controlled study of two community-based treatment programs. Acta Psychiatrica Scandinavica 107, 415–423.CrossRefGoogle ScholarPubMed
Man, J.J. & Streiner, D.L. 1994. An overview of family interventions and relapse on schizophrenia: meta-analysis of research findings. Psychological Medicine 24, 565–578.Google Scholar
McDonell, M.G., Short, R.A., Berry, C.M. & Dyck, D.G. 2003. Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality. Family Process 42, 91–103.CrossRefGoogle ScholarPubMed
McFarlane, W.R., Dixon, L., Lukens, E. & Lucksted, A. 2003. Family psychoeducation and schizophrenia: a review of the literature. Journal of Marital and Family Therapy 29, 223–245.CrossRefGoogle ScholarPubMed
Montero, I., Asencio, A., Ruiz, I. & Hernandez, I. 1999. Family interventions in schizophrenia: an analysis of non-adherence. Acta Psychiatrica Scandinavica 100, 136–141.CrossRefGoogle ScholarPubMed
Montero, I., Asencio, A., Hernandez, I., Masanet, M.J., Lacruz, M., Bellver, F., Iborra, M. & Ruiz, I. 2001. Two strategies for family intervention in schizophrenia: a randomized trial in a Mediterranean environment. Schizophrenia Bulletin 27, 661–670.CrossRefGoogle Scholar
Montero, I., Hernandez, I., Asencio, A., Bellver, F., Lacruz, M. & Masanet, M.J. 2005. Do all people with schizophrenia receive the same benefit from different family intervention programs? Psychiatric Research 133, 187–195.CrossRefGoogle Scholar
Montero, I., Masanet, M.J., Bellver, F. & Lacruz, M. 2006. The longterm outcome of 2 family intervention strategies in schizophrenia. Comprehensive Psychiatry 47, 362–367.CrossRefGoogle ScholarPubMed
Mueser, K.T., Sengupta, A., Schooler, N.R., Bellack, A.S., Xie, H., Glick, I.D. & Keith, S.J. 2001. Family treatment and medication dosage reduction in schizophrenia: effects on patient social functioning, family attitudes, and burden. Journal of Consulting and Clinical Psychology 69, 3–12.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence 2002. Clinical Guideline I: Schizophrenia. Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. NICE: London.Google Scholar
Nugter, A., Dingemans, P., Van der Does, J.W., Linszen, D. & Gersons, B. 1997. Family treatment, expressed emotion and relapse in recent onset schizophrenia. Psychiatry Research 72, 23–31.CrossRefGoogle ScholarPubMed
Ohaeri, J. 2003. The burden of caregiving in families with a mental illness: a review of 2002. Current Opinions in Psychiatry 16, 457–465.CrossRefGoogle Scholar
Petersen, L., Jeppesen, P., Thorup, P., Abel, M.-B., Ohlenschlaeger, J., Christensen, T.O., Krarup, G., Jorgensen, P. & Nordentoft, M. 2005. A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331, 662–669.CrossRefGoogle ScholarPubMed
Pharoah, F.M., Rathbone, J., Man J, J. & Streiner, D. 2006. Family intervention for schizophrenia. Cochrane Database Systematic Review, Issue 4.Google Scholar
Roland, M. & Torgerson, D.J. (1998a). Understanding controlled trials: what are pragmatic trials? British Medical Journal 316, 285.CrossRefGoogle Scholar
Roland, M. & Torgerson, D. (1998b). What outcomes should be measured? British Medical Journal 317, 1075.CrossRefGoogle ScholarPubMed
Schooler, N.R., Keith, S.J., Severe, J.B., Matthews, S.M., Bellack, A.S., Glick, I.D., Hargreaves, W.A., Kane, J.M., Ninan, P.T., Frances, A., Jacobs, M., Lieberman, J.A., Mance, R., Simpson, G.M. & Woerner, M.G. 1997. Relapse and rehospitalization during maintenance treatment of schizophrenia. The effects of dose reduction and family treatment. Archives of General Psychiatry 54, 453–463.CrossRefGoogle ScholarPubMed
Sellwood, W., Barrowclough, C., Tarrier, N., Quinn, J., Mainwaring, J and Lewis, S. 2001. Needs-based cognitive-behavioural family intervention for carers of patients suffering from schizophrenia: 12 month follow-up. Acta Psychiatrica Scandinavica 104, 346–355.CrossRefGoogle Scholar
Shimodera, S., Inoue, S., Mino, Y., Tanaka, S., Kii, M. & Motoki, Y. 2000. Expressed emotion and psychoeducational intervention for relatives of patients with schizophrenia: a randomized controlled study in Japan. Psychiatry Research 96, 141–148.CrossRefGoogle ScholarPubMed
Stam, H. & Cuijpers, P. 2001. Effects of family intervention on burden of relatives of psychiatric patients in the Netherlands: a pilot study. Community Mental Health Journal 37, 179–187.CrossRefGoogle ScholarPubMed
Stroup, S. 2005. Practical clinical trials for schizophrenia. Epidemiologia e Psichiatria Sociale 14, 3, 132–136.CrossRefGoogle Scholar
Tarrier, N., Barrowclough, C., Vaughn, C., Bamrah, J., Porceddu, K., Watts, S. & Freeman, H. 1988. The community management of schizophrenia: a controlled trial of a behavioural intervention with families to reduce relapse. British Journal of Psychiatry 153, 532–542.CrossRefGoogle ScholarPubMed
Tarrier, N., Barrowclough, C., Vaughn, C., Bamrah, J., Porceddu, K., Watts, S. & Freeman, H. 1989. Community management of schizophrenia: a two-year follow-up of a behavioural intervention with families. British Journal of Psychiatry 154, 625–628.CrossRefGoogle ScholarPubMed
Tarrier, N., Barrowclough, C., Haddock, G. & McGovern, J. 1999. The dissemination of innovative cognitive-behavioural psychosocial treatments for schizophrenia. Journal of Mental Health 8, 569–582.Google Scholar
Tomaras, V., Mavreas, V., Economou, M., Ioannovich, E., Karydi, V. & Stefanis, C. 2000. The effect of family intervention on chronic schizophrenics under individual psychosocial treatment: a 3-year study. Social Psychiatry and Psychiatric Epidemiology 35,487–493.CrossRefGoogle Scholar
Veltro, F., Magliano, L., Morosini, P., Fasulo, E., Pedicini, G., Cascavilla, I., Falloon, I. & Gruppo di Lavoro DSM-BN1 2006. Randomised controlled trial of a behavioural family intervention: 1-year and 11- years follow-up. Epidemiologia e Psichiatria Sociale 15, 44–51.CrossRefGoogle Scholar
Wearden, A.J., Tarrier, N., Barrowclough, C., Zastowny, T.R. & Rahill, A.A. 2000. A review of expressed emotion research in health care. Clinical Psychology Review 20, 633–666.CrossRefGoogle ScholarPubMed
Zubin, J. & Spring, B. 1977. Vulnerability-a new view of schizophrenia. Journal of Abnormal Psychology 86, 103–126.CrossRefGoogle ScholarPubMed