Hostname: page-component-66644f4456-srn29 Total loading time: 0 Render date: 2025-02-12T19:52:35.336Z Has data issue: true hasContentIssue false
  • English
  • Français

The Community Management of Schizophrenia

A Controlled Trial of a Behavioural Intervention with Families to Reduce Relapse

Published online by Cambridge University Press:  02 January 2018

Nicholas Tarrier ,
Christine Barrowclough ,
Christine Vaughn ,
J. S. Bamrah ,
Kathleen Porceddu ,
Susan Watts  and
Hugh Freeman
Nicholas Tarrier*
Affiliation:
District Department of Psychology, Prestwich Hospital, now at MRC Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park
Christine Barrowclough
Affiliation:
District Department of Psychology, Prestwich Hospital, now at MRC Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park
Christine Vaughn
Affiliation:
District Department of Psychology, Prestwich Hospital, now at MRC Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park
J. S. Bamrah
Affiliation:
Hope Hospital, Salford, now Senior Registrar, Prestwich Hospital
Kathleen Porceddu
Affiliation:
Prestwich Hospital
Susan Watts
Affiliation:
University of Salford and Hope Hospital, Salford
Hugh Freeman
Affiliation:
University of Salford and Hope Hospital, Salford
*
∗District Department of Psychology, Salford Health Authority, Prestwich Hospital, Manchester M25 7BL
Get access Rights & Permissions [Opens in a new window]

Abstract

Schizophrenic patients were recruited into a trial of a prophylactic behavioural intervention with families. Families with at least one high Expressed Emotion (EE) relative were randomly allocated to one of four intervention groups: Behavioural Intervention Enactive; Behavioural Intervention Symbolic; Education Only; Routine Treatment. Patients from low-EE families were randomly allocated to two groups: Education Only or Routine Treatment. Relapse rates over nine months after discharge were significantly lower for patients in the two Behavioural Intervention, compared with Education Only and Routine Treatment groups. There was little difference between the two low-EE groups. Patients returning to high-EE relatives showed significantly higher relapse rates than those returning to low-EE relatives, in groups not receiving active intervention. Changes from high to low EE occurred in the Behavioural Intervention groups, and similar although less extensive changes occurred in the Education Only and Routine Treatment groups. Changes in criticism and marked emotional over-involvement (EOI) occurred generally in high-EE groups but were larger in magnitude in the Enactive and Symbolic groups. Reduction of hostility only occurred in the Behavioural Intervention groups. These results give partial support for the causal role of EE in relapse. There were no significant differences between the groups with respect to contact with the psychiatric services or medication.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 153 , Issue 4 , October 1988 , pp. 532 - 542
Copyright
Copyright © Royal College of Psychiatrists, 1988 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baldwin, S. (1987) From communities to neighbourhoods – 1. Disability, Handicap and Society, 2, 41–52.CrossRefGoogle Scholar
Barrowclough, C. & Tarrier, N. (1984) Psychosocial interventions with families and their effects on the course of schizophrenia: a review. Psychological Medicine, 14, 629–642.CrossRefGoogle ScholarPubMed
Barrowclough, C. & Tarrier, N. (1987) A behavioural family intervention with a schizophrenic patient: a case study. Behavioural Psychotherapy, 15, 252–271.CrossRefGoogle Scholar
Barrowclough, C., Tarrier, N., Watts, S., Vaughn, C., Bamrah, J. S. & Freeman, H. (1987) Assessing the functional value of relatives' knowledge about schizophrenia: a preliminary report. British Journal of Psychiatry, 151, 1–8.CrossRefGoogle ScholarPubMed
Birchwood, M. (1983) Family coping behaviour and the course of schizophrenia: a two-year follow-up study. PhD Thesis, University of Birmingham.Google Scholar
Brown, G. W., Birley, J. T. L. & Wing, J. K. (1972) Influence of family life on the course of schizophrenia: a replication. British Journal of Psychiatry, 121, 241–258.CrossRefGoogle ScholarPubMed
Brown, G. W., Monck, E. M., Carstairs, G. M. & Wing, J. K. (1962) Influence of family life on the course of schizophrenia. British Journal of Preventative and Social Medicine, 16, 55–68.Google Scholar
Bruner, J. S. (1966) Towards a Theory of Instruction. New York: Norton.Google Scholar
Davis, J. M. (1975) Overview: maintenance therapy in psychiatry: I. Schizophrenia. American Journal of Psychiatry, 13, 1237–1254.Google Scholar
Dultz, B. & Hand, I. (1986) Short-term relapse in young schizophrenics: can it be predicted and affected by family (CFI), patient, and treatment variables? An experimental study In Treatment of Schizophrenia: Family Assessment and Intervention (eds Goldstein, M. J., Hand, I. & Hahlweg, K.). Berlin: Springer.Google Scholar
Falloon, I. R. H., Boyd, J. L., McGill, C. W., Razani, J., Moss, H. B. & Gilderman, A. M. (1982) Family management in the prevention of exacerbations of schizophrenia. New England Journal of Medicine, 306, 1437–1440.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Boyd, J. L., McGill, C. W., Williamson, M., Razani, J., Moss, H. B., Gliderman, A. M. & Simpson, G. M. (1985) Family management in the prevention of morbidity of schizophrenia: clinical outcome of a two year longitudinal study. Archives of General Psychiatry, 42, 887–896.CrossRefGoogle ScholarPubMed
Goldberg, D. (1972) The Detection of Psychiatric Illness by Questionnaire, Maudsley Monographs No 21. London: Oxford University Press.Google Scholar
Goldiamond, I. (1974) Towards a constructional approach to social problems. Ethical and constitutional issues raised by applied behaviour analysis. Behaviourism, 2, 1–84.Google Scholar
Hogarty, G. E., Anderson, C. M., Reiss, D. J., Kornblith, S. J., Greenwald, P., Javan, C. D., Manonia, M. J. and the EPICS Research Group (1986) Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. Archives of General Psychiatry, 43, 633–642.CrossRefGoogle ScholarPubMed
Kellner, R. & Sheffield, B. F. (1973) A self-rating scale of distress. Psychological Medicine, 3, 101–106.CrossRefGoogle ScholarPubMed
Koenigsberg, H. & Handley, R. (1986) Expressed emotion: from predictive index to clinical construct. American Journal of Psychiatry, 43, 1361–1373.Google Scholar
Kottgen, C., Sonnichsen, I., Mollenhauer, K. & Jurth, R. (1984) Group therapy with families of schizophrenic patients: results of the Hamburg Camberwell Family Interview Study III. International Journal of Family Psychiatry, 5, 83–94.Google Scholar
Krawieka, M., Goldberg, D. & Vaughan, M. (1977) A standardised psychiatric assessment scale for rating chronic psychotic patients. Acta Psychiatrica Scandinavica, 55, 299–308.CrossRefGoogle Scholar
Leff, J. (1985) Family treatment of schizophrenia In Recent Advances in Clinical Psychiatry (ed. Granville-Grossman, K.). London: Churchill-Livingston.Google Scholar
Leff, J. & Vaughn, C. E. (1985) Expressed Emotion in Families. New York: Guilford Press.Google Scholar
Leff, J., Kuipers, L., Berkowitz, R., Eberlein-Vries, R. & Sturgeon, D. (1982) A controlled trial of social intervention in families of schizophrenic patients. British Journal of Psychiatry, 141, 121–134.CrossRefGoogle ScholarPubMed
Leff, J., Kuipers, L., Berkowitz, R. & Sturgeon, D. (1985) A controlled trial of social intervention in families of schizophrenic patients: two year follow-up. British Journal of Psychiatry, 146, 594–600.CrossRefGoogle ScholarPubMed
MacMillan, J. F., Gold, A., Crow, T. J., Johnson, A. L. & Johnstone, E. C. (1986) The Northwick Park study of first episodes of schizophrenia: IV expressed emotion and relapse. British Journal of Psychiatry, 148, 133–143.CrossRefGoogle Scholar
Moline, R. E., Singh, S., Morris, A. & Meltzer, H. Y. (1985) Family expressed emotion and relapse in schizophrenia in 24 urban American patients. American Journal of Psychiatry, 142, 1078–1081.Google ScholarPubMed
Nuechterlein, K. H. & Dawson, M. E. (1984) A heuristic vulnerability–stress model of schizophrenic episodes. Schizophrenia Bulletin, 10, 300–312.CrossRefGoogle ScholarPubMed
Siegel, S. (1956) Non-parametric Statistics for the Behavioural Sciences. Tokyo: McGraw-Hill Kogakusha.Google Scholar
Strachan, A. M. (1986) Family intervention for the rehabilitation of schizophrenia. Schizophrenia Bulletin, 12, 678–698.CrossRefGoogle ScholarPubMed
Suy, E., Woestenborghs, R. & Heykants, J. (1982) Bioavailability and clinical effects of two different concentrations of haloperidol decanoate. Current Therapeutic Research, 31, 982–991.Google Scholar
Tarrier, N. (1988) The role of family atmosphere and family intervention in the management of schizophrenia In Reconstructing Schizophrenia (ed. Bentall, R.). Chichester: John Wiley (in press).Google Scholar
Tarrier, N. & Barrowclough, C. (1984) Psychophysiological assessment of expressed emotion in schizophrenia: a case example. British Journal of Psychiatry, 145, 197–203.CrossRefGoogle ScholarPubMed
Tarrier, N., Barrowclough, C., Porceddu, K. & Watts, S. (1988) The assessment of psychophysiological reactivity to the expressed emotion of the relatives of schizophrenic patients. British Journal of Psychiatry (in press).CrossRefGoogle Scholar
Vaughn, C. E. & Leff, J. (1976a) The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry, 129, 125–137.CrossRefGoogle ScholarPubMed
Vaughn, C. E. & Leff, J. (1976b) The measurement of expressed emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology, 15, 423–429.CrossRefGoogle ScholarPubMed
Vaughn, C. E., Snyder, K. S., Jones, S., Freeman, W. B. & Falloon, I. R. H. (1984) Family factors in schizophrenic relapse: a California replication of the British research on expressed emotion. Archives of General Psychiatry, 41, 1169–1177.CrossRefGoogle ScholarPubMed
Wing, J., Cooper, J. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptomatology: An Instruction Manual for the PSE and CATEGO System. London: Cambridge University Press.Google Scholar
Wooff, K., Goldberg, D. P. & Fryers, T. (1988) The practice of community nursing and mental health work in Salford: some implications for community care. British Journal of Psychiatry, 152, 783–792.CrossRefGoogle ScholarPubMed
Zubin, J. & Spring, B. (1977) Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology, 86, 103–126.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.