Psychological Therapies; Family interventions

Question 1

Family intervention

Answer 1

Family intervention is a psychological therapy that involves intervening in the family life to help someone who may have Sz in a family. It involves educating, talking and suggesting family adjustments.

Question 2

Use

Answer 2

With family members of (i.e., those who live with) people with schizophrenia as well as the patient

Question 3

Rationale

Answer 3

Schizophrenia is maintained, i.e., relapse is made more likely, by communication and emotional problems, particularly high levels of EE, within the family of people with schizophrenia

Question 4

Aim

Answer 4

To provide the family with practical coping skills that enable them to manage difficulties, reduce levels of EE within families, reduce the risk of relapse

Question 5

Process

Answer 5

To educate the family about schizophrenia, e.g., its causes, course and symptoms, improve communication within families, develop cooperative and trusting relationship within the family, adjust expectations of family members to avoid imposing guilt, etc on the patient, recognise early signs of relapse, expand social networks of family to allow communication with other parents of people with schizophrenia

Question 6

Leff et al (1982)

Answer 6

Aim: To develop and test the effectiveness of family intervention. Measured over tow years and involved a control group.
Procedure: A programme involved; educational sessions of how to deal with Sz; Group meetings with other family’s who coped well with Sz; Family sessions involving social workers & other professionals.
Results: Families who had been through the programme showed sig decrease in no of critical comments and emotional over involvement.
78% of patients in the control group had been readmitted to hospital, while 14% of the family intervention group had to be rehospitalised

Question 7

Pharoah et al

Answer 7

-A cochrane review
found that family intervention decreased the frequency of relapse and reduced hospital admission.
Also seems to improve general social impairment and levels of expressed emotion within the family.

Question 8

Methodological evaluation of Pharoah et al.

Answer 8

• Cochrane review: independent review so less bias
• Good quality studies; good controlled trials
• Meta-analysis; good sample size

Question 9

McCreadie et al

Answer 9

63 relatives of 52 schizophrenics living at home were offered a package of treatments by professionals working in an everyday NHS setting: educational, seminars, relatives’ groups, and family meetings. Thirty-two relatives refused intervention. Of the 31 relatives who agreed, 14 attended neither the educational seminars nor the relatives’ groups.

Question 10

Effectiveness

Answer 10

Leff et al (1982) first showed, in a RCT, that training families to reduce levels of EE reduced relapse rates from 78 to 14%. A NICE review (2009) found average relapse rates of 26% in the treatment condition and 50% in control groups. Pharaoh et al (2012) reviewed 53 randomised studies, with positive results in relation to relapse, hospital admission and compliance with medication. However, there are major issues about bias due to the lack of random allocation and blind assessments in many of the studies that were conducted in China.

Question 11

Appropriateness

Answer 11

Family intervention (FL) is probably best used as a complement to drug treatments (as occurs in trials). A problem is that family members may not want or be able to take part, due to guilt or lack of time respectively, as suggested by McCreadie who found that only half of relatives of Ss volunteered to take part in FI and only half of them actually turned up.