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Zabihi Poursaadati M, Maarefvand M, Bolhari J, Hosseinzadeh S, Songhori N, Derakhshan L, Khubchandani J. Caregivers' experiences and perspectives of factors associated with relapse in Iranian people living with schizophrenia: A qualitative study. Int J Soc Psychiatry 2023; 69:86-100. [PMID: 34971526 DOI: 10.1177/00207640211068977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relapse in People Living with Schizophrenia (PLS) has several reasons and recognizing these can increase the effectiveness of treatment interventions. Formal and informal caregivers are an informed source to reduce relapse in PLS. AIM This study explores the caregivers' perspective in Iran on the factors affecting relapse in PLS. METHOD A total of 28 caregivers (16 formal caregivers and 12 informal caregivers) of PLS were enrolled in our qualitative study. A content analysis was conducted using individual and group, semi-structured in-depth interviews with informal and formal caregivers of PLS. This study was conducted in a hospital, three universities, and a non-governmental organization in Tehran, Iran. RESULTS The majority (69%) of the participants were females. About half of the informal caregivers were over 60 years old and about 40% of the formal caregivers were in the age range of 30 to 40 years. The average number of years of work for informal caregivers was 17.6 years and the average of work experience among the formal caregivers was 14.1 years. Seven key dual themes were identified from data: 'awareness-stigma', 'social support-social exclusion', 'treatment adherence-treatment discontinuation', 'holistic approach - one-dimensional approach', 'supported employment-social dysfunction', 'emotional management in family - family with high emotional expression', and 'access to treatment-treatment gap'. CONCLUSION The results of this research can help practitioners and policymakers to enable evidence-based practices to reduce relapse in PLS by emphasizing and acting on factors identified in our analyses.
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Affiliation(s)
| | - Masoomeh Maarefvand
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Biostatistics department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nahid Songhori
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Leili Derakhshan
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico University, Las Cruces, NM, USA
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Morokuma I, Shimodera S, Fujita H, Hashizume H, Kamimura N, Kawamura A, Nishida A, Furukawa TA, Inoue S. Psychoeducation for major depressive disorders: a randomised controlled trial. Psychiatry Res 2013; 210:134-9. [PMID: 23835139 DOI: 10.1016/j.psychres.2013.05.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 11/17/2022]
Abstract
Various psychological therapies have been shown to be effective for the treatment of mood disorders. Among them, family psychoeducation has demonstrated efficacy in reducing symptom severity and extending the time to relapse. We tested the efficacy of adding psychoeducation focussed on how to deal with the family's expressed emotion to treatment as usual (TAU) to prevent relapse among patients with remitted major depression. A total of 34 patients with major depressive disorders in full or partial remission were randomised to receive either group psychoeducation over six sessions, each consisting of a didactic lecture and group problem-solving (n=19), plus TAU or TAU alone (n=15). The primary outcome was relapse by Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Masked raters administered the Hamilton Rating Scale for Depression-17 (HRSD-17). As many as 18 patients in the intervention group and 14 patients in the control group completed the study. Time to relapse was significantly longer in the intervention group than in the control group, with a risk ratio (RR) of relapse by 9 months of 0.12. At 9 months, there was a significantly greater decrease in the HRSD-17 score in the intervention group than in the control group. We demonstrated the effectiveness of patient psychoeducation on the course and outcome of major depressive disorders.
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Affiliation(s)
- Ippei Morokuma
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, 185-1 Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan
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Tursi MFDS, Baes CVW, Camacho FRDB, Tofoli SMDC, Juruena MF. Effectiveness of psychoeducation for depression: a systematic review. Aust N Z J Psychiatry 2013; 47:1019-31. [PMID: 23739312 DOI: 10.1177/0004867413491154] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Pharmacological treatment is considered indispensable to major depressive disorder. In spite of this, a significant number of patients do not respond adequately to treatment based only on medication, presenting high relapse and recurrence rates. Therefore, psychosocial interventions, such as psychoeducation, have been increasingly recognized as an essential component in the treatment of depression, associated with pharmacological strategies. Thus, the aim of the present systematic review was to evaluate the effectiveness of psychoeducation for patients with unipolar depression, analyzing the evidence from the literature. METHOD Searches were undertaken from April to October 2012 in LILACS, PsycINFO, PubMed, SCOPUS and ISI Web of Knowledge with keywords including 'psychoeducation', 'psychoeducational intervention' and 'depression', with no restriction regarding publishing dates. RESULTS Fifteen studies were included in the review, 13 of which evaluated the effectiveness of psychoeducation for patients with depression: 10 papers evaluated in-person psychoeducation approaches and three papers evaluated long-distance approaches. In addition to these 13 papers, one evaluated psychoeducational interventions for patients' families and patients' responses and another evaluated psychoeducational interventions for patients' families and families' responses. Findings suggest that increased knowledge about depression and its treatment is associated with better prognosis in depression, as well as with the reduction of the psychosocial burden for the family. CONCLUSIONS Psychoeducation is a psychosocial treatment that has been well documented as an adjunct to pharmacological therapy. However, there are only a few studies regarding its effectiveness on adult patients with major depressive disorder. Although the publications in this area are still very limited, the articles selected in this review suggest that psychoeducation is effective in improving the clinical course, treatment adherence, and psychosocial functioning of depressive patients.
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Affiliation(s)
- Mariana Flávia de Souza Tursi
- 1Department of Neuroscience and Behavior, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Absalom-Hornby V, Gooding PA, Tarrier N. Implementing family intervention within forensic services: The perspectives of clinical staff. J Ment Health 2011; 20:355-67. [DOI: 10.3109/09638237.2011.583948] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Psychoeducational family interventions for schizophrenia in the last decade: from explanatory to pragmatic trials. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00004589] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARYA 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.
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Shimazu K, Shimodera S, Mino Y, Nishida A, Kamimura N, Sawada K, Fujita H, Furukawa TA, Inoue S. Family psychoeducation for major depression: randomised controlled trial. Br J Psychiatry 2011; 198:385-90. [PMID: 21343330 DOI: 10.1192/bjp.bp.110.078626] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The value of family psychoeducation for schizophrenia has been well established, and indications for its use have recently expanded to include bipolar affective disorder. However, no study to date has adequately examined its use in depression. AIMS To examine family psychoeducation in the maintenance treatment of depression and to investigate the influence of the family's expressed emotion (EE) on its effectiveness. METHOD Of 103 patients diagnosed with major depression and their primary family members, 57 pairs provided written informed consent. The pairs were randomly allocated to the intervention (n = 25) or control (n = 32). One family in the intervention group and two in the control group withdrew their consent after randomisation. The intervention group underwent four psychoeducation sessions consisting of didactic lectures about depression and group problem-solving focusing on how to cope in high-EE situations. Patients did not attend these sessions. Patients in both the intervention and control groups received treatment as usual. The families' EE levels were evaluated through Five-Minute Speech Samples. The primary outcome was relapse. RESULTS Time to relapse was statistically significantly longer in the psychoeducation group than in the control group (Kaplan-Meier survival analysis, P = 0.002). The relapse rates up to the 9-month follow-up were 8% and 50% respectively (risk ratio 0.17, 95% CI 0.04-0.66; number needed to treat 2.4, 95% CI 1.6-4.9). In Cox proportional hazard analysis, baseline EE did not moderate the effectiveness of the intervention. CONCLUSIONS Family psychoeducation is effective in the prevention of relapse in adult patients with major depression.
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Affiliation(s)
- Kae Shimazu
- Department of Neuropsychiatry, Kochi Medical School, Koch, Japan
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Pharoah F, Mari JJ, Rathbone J, Wong W. Family intervention for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [PMID: 21154340 DOI: 10.1002/14651858.cd000088.pub3] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Fiona Pharoah
- Oxford and Buckinghamshire Mental Health NHS Foundation Trust; South West Community Mental Health Team; Apex 550 (Unit 5), The Valley Centre Gordon Road High Wycombe Buckinghamshire UK HP13 6EQ
| | - Jair J Mari
- Universidade Federal de São Paulo; Department of Psychiatry; Rua Borges Lagoa, 570 São Paulo São Paulo Brazil 04023-900
| | - John Rathbone
- The University of Sheffield; HEDS, ScHARR; Regent Court 30 Regent Street Sheffield UK S1 4DA
| | - Winson Wong
- Yorkshire and Humber Postgraduate Deanery; Ground Floor, Don Valley House Savile Street East Sheffield UK S4 7UQ
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Abstract
BACKGROUND People with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of emotions. Forms of psychosocial intervention, designed to reduce these levels of expressed emotions within families, are now widely used. OBJECTIVES To estimate the effects of family psychosocial interventions in community settings for people with schizophrenia or schizophrenia-like conditions compared with standard care. SEARCH STRATEGY We updated previous searches by searching the Cochrane Schizophrenia Group Trials Register (September 2008). SELECTION CRITERIA We selected randomised or quasi-randomised studies focusing primarily on families of people with schizophrenia or schizoaffective disorder that compared community-orientated family-based psychosocial intervention with standard care. DATA COLLECTION AND ANALYSIS We independently extracted data and calculated fixed-effect relative risk (RR), the 95% confidence intervals (CI) for binary data, and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). MAIN RESULTS This 2009-10 update adds 21 additional studies, with a total of 53 randomised controlled trials included. Family intervention may decrease the frequency of relapse (n = 2981, 32 RCTs, RR 0.55 CI 0.5 to 0.6, NNT 7 CI 6 to 8), although some small but negative studies might not have been identified by the search. Family intervention may also reduce hospital admission (n = 481, 8 RCTs, RR 0.78 CI 0.6 to 1.0, NNT 8 CI 6 to 13) and encourage compliance with medication (n = 695, 10 RCTs, RR 0.60 CI 0.5 to 0.7, NNT 6 CI 5 to 9) but it does not obviously affect the tendency of individuals/families to leave care (n = 733, 10 RCTs, RR 0.74 CI 0.5 to 1.0). Family intervention also seems to improve general social impairment and the levels of expressed emotion within the family. We did not find data to suggest that family intervention either prevents or promotes suicide. AUTHORS' CONCLUSIONS Family intervention may reduce the number of relapse events and hospitalisations and would therefore be of interest to people with schizophrenia, clinicians and policy makers. However, the treatment effects of these trials may be overestimated due to the poor methodological quality. Further data from trials that describe the methods of randomisation, test the blindness of the study evaluators, and implement the CONSORT guidelines would enable greater confidence in these findings.
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Affiliation(s)
- Fiona Pharoah
- South West Community Mental Health Team, Oxford and Buckinghamshire Mental Health NHS Foundation Trust, High Wycombe, UK
| | - Jair Mari
- Departamento de Psiquiatria, UNIFESP, CEP 04023-900 Sao Paulo, Brazil
| | - John Rathbone
- HEDS, ScHARR, The University of Sheffield, Sheffield, UK
| | - Winson Wong
- Huddersfield Royal Infirmary, Huddersfield, UK
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Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [PMID: 21154340 DOI: 10.1002/14651858.cd000088.pub3.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND People with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of emotions. Forms of psychosocial intervention, designed to reduce these levels of expressed emotions within families, are now widely used. OBJECTIVES To estimate the effects of family psychosocial interventions in community settings for people with schizophrenia or schizophrenia-like conditions compared with standard care. SEARCH STRATEGY We updated previous searches by searching the Cochrane Schizophrenia Group Trials Register (September 2008). SELECTION CRITERIA We selected randomised or quasi-randomised studies focusing primarily on families of people with schizophrenia or schizoaffective disorder that compared community-orientated family-based psychosocial intervention with standard care. DATA COLLECTION AND ANALYSIS We independently extracted data and calculated fixed-effect relative risk (RR), the 95% confidence intervals (CI) for binary data, and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). MAIN RESULTS This 2009-10 update adds 21 additional studies, with a total of 53 randomised controlled trials included. Family intervention may decrease the frequency of relapse (n = 2981, 32 RCTs, RR 0.55 CI 0.5 to 0.6, NNT 7 CI 6 to 8), although some small but negative studies might not have been identified by the search. Family intervention may also reduce hospital admission (n = 481, 8 RCTs, RR 0.78 CI 0.6 to 1.0, NNT 8 CI 6 to 13) and encourage compliance with medication (n = 695, 10 RCTs, RR 0.60 CI 0.5 to 0.7, NNT 6 CI 5 to 9) but it does not obviously affect the tendency of individuals/families to leave care (n = 733, 10 RCTs, RR 0.74 CI 0.5 to 1.0). Family intervention also seems to improve general social impairment and the levels of expressed emotion within the family. We did not find data to suggest that family intervention either prevents or promotes suicide. AUTHORS' CONCLUSIONS Family intervention may reduce the number of relapse events and hospitalisations and would therefore be of interest to people with schizophrenia, clinicians and policy makers. However, the treatment effects of these trials may be overestimated due to the poor methodological quality. Further data from trials that describe the methods of randomisation, test the blindness of the study evaluators, and implement the CONSORT guidelines would enable greater confidence in these findings.
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Affiliation(s)
- Fiona Pharoah
- South West Community Mental Health Team, Oxford and Buckinghamshire Mental Health NHS Foundation Trust, Apex 550 (Unit 5), The Valley Centre, Gordon Road, High Wycombe, Buckinghamshire, UK, HP13 6EQ
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Billiet C, Antoine P, Lesage R, Sangare ML. Insight et interventions psychoéducationnelles dans la schizophrénie. ANNALES MEDICO-PSYCHOLOGIQUES 2009. [DOI: 10.1016/j.amp.2008.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rodrigues MGA, Krauss-Silva L, Martins ACM. [Meta-analysis of clinical trials on family intervention in schizophrenia]. CAD SAUDE PUBLICA 2009; 24:2203-18. [PMID: 18949223 DOI: 10.1590/s0102-311x2008001000002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 06/16/2008] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to assess the efficacy of cognitive-behavioral family interventions by relatives of schizophrenic patients under community care, specifically targeting relapse and family burden as outcomes. Independent researchers conducted the analyses of the pertinence and quality of trials identified through a search strategy, following a previously developed protocol. Eleven randomized or quasi-randomized trials were selected. The summary relative risk of relapse using the fixed effects model was favorable to family intervention, with estimated efficacy reaching nearly 60% (50%-70%). Summary relative risk in the cognitive-behavioral therapy trials subgroup [RR = 0.43 (0.28-0.67)] was equivalent to that of the behavioral therapy subgroup [RR = 0.37 (0.23-0.60)] and the "pragmatic" subgroup [RR = 0.37 (0.21-0.66)], although the "pragmatic" trials were generally analyzed for effective treatment. The difference in summary overall risk of relapse was nearly 30% using the random effects model. Only four trials analyzed family burden as outcome, including different dimensions of burden. Results of individual trials were generally favorable to family intervention, for both the objective and subjective dimensions.
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Caqueo-Urízar A, Gutiérrez-Maldonado J. Satisfaction with mental health services in a Latin American community of carers of patients with schizophrenia. Community Ment Health J 2009; 45:285-9. [PMID: 19582573 DOI: 10.1007/s10597-009-9220-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 06/24/2009] [Indexed: 11/25/2022]
Abstract
The aim of this study is to compare levels of satisfaction with Mental Health Services in a sample of 41 relatives of patients with schizophrenia, users of the Mental Health Public Service in the city of Arica, Chile. Of this sample, 18 participated in a group family intervention and 23 did not. Overall, the total sample of relatives expressed satisfaction with the Mental Health Service. However, in the compound satisfaction measure (patient's evolution and satisfaction with the mental health service), there were significant differences between caregivers who participated in the psycho-educative multifamily intervention and those who did not. The control group was more satisfied with the care provided by mental health services. The experimental group reported greater satisfaction in the area of patient's evolution. This result is of special interest since it indicates that psycho-educational programs increase relatives' satisfaction with the patient's evolution and also has positive consequences for the relationship between patients and their relatives.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Depto. de Filosofía y Psicología, Universidad de Tarapacá, 18 de Septiembre # 2222, Arica, Chile.
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Sota S, Shimodera S, Kii M, Okamura K, Suto K, Suwaki M, Fujita H, Fujito R, Inoue S. Effect of a family psychoeducational program on relatives of schizophrenia patients. Psychiatry Clin Neurosci 2008; 62:379-85. [PMID: 18778434 DOI: 10.1111/j.1440-1819.2008.01815.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS Family psychoeducational programs have been shown to be effective in terms of knowledge acquirement and relapse prevention, but few studies have looked at whether one mode of educational method is more effective than another. The aim of the present study was to compare several modes of educational approaches and to elucidate which mode of education is more effective. METHODS A total of 110 relatives of 95 patients with schizophrenia received three types of family psychoeducational programs between January 1995 and September 2003: a small group with two sessions (P1), a large group with nine sessions (P2), and a large group with five sessions (P3). In addition to the demographic data, acquired knowledge was measured using the modified Knowledge About Schizophrenia Interview (KASI), family expressed emotion (EE), and relapse episodes. RESULTS Overall there were significant increases in many KASI subcategory scores after the three programs, in mothers in particular. The change in KASI scores indicated that the low EE group was able to be highly educated and that the relatives of non-relapsers were more effectively educated. As for the mode of the family psychoeducational program, the P1 and P2 groups surpassed the P3 in terms of knowledge acquired. CONCLUSIONS Effects of family psychoeducation may depend not on the number of members or sessions but on the time spent on the program per member.
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Affiliation(s)
- Satoko Sota
- Department of Neuropsychiatry, Kochi Medical School, Kochi, Japan
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Chan H, Inoue S, Shimodera S, Fujita H, Fukuzawa K, Kii M, Kamimura N, Kato K, Mino Y. Residential program for long-term hospitalized persons with mental illness in Japan: Randomized controlled trial. Psychiatry Clin Neurosci 2007; 61:515-21. [PMID: 17875030 DOI: 10.1111/j.1440-1819.2007.01701.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Research on the merits of long-term group residences is inconclusive. The purpose of the present paper was to investigate the effects of supported group residence on the symptoms, social function, quality of life, general health quality, and the medical/psychiatric cost in Japan of a large number of psychiatric beds and long average length of stay. Patients were assessed every 6 months for 2 years using Positive and Negative Syndrome Scale, Katz Adjustment Scale, World Health Organization Quality of Life (WHO-QOL) and General Health Questionnaire 12-item version. Patients discharged to the supported group residence (SGR) significantly improved with regard to positive symptoms, the level of socially expected activities and free-time activities. The QOL physical domain of the inpatients was significantly more deteriorated compared to the SGR group. The total psychiatric/medical cost of the SGR group was approximately one-third that of the inpatient group, while the cost of the SGR to treat physical comorbidity was much higher. The present findings indicate that SGR has advantages for mental and social function but not for physical health. A major limitation of the present study was the high mean age (>60 years) of the subjects who had been hospitalized for a long period (mean, 24 years).
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Affiliation(s)
- Hong Chan
- Medical Graduate School, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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Gutiérrez-Maldonado J, Caqueo-Urízar A. Effectiveness of a psycho-educational intervention for reducing burden in Latin American families of patients with schizophrenia. Qual Life Res 2007; 16:739-47. [PMID: 17286192 DOI: 10.1007/s11136-007-9173-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 12/30/2006] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To explore the effectiveness of a psycho-educational family intervention program for reducing burden in caregivers of patients with schizophrenia in a developing country. METHOD Forty-five caregivers participated, 22 in a psycho-educational family intervention group and 23 in a control group. The family program was held once a week for 5 months. In the control group the caregivers received standard intervention, comprising periodical meetings with the staff to monitor the effects of the medication. Burden was measured before and after the intervention: relatives in the psycho-educational group were evaluated at inclusion and at the end of the program; controls were evaluated at inclusion and 5 months later. RESULTS Burden decreased significantly in the psycho-educational group; mean scores on the Zarit Caregiver Burden Scale fell from 85.06 pre-intervention to 52.44 post-intervention, while scores fell only slightly in the control group, from 87.65 to 87.22. Treatment was especially effective in mothers and caregivers with lower educational levels. CONCLUSION This intervention program for reducing caregiver burden in developing Latin American countries was effective. Future investigations should focus on obtaining more precise estimates of the contributions of specific components of these programs to reducing burden.
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Affiliation(s)
- José Gutiérrez-Maldonado
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Barcelona, Paseo Valle de Hebrón, 171, 08035, Barcelona, Spain.
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Mino Y, Shimodera S, Inoue S, Fujita H, Fukuzawa K. Medical cost analysis of family psychoeducation for schizophrenia. Psychiatry Clin Neurosci 2007; 61:20-4. [PMID: 17239034 DOI: 10.1111/j.1440-1819.2007.01605.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Family psychoeducation has been shown to prevent the relapse of schizophrenia. However, whether medical costs are reduced by this approach remains uncertain. The subjects were patients with schizophrenia who lived with high-expressed emotion (EE) families and were at high risk of relapse. A total of 30 patients whose families underwent psychoeducation and intensive family sessions or psychoeducation and subsequent support were regarded as the psychoeducation group. A high-EE group without family psychoeducation made up of 24 patients was used as a control group. The mean outpatient medical cost, duration of hospitalization, inpatient medical cost, and total medical cost during the follow-up period were compared between the psychoeducation group and the control group. The mean inpatient medical cost was 270,000 yen in the psychoeducation group and 470,000 yen in the control group. The mean total medical costs were 500,000 yen in the psychoeducation group and 710,000 yen in the control group. The cost in the psychoeducation group was significantly lower than the control group by Mann-Whitney U-test. The proportion of patients with a total medical cost greater than the median value was 23% in the psychoeducation group and 54% in the control group with a significant difference. The medical cost can be reduced in the psychoeducation group compared with the control group due to the prevention of re-hospitalization by family psychoeducation.
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Affiliation(s)
- Yoshio Mino
- Osaka Prefecture University, School of Human Science, Mental Health Section, Sakai, Osaka, Japan.
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Rodrigues MGA, Silva LK. Intervenção familiar na esquizofrenia: recorte de modelos de ensaios clínicos. ACTA ACUST UNITED AC 2006. [DOI: 10.1590/s0104-80232006000200008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O entendimento do formato da Intervenção Familiar citada pelos ensaios clínicos controlados na condição esquizofrenia foi o foco de nossa investigação aqui relatada. Procedemos a uma busca sistemática na base de dados MedLine e elaboramos a compreensão da fundamentação teórica das práticas descritas para avaliar a heterogeneidade clínica das intervenções que são objeto de estudo dos ensaios que resgatamos. Descrevemos um modelo denominado "pragmático", que apresenta fragmentos de técnicas, sem princípios de base ou técnicas derivadas de teorias; outro modelo cuja ênfase do trabalho é na mudança comportamental; e por fim um modelo cognitivo comportamental, que privilegia a abordagem cognitiva. Fazemos considerações sobre os conceitos de Emoção Expressa (EE) e Sobrecarga Familiar, subjacentes aos modelos comportamental e cognitivo comportamental na Intervenção Familiar para Portadores de Esquizofrenia. Consideramos que esse modelo, que privilegia um maior entendimento do familiar acerca da esquizofrenia, com a devida adequação devido às especificidades culturais nacionais, deve ser investigado para a utilização nos CAPS do Brasil.
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Pfammatter M, Junghan UM, Brenner HD. Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophr Bull 2006; 32 Suppl 1:S64-80. [PMID: 16905634 PMCID: PMC2632545 DOI: 10.1093/schbul/sbl030] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Over the past years, evidence for the efficacy of psychological therapies in schizophrenia has been summarized in a series of meta-analyses. The present contribution aims to provide a descriptive survey of the evidence for the efficacy of psychological therapies as derived from these meta-analyses and to supplement them by selected findings from an own recent meta-analysis. Relevant meta-analyses and randomized controlled trials were identified by searching several electronic databases and by hand searching of reference lists. In order to compare the findings of the existing meta-analyses, the reported effect sizes were extracted and transformed into a uniform effect size measure where possible. For the own meta-analysis, weighted mean effect size differences between comparison groups regarding various types of outcomes were estimated. Their significance was tested by confidence intervals, and heterogeneity tests were applied to examine the consistency of the effects. From the available meta-analyses, social skills training, cognitive remediation, psychoeducational coping-oriented interventions with families and relatives, as well as cognitive behavioral therapy of persistent positive symptoms emerge as effective adjuncts to pharmacotherapy. Social skills training consistently effectuates the acquisition of social skills, cognitive remediation leads to short-term improvements in cognitive functioning, family interventions decrease relapse and hospitalization rates, and cognitive behavioral therapy results in a reduction of positive symptoms. These benefits seem to be accompanied by slight improvements in social functioning. However, open questions remain as to the specific therapeutic ingredients, to the synergistic effects, to the indication, as well as to the generalizability of the findings to routine care.
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Affiliation(s)
- Mario Pfammatter
- Department of Psychotherapy, University Hospital of Psychiatry, Laupenstrasse 49, CH-3010 Bern, Switzerland.
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McDonell MG, Dyck DG. Multiple-family group treatment as an effective intervention for children with psychological disorders. Clin Psychol Rev 2004; 24:685-706. [PMID: 15385094 DOI: 10.1016/j.cpr.2004.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Accepted: 02/10/2004] [Indexed: 11/23/2022]
Abstract
An estimated 20% of children suffer from psychological disorders and only 10-20% receive adequate treatment. A lack of empirically supported treatments is one reason why relatively few children receive treatment for their psychological difficulties. Multiple-family group treatment (MFGT) is an empirically supported intervention for adults with chronic mental illnesses that may be an effective treatment for children with psychological disorders. This article reviewed the adult MFGT model and its empirical support. The quantity and quality of child MFGT research was then reviewed. Child MFGT models are compared with one another and to the adult MFGT model. All studies provided initial support of MFGT as an appropriate treatment for childhood disorders. However, the child literature as whole was relatively limited, unfocused, and lacked replication. Suggestions for future research are made, focusing on a structured and scientific approach to establishing MFGT as an empirically supported intervention for children.
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Affiliation(s)
- Michael G McDonell
- The Washington Institute for Mental Illness, Research and Training, Spokane, WA, USA
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Abstract
BACKGROUND It has been found that people with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of their emotions. Psychosocial interventions designed to reduce these levels of expressed emotions within families now exist. These interventions are proposed as adjuncts rather than alternatives to drug treatments and their main purpose is to decrease the stress within the family and also the rate of relapse. OBJECTIVES To estimate the effects of family psychosocial interventions in community settings for the care of those with schizophrenia or schizophrenia-like conditions compared to standard care. SEARCH STRATEGY We updated previous searches of the Cochrane Schizophrenia Group Register (June 1998), MEDLINE (1966-1995), the Cochrane Library (Issue 2 1998), EMBASE (1981-1995) and MEDLINE (1966-1995) by searching Cochrane Schizophrenia Group Register (November 2002). References of all identified studies were searched for further trial citations and authors of trials were contacted. SELECTION CRITERIA Randomised or quasi-randomised studies were selected if they focused primarily on families of people with schizophrenia or schizoaffective disorder and compared community-orientated family-based psychosocial intervention of more than five sessions with standard care. DATA COLLECTION AND ANALYSIS Data were reliably extracted, and, where appropriate and possible, summated. Relative risk (RR) with 95% confidence intervals (CI) and number needed to treat (NNT) were estimated. The reviewers assume that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. MAIN RESULTS Family intervention may decrease the frequency of relapse (n=721, 14 RCTs, RR 0.72 CI 0.6 to 0.9, NNT 7 CI 5 to 16). These data are statistically heterogeneous, the trend over time of this finding is towards the null and some small but negative studies may not have been identified by the search. Family intervention may also encourage compliance with medication (n=369, 7 RCTs, RR 0.74 CI 0.6 to 0.9, NNT 7 CI 4 to 19) but does not obviously affect the tendency of individuals/families to drop out of care (n=327, 4 RCTs, RR attrition at 3 months 0.86 CI 0.3 to 2.1). It may improve general social impairment and the levels of expressed emotion within the family. This review provides no data to suggest that family intervention either prevents or promotes suicide. REVIEWER'S CONCLUSIONS Clinicians, researchers, policy makers and recipients of care cannot be confident of the effects of family intervention from the findings of this review. Further data from already completed trials could greatly inform practice and more trials are justified as long as their participants, interventions and outcomes are applicable to routine care.
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Affiliation(s)
- F M Pharoah
- Willow House, Littlemore Mental Health Centre, Sandford Rd, Oxford, UK, OX4 4XN.
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Shimodera S, Mino Y, Fujita H, Izumoto Y, Kamimura N, Inoue S. Validity of a five-minute speech sample for the measurement of expressed emotion in the families of Japanese patients with mood disorders. Psychiatry Res 2002; 112:231-7. [PMID: 12450632 DOI: 10.1016/s0165-1781(02)00242-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Both the Camberwell Family Interview (CFI) and the Five-Minute Speech Sample (FMSS) have been used to define expressed emotion (EE), but the validity of the FMSS relative to the CFI in mood disorders has not been evaluated. In our study, the FMSS and the CFI were performed on the same day in close family members of inpatients with mood disorders within 2 weeks after their admission. The ratings obtained from the CFI were then used to estimate the validity of the FMSS, which was defined by sensitivity and specificity on the basis of the overall evaluation of EE. Validity was also assessed by including borderline ratings of 'low EE' in the category of 'high EE.' Based on the overall evaluation, sensitivity and specificity were 66.7 and 96.8%, respectively. When borderline low EE was included in high EE, the sensitivity and specificity were 100 and 90.3%, respectively. The validity of definitions of EE by the FMSS relative to the CFI was high in mood disorders. Evaluation of EE by the FMSS, which is clinically applicable to patients with mood disorders, is feasible. The validity of this approach is enhanced when families defined as 'borderline low EE' are included in the high-EE category.
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Affiliation(s)
- Shinji Shimodera
- Department of Neuropsychiatry, Kochi Medical School, Kohasu, Okoh-cho, Nankoku-shi, Kochi, Japan.
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Fujita H, Shimodera S, Izumoto Y, Tanaka S, Kii M, Mino Y, Inoue S. Family attitude scale: measurement of criticism in the relatives of patients with schizophrenia in Japan. Psychiatry Res 2002; 110:273-80. [PMID: 12127477 DOI: 10.1016/s0165-1781(02)00108-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Expressed emotion (EE) is traditionally measured with the Camberwell Family Interview (CFI), but the CFI requires considerable time for both execution and evaluation. As an alternative, we investigated the validity of the Family Attitude Scale (FAS), a questionnaire developed for the measurement of EE. The CFI, the FAS, the General Health Questionnaire (GHQ), and the Five-Minute Speech Sample (FMSS) were administered in 57 members of the families of 41 patients with acute episodes of schizophrenia. The relative sensitivity and specificity of EE assessment with the FAS compared with the criticism component of the CFI were 100% and 88.5%, respectively. EE assessment based on criticism as assessed with the FMSS compared with the CFI had a sensitivity of 40.0% and a specificity of 90.4%. The GHQ score tended to be higher in the high-scoring FAS group than in the low-scoring FAS group. The FAS showed excellent validity for the measurement of critical aspects of family attitudes, and the FAS score reflected the state of psychological health of the families.
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Affiliation(s)
- Hirokazu Fujita
- Department of Neuropsychiatry, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
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