Family intervention treatment

Question 1

How does Family Intervention treat schizophrenia?

Answer 1

• Research on Expressed Emotion shows certain aspects of family life can affect the course of the condition
• This has led to the development of various family intervention programmes
• Family Therapy aims to improve the quality and interaction between family members, in turn reducing the stress that may contribute to the risk of the patient’s relapse.
• Central to these programmes is the emphasis on inclusion and sharing information.

Question 2

What are the aims of sessions at the beginning?

Answer 2

• To develop a cooperative and trusting relationship with family group, contributions of all members are valued
• Therapist provides info about the cause, course and symptoms
• Mbers of family, including patient, will bring up their own experiences of the disorder.
• Goal is to provide all with practical coping skills that enable them to manage everyday difficulties
• Learn more constructive ways of interaction and communication
• It is accepted that they may feel angry or impatient so ways of expressing these feelings are discussed without resorting to high EE patterns.
• All are trained to recognise the early signs of relapse so they can respond rapidly and reduce its severity.

Question 3

What does Pharaoh et al suggest about family intervention?

Answer 3

• These strategies work by reducing levels of stress and expressed emotion, whilst increasing chances of complying with medicine.
• This combination tends to result in a reduced likelihood of relapse

Question 4

What is the nature of family therapy?

Answer 4

• Typically offered between 3-12 months
• At least 10 sessions
• Aimed to reduce level of expressed emotion, to reduce chance of relapse

Question 5

What are 2 strengths of family intervention?

Answer 5

Patients are responsible for their recovery:
- As a group taught coping mechanisms and techniques in order to prevent relapse
- This increases their motivation to improve as it gives them a sense of self-efficiency (feel good when see an improvement)
This is denied in biological treatments where the patient is totally reliant

Cost effective for the NHS long term:
- NICE review of family therapy studies demonstrated it is associated with cost savings when offered in addition to standard care
- Initial extra cost, but eventual reduction in costs of hospitalisation due to lower relapse rates
- Schizophrenia Commission estimates it cheaper than standard care by £1004 per patient per 3yrs
- Evidence of lower relapse rates for a significant period
This means cost savings associated with family therapy would be even higher, suggesting it is cost-effective

Question 6

What are 2 limitations of family intervention?

Answer 6

Time and cost for patient and family:
- Required to attend sessions with therapists to teach them bespoke techniques which will work within their individual dynamics
- Extremely costly and would take months or even years to prove effective
This means a lot of patients would prefer the quicker, cheaper anti-anxiety drugs available on NHS and don’t incur huge commitment and cost.

Family over individual:
- Question is whether family intervention makes schizophrenia less intrusive or is simply educating family to live with them
- If latter, then not really a way of treating effects of schizophrenia; just makes it easier to live with
This is not a bad thing but just makes it not treatment

Question 7

What is a conclusion to family intervention?

Answer 7

A combined course of treatment may be most effective:
- antipsychotics are fast acting, cheap and effective in tackling positive symptoms
- psychologicals e.g. CBT proven more effective with negative symptoms, tackling the cause, and teaching individual skills for a long term solution
With this in mind, best approach would be a combination of drugs and psychological treatments