Schizophrenia: Family therapy Flashcards
What is family therapy?
It is the name given to a range of interventions aimed at the family of someone with SZ. In their guidance on the treatment and management of SZ, NICE recommend that family therapy should be offered to all individuals diagnosed with SZ who are in contact with or live with family members. They also stress that such interventions should be considered a priority where there are persistent symptoms or a high risk of relapse.
What is the nature of family therapy?
Family therapy is typically offered for a period of between 3-12 months and at least ten sessions. They’re aimed at reducing the level of expressed emotion within the family, as expressed emotion has been demonstrated to increase the likelihood of relapse. Garety (2008) estimate the relapse rate for individuals who receive family therapy is 25% compared to 50% for those who receive standard care alone. It involves providing family members with information about SZ finding ways of supporting an individual with SZ and resolving any practical problems.
What was the key study to do with family therapy?
Pharoah et al (2010)
How does family therapy work?
Family therapy makes use of a number of strategies:
- Psychoeducation - helping the person and their carers to understand and are better able to deal with the illness.
- Forming an alliance with relatives who care for the person with schizophrenia.
- Reducing the emotional climate within the family and the burden of care for family members.
- Enhancing relative’s ability to anticipate and solve problems.
- Reducing expressions of anger and guilt by family members.
- Maintaining reasonable expectations among family members for patient performance.
- Encouraging relatives to set appropriate limits whilst maintaining some degree of separation when needed.
Family therapy forms part of an overall treatment package and is commonly used in conjunction with routine drug treatment and outpatient clinical care. During family therapy sessions, individual with schizophrenia is encouraged to talk to their family and explain what sort of support they find helpful – and what makes things worse for them.
What was Pharaoh’s procedure?
Pharoah et al (2010) reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family intervention. Studies chosen were conducted in Europe, Asia and North America. The studies compared outcomes from family therapy to ‘standard’ care alone. The researchers concentrated on studies that were randomised controlled trials.
What was Pharaoh’s findings?
- Mental state: The overall impression was mixed. Some studies reported an improvement in the overall mental state of patients compared to those receiving standard care, whereas others did not.
- Compliance with medication: The use of family intervention increased patients’ compliance with medication.
- Social functioning: Although appearing to show some improvement in general functioning, the family intervention did not appear to have much of an effect on more concrete outcomes such as living independently or employment.
- Reduction in relapse and readmission: There was a reduction in the risk of relapse and a reduction in hospital admission during treatment and in the 24 months after.
A03:
+ Why is family therapy effective?
+ Economic benefits of family therapy
- Methodological limitations
- Impact on family members
A03: Why is family therapy effective?
The Pharoah et al (2010) meta-analysis established that family therapy can be effective in improving clinical outcomes such as mental state and social functioning. However, the author suggests that the main reason for its effectiveness may have less to do with any improvement in these clinical markers and more to do with the fact that it increases medication compliance. Patients are more likely to reap the benefit of medication because they are more likely to comply with the medication regime.
A03: Economic benefits of family therapy
An additional advantage of family therapy is that it has considerable economic benefits associated with the treatment of schizophrenia. The NICE review of family therapy studies demonstrates that family therapy is associated with significant cost savings went offered to people with schizophrenia in addition to standard care. The extra cost of family therapy is offset by a reduction in the cost of hospitalisation because of the low relapse rates associated with this form of intervention. There is also evidence that family therapy reduces relapse rates for a significant period after completion of the intervention. This means that the cost savings associated with family therapy would be even higher.
A03: Methodological criticisms
The Pharoah et al. meta-analysis has a number of methodological issues in the studies reviewed.
Random allocation: Although all 53 studies claimed to have randomly allocated participants to treatment conditions, the researchers note that a large number of studies used in this review were from the People’s Republic of China. Evidence has emerged that, in many Chinese studies, the random allocation has been stated as having been used, yet was not.
Lack of blinding: There is a possibility of observer bias where raters were not blinded to the condition to which people were allocated. 10 studies reported that no form of blinding was used. A further 16 did not mention whether blinding had been used.
A03: Impact on family members
Family therapy has been shown to improve outcomes for individuals with schizophrenia, but there may be an additional advantage in that it can have a positive impact on family members as well. Lobban et al (2013) analyse the results of 50 family therapy studies that included in interventions to support relatives. 60% of the studies reported a significant positive impact of the intervention on at least one outcome category for relatives e.g. coping and problem-solving skills, family functioning and relationship quality. However, the research has also concluded that the methodological quality of the studies was generally poor, making it difficult to distinguish effective from ineffective interventions.
