Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T14:52:20.206Z Has data issue: false hasContentIssue false

Psychosocial Interventions for Schizophrenia

Published online by Cambridge University Press:  06 October 2014

Ian R. H. Falloon
Affiliation:
University of Auckland
Charles Brooker
Affiliation:
Trent Regional Health Authority
Victor Graham-Hole
Affiliation:
COMMEND Project, Buckingham, U.K.
Get access

Extract

During the past decade there has been a major advance in clinical management of schizophrenic disorders (Falloon & Shanahan, 1990; Lam, 1991; Schooler & Hogarty, 1987). This has resulted from application of strategies based upon a vulnerability-stress model of mental disorders. This considers mental disorders to result from interactions between specific biological vulnerability and non-specific environmental stresses (Falloon & Fadden, 1993).

Therapeutic interventions derived from this model combine biomedical strategies, predominantly optimal pharmacotherapy, with psychosocial strategies that aim to enhance the capacity of the index patient and his/her social network to cope with the impact of environmental stresses on the course of the disorder. Ten controlled studies have been published since 1980 that meet minimal standards of research design, with follow-up for at least 1 year (Bellack, Turner, Hersen, & Luber, 1985; Falloon, 1985; Gunderson et al., 1984; Hogarty et al., 1986; Leff, Kuipers, Berkowitz, Eberlein-Fries, & Sturgeon, 1982; Leff et al., 1989; Malm, 1982; McFarlane, 1990; Tarrier et al., 1988; Wallace & Liberman, 1985). Nine also provided 2-year results. Overall, these studies show that the addition of psychosocial strategies to optimal case management and long-term drug prophylaxis halves the rate of major clinical exacerbations in people suffering from schizophrenia. This benefit is most notable during the first year after a major schizophrenic episode, particularly when the psychosocial interventions encompass patients' immediate social support systems, usually the family or marital household (Falloon, 1985; Hogarty et al., 1986; Leff et al., 1982; Leff et al., 1989; McFarlane, 1990; Tarrier et al., 1988).

Type
Research Article
Copyright
Copyright © The Author(s) 1992

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

REFERENCES

Barrowclough, C., & Tarrier, N. (1990). Social functioning in schizophrenic patients: I. The effects of expressed emotion and family intervention. Social Psychiatry and Psychiatric Epidemiology, 25, 125129.Google Scholar
Bellack, A.S., Turner, S.M., Hersen, M., & Luber, R.F. (1985). An examination of the efficacy of social skills training for chronic schizophrenic patients. Hospital and Community Psychiatry, 35, 10231028.Google Scholar
Brooker, C., Falloon, I.R.H., Butterworth, A., Goldberg, D., Graham-Hole, V., & Hillier, V. (1992). Training community psychiatric nurses to undertake psychosocial intervention. Final Report to Department of Health, London, U.K.Google Scholar
Brooker, C., Tarrier, N., Barrowclough, C., Butterworth, C., & Goldberg, D. (in press). Training community psychiatric nurses to undertake psychosocial intervention: Report of a pilot study. British Journal of Psychiatry.Google Scholar
Brown, G.W., Birley, J.L.T., & Wing, J.K. (1972). Influence of family life on the course of schizophrenic disorders. A replication. British Journal of Psychiatry, 121, 241258.Google Scholar
Curran, J. (1988, 09). Social skills training and behavioural family therapy for schizophrenia: A field trial. Paper presented at the World Congress of Behaviour Therapy, Edinburgh, Scotland.Google Scholar
Doane, J.A., Goldstein, M.J., Miklowitz, D.J., & Falloon, I.R.H. (1986). The impact of individual and family treatment on the affective climate of families of schizophrenics. British Journal of Psychiatry, 148, 279287.Google Scholar
Doane, J.A., Goldstein, M.J., Falloon, I.R.H., & Mintz, J. (1985). Parental affective style and the treatment of schizophrenia: Predicting course of illness and social functioning. Archives of General Psychiatry, 42, 3442.Google Scholar
Falloon, I.R.H. (1985). Family management of schizophrenia. Baltimore: John Hopkins University Press.Google Scholar
Falloon, I.R.H. (1992). Early intervention for first episodes of schizophrenia: A preliminary exploration. Psychiatry, 55, 112.Google Scholar
Falloon, I.R.H., & Fadden, G. (1993). Integrated mental health care. Cambridge: Cambridge University Press.Google Scholar
Falloon, I.R.H., & Shanahan, W.J. (1990). Community management of schizophrenia. British Journal of Hospital Medicine, 43, 6266.Google Scholar
Fenton, F.R., Tessier, L., Struening, E.L., Smith, F.A., & Benoit, C. (1981). Home and hospital psychiatric treatment. London: Croon-Helm.Google Scholar
Gunderson, J.G., Frank, A.F., Katz, H.M., Vannicelli, M.L., Frosch, J.P., & Knapp, P.H. (1984). Effects of psychotherapy in schizophrenia: II. Comparative outcome of two forms of treatment. Schizophrenia Bulletin, 10, 564598.Google Scholar
Held, T. (1990, 09). Behavioural family therapy: A controlled field trial. Paper presented at seminar, Bonn, Germany.Google Scholar
Hogarty, G.E., Anderson, C.M., Reiss, D.J., Kornblith, S.J., Greenwald, D.P., Javna, C.D., & Madonia, M.J. (1986). Family psycho-education, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia. Archives of General Psychiatry, 43, 633642.CrossRefGoogle Scholar
Hogarty, G.E., Anderson, C.M., Reiss, D.J., Kornblith, S.J., Greenwald, D.P., Ulrich, R.F., Carter, M.et al. (1991). Family psycho-education, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia: II. Two-year effects of a controlled study on release and adjustment. Archives of General Psychiatry, 48, 340347.Google Scholar
Hogarty, G.E., Goldberg, S.C., Schooler, N.R., & Ulrich, R.F. (1974). Drug and sociotherapy in the aftercare of schizophrenic patients: II. Two-year relapse rates. Archives of General Psychiatry, 31, 603608.Google Scholar
Hogarty, G.E., Schooler, N.R., Ulrich, R.F., Mussare, F., Ferro, P., & Herron, E. (1979). Fluphenazine and social therapy in the aftercare of schizophrenic patients: Relapse analysis of a two-year controlled trial. Archives of General Psychiatry, 36, 12831294.Google Scholar
Hoult, J., Reynolds, I., Charbonneau-Powis, M., Weekes, P., & Briggs, J. (1983). Psychiatric hospital versus community treatment: Results of a randomised trial. Australian & New Zealand Journal of Psychiatry, 17, 160167.CrossRefGoogle ScholarPubMed
Kavanagh, D.J. (1992, 07). Cognitive-behavioural family intervention for schizophrenia. Paper presented at the World Congress of Behaviour Therapy, Gold Coast, Queensland, Australia.Google Scholar
Kottgen, C., Sonnichsen, I., Mollenhauer, K., & Jurth, R. (1984). Group therapy with the families of schizophrenic patients: Results of the Hamburg Camberwell-Family-Interview Study: III. International Journal of Family Psychiatry, 5, 8494.Google Scholar
Lam, D.H. (1991). Psychosocial family intervention in schizophrenia: A review of empirical studies. Psychological Medicine, 21, 423441.Google Scholar
Leff, J.P., Berkowitz, R., Shavit, N., Strachan, A.S., Glass, I, & Vaughn, C. (1989). A trial of family therapy versus a relatives' group for schizophrenia. British Journal of Psychiatry, 154, 5866.Google Scholar
Leff, J.P., Berkowitz, R., Shavit, N., Strachan, A.S., Glass, I, & Vaughn, C. (1990). A trial of family therapy versus a relatives' group for schizophrenia: Two-year follow-up. British Journal of Psychiatry, 153, 571577.Google Scholar
Leff, J.P., Kuipers, L., Berkowitz, R., Eberlein-Fries, R., & Sturgeon, D. (1982). A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry, 141, 121134.Google Scholar
Leff, J.P., Kuipers, L., Berkowitz, R., & Sturgeon, D. (1985). A controlled study of social intervention in the families of schizophrenic patients: Two-year follow-up. British Journal of Psychiatry, 146, 594600.Google Scholar
Malm, U. (1982). The influence of group therapy on schizophrenia. Acta Psychiatrica Scandinavica, 297, 165.Google Scholar
MacCarthy, B., Kuipers, L., Hurry, J., Harper, R., & LeSage, A. (1989). Counselling relatives of the long-term adult mentally ill: I. Evaluation of the impact on relatives and patients. British Journal of Psychiatry, 154, 768775.Google Scholar
McCreadie, R.G., Phillips, K., Harvey, J.A., Waldrun, G., Stewart, M., & Baird, D. (1991). The Nithsdale schizophrenia surveys VIII. Do relatives want family intervention — and does it help? British Journal of Psychiatry, 158, 110113.Google Scholar
McFarlane, W.R. (1990). In Herz, M.I., Keith, S.J., & Docherty, J.P. (Eds.), Handbook of schizophrenia: Vol. 4. Psychosocial treatment of schizophrenia (pp. 167189). Amsterdam: Elsevier.Google Scholar
Muijen, M, Marks, I., Connolly, J., & Audini, B. (1992). Home-based care and standard hospital care for patients with severe mental illness: A randomised controlled trial. British Medical Journal, 304, 749754.Google Scholar
Paul, G.L. (1967). Strategy of outcome research in psychotherapy. Journal of Consulting Clinical Psychology, 31, 109118.CrossRefGoogle ScholarPubMed
Schooler, N.R., & Hogarty, G.E. (1987). Medication and psychosocial strategies in the treatment of schizophrenia. In Meltzer, H.Y. (Ed.), Psychopharmacology: The third generation of progress (pp. 11111119). New York: Raven Press.Google Scholar
Stein, L.I., & Test, M.A. (1980). An alternative to mental hospital treatment. Archives of General Psychiatry, 37, 392399.Google Scholar
Tarrier, N., Barrowclough, C., Vaughn, C., Bamrah, J.S., Porceddu, K., Watts, S., & Freeman, H. (1988). The community management of schizophrenia: A controlled trial of a behavioural intervention with families to reduce relapse. British Journal of Psychiatry, 153, 532542.Google Scholar
Tarrier, N., Barrowclough, C., Vaughn, C., Bamrah, J.S., Porceddu, K., Watts, S., & Freeman, H. (1989). Community management of schizophrenia: A two-year follow-up of a behavioural intervention with families. British Journal of Psychiatry, 154, 625628.Google Scholar
Tarrier, N., Beckett, R., Harwood, S., Baker, A., Yusupoff, L., & Ugarteburu, I. (in press). A trial of two cognitive behavioural methods of treating drug resistant residual psychotic symptoms in schizophrenic patients: I. Outcome. British Journal of Psychiatry.Google Scholar
Tarrier, N., Lowson, K., & Barrowclough, C. (1991). Some aspects of family interventions in schizophrenia: II. Financial considerations. British Journal of Psychiatry, 159, 481484.Google Scholar
Test, M.A., Knoedler, W.H., & Allness, D.J. (1985). The long-term treatment of young schizophrenics in a community support program. In Stein, L.I. & Test, M.A. (Eds.), The training in community living model (pp. 1727). San Francisco: Jossey-Bass.Google Scholar
Vaughan, K., Doyle, M., & McConaghy, N. (in press). The Sydney intervention trial. A controlled trial of relatives' counselling to reduce schizophrenic relapse. Social Psychiatry and Psychiatric Epidemiology.Google Scholar
Wallace, C.J., & Liberman, R.P. (1985). Social skills training for patients with schizophrenia: A controlled clinical trial. Psychiatry Research, 15, 239247.Google Scholar
Whitfield, W., Taylor, C., & Virgo, N. (1988). Family care of schizophrenia. Journal of the Royal Society of Health, 1, 45.Google Scholar