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An overview of family interventions and relapse on schizophrenia: meta-analysis of research findings

Published online by Cambridge University Press:  09 July 2009

Jair De Jesus Mari  and
David L. Streiner
Jair De Jesus Mari*
Affiliation:
Departamento de Psiquiatria e Psicologia Medica da Escola Paulista de Medicina, São Paulo, Brazil: Departments of Clinical Epidemiology and Biostatistics and Psychiatry, McMaster University, Toronto, Canada
David L. Streiner
Affiliation:
Departamento de Psiquiatria e Psicologia Medica da Escola Paulista de Medicina, São Paulo, Brazil: Departments of Clinical Epidemiology and Biostatistics and Psychiatry, McMaster University, Toronto, Canada
*
1Address for correspondence: Dr Jair de Jesus Mari, Departamento de Psiquiatria. Rua Botucatu, 740 3° andar, CEP 04023, São Paulo, Brazil
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Synopsis

The purpose of this overview is to appraise the studies on the efficacy and effectiveness of family interventions in decreasing relapse in schizophrenic patients. The studies were identified by means of a computerized MEDLINE search, and the scanning of review articles and the reference lists of the primary articles identified. More than 300 citations were reviewed, and the potentially relevant articles revealed six randomized controlled trials that were included in this meta-analysis. The criteria for selecting potential studies as well as for the meta-analysis were tested by means of an inter-rater reliability check that showed a good agreement between two independent raters (K = 0·83, and K = 0·82, respectively). There were independent assessments of the quality of the studies selected, and data extraction comprised a descriptive information of the study population, the types of interventions, and the relevant outcome measurements. The total number of patients included in the six trials was 350 (181 in the control group and 169 in the experimental group). Regarding the decrease of relapse in the experimental group, the pooled odds ratios and their 95% confidence intervals were: 0·30 (0·06, 0·71) for six months; 0·22 (0·09, 0·37) for nine months; and 0·17 (0·10, 0·35) for the 2-year follow-up. Two to five patients needed to be treated to avert one episode of relapse in a nine-month follow-up. The changes in Expressed Emotion status between experimental and control group combining nine months and one year follow-ups were shown to be marginally significant (P < 0·06), in favour of the experimental group. Emotional over-involvement was also marginally significant (P < 0·07), and there was no statistical difference in the distribution of criticism and hostility. In addition, the experimental group showed a significant increase with drug compliance and a reduction in hospitalization over time. These findings are discussed in light of the potential ingredients in the efficacy of family interventions by focusing on the limitations of using relapse as primary outcome in the assessment of efficacy trials with schizophrenic patients.

Type
Original Articles
Information
Psychological Medicine , Volume 24 , Issue 3 , August 1994 , pp. 565 - 578
Copyright
Copyright © Cambridge University Press 1994

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References

Barrowclough, C. & Tarrier, N. (1984). ‘Psychosocial’ interventions with families and their effects on the course of schizophrenia: a review. Psychological Medicine 14, 629–642.CrossRefGoogle ScholarPubMed
Brooker, C., Tarrier, N., Barrowclough, C., Butterworth, A. & Goldberg, D. (1992). Training community psychiatric nurses for psychosocial intervention. Report of a pilot study. British Journal of Psychiatry 160, 836–844.CrossRefGoogle ScholarPubMed
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, 241–258.CrossRefGoogle ScholarPubMed
Cardin, V., McGill, C. & Falloon, I. (1985). Economic Analysis: Costs, Benefit and Effectiveness in Family Management of Schizophrenia: a Study of Clinical, Social and Economic Benefits. Johns Hopkins Press: Baltimore.Google Scholar
Carpenter, W. T., Hanlon, T. E., Heinrichs, D. W., Summerfelt, A. T., Kirkpatrick, B., Levene, J. & Buchanan, R. W. (1990). Continuous versus targeted medication in schizophrenic outpatients: Outcome results. American Journal of Psychiatry 147, 1138–1148.Google ScholarPubMed
Collins, E. J., Hogan, T. P. & Desai, H. (1991). Measurement of therapeutic response in schizophrenia: a critical survey. Schizophrenia Research 5, 249–253.CrossRefGoogle ScholarPubMed
Collins, E. J., Hogan, T. P. & Nuttall, S. E. (1993). Methodological standards in schizophrenia research: a critical survey of clinical trials. International Journal of Methods in Psychiatric Research (in the press).Google Scholar
Corin, E. E. (1990). Facts and meaning in psychiatry: an anthropological approach to the lifeworld of schizophrenics. Culture, Medicine and Psychiatry 14, 153–188.CrossRefGoogle Scholar
Dulz, B. & Hand, I. (1986). Short-term relapse in young schizophrenics: Can it be predicted and affected by family (CFI), patient, and treatment variables? An experimental study. In Treatment of Schizophrenia (ed. Goldstein, M. J., Hand, I. and Hahlweg, K.), pp. 59–77. Springer-Verlag: New York.CrossRefGoogle Scholar
Falloon, I. R., Boyd, J. L., McGill, C. W., Razani, J., Moss, H. B. & Gilderman, A. M. (1982). Family management in the prevention of exacerbations of schizophrenia: a controlled study. New England Journal of Medicine 306, 1437–1440.Google Scholar
Falloon, I. R., Boyd, J. L., McGill, C. W., Williamson, M., Razani, J., Moss, H. B., Gilderman, A. M. & Simpson, G. M. (1985). Family management in the prevention of morbidity of schizophrenia: Clinical outcome of a two-year longitudinal study. Archives of General Psychiatry 42, 887–896.CrossRefGoogle ScholarPubMed
Fletcher, R. H., Fletcher, S. W. & Wagner, E. H. W. (1988). Clinical Epidemiology: The Essentials. Williams & Wilkins: London.Google Scholar
Goldstein, M. J., Rodnick, E. H., Evans, J. R., May, P. R. & Steinberg, M. R. (1978). Drug and family therapy in the aftercare of acute schizophrenics. Archives of General Psychiatry 35, 1169–1177.CrossRefGoogle ScholarPubMed
Hawk, A. B., Carpenter, W. T. & Strauss, J. S. (1975). Diagnostic criteria and two-year outcome in schizophrenia: a report from the International Pilot Study of Schizophrenia. Archives of General Psychiatry 32, 343–347.CrossRefGoogle Scholar
Heinrichs, D. W., Hanlon, E. T. & Carpenter, W. T. Jr. (1984). The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 10, 388–396.CrossRefGoogle ScholarPubMed
Hogarty, G. E., Anderson, C. M., Reiss, D. J., Kornblith, S. J., Greenwald, D. P., Javna, C. D. & Madonia, M. J. (1986). Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. One-year effects of a controlled study on relapse and expressed emotion. Archives of General Psychiatry 43, 633–642.CrossRefGoogle Scholar
Hogarty, G. E., Anderson, C. M. & Reiss, D. J. (1987). Family psychoeducation, social skills training, and medication in schizophrenia: the long and short of it. Psychopharmacology Bulletin 23, 12–13.Google Scholar
Kane, J., Honingfeld, G., Singer, J. & Meltzer, H. (1988). Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Archives of General Psychiatry 45, 789–796.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, 83–94.Google Scholar
Kreisman, D., Blumenthal, R., Borenstein, M., Woerner, M., Kane, J., Rifkin, A. & Reardon, G. (1988). Family attitudes and patient social adjustment in a longitudinal study of outpatient schizophrenics receiving low-dose neuroleptics: the family's view. Psychiatry 51, 3–13.CrossRefGoogle Scholar
Lam, D. H. (1991). Psychosocial family intervention in schizophrenia: a review of empirical studies. Psychological Medicine 21, 423–441.Google Scholar
Langsley, D., Machotka, P. & Flomenhaft, K. (1971). Avoiding mental hospital admission: a follow-up study. American Journal of Psychiatry 127, 1391–1394.CrossRefGoogle ScholarPubMed
Laupacis, A., Sackett, D. L. & Roberts, R. S. (1988). An assessment of clinically useful measures of the consequences of treatment. New England Journal of Medicine 318, 1728–1733.CrossRefGoogle ScholarPubMed
Leff, J., Kuipers, L., Berkowitz, R., Eberlein-Vries, R. & Sturgeon, D. (1982). A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry 141, 121–134.CrossRefGoogle ScholarPubMed
Leff, J., Kuipers, L., Berkowitz, R. & Sturgeon, D. (1985). A controlled trial of social intervention in the families of schizophrenic patients: two-year follow-up. British Journal of Psychiatry 146, 594–600.CrossRefGoogle ScholarPubMed
Leff, J., Berkowitz, R., Shavit, A., Strachan, A., Glass, I. & Vaughn, C. (1989). A trial of family therapy v. a relatives group for schizophrenia. British Journal of Psychiatry 154, 58–66.Google Scholar
Leff, J., Berkowitz, R., Shavit, N., Strachan, A., Glass, I. & Vaughn, C. (1990). A trial of family therapy versus a relatives' group for schizophrenia: two-year follow-up. British Journal of Psychiatry 157, 571–577.CrossRefGoogle Scholar
Levene, J. E., Newman, F. & Jefferies, J. J. (1989). Focal family therapy outcome study. I. Patient and family functioning. Canadian Journal of Psychiatry 34, 641–647.CrossRefGoogle ScholarPubMed
MacCarthy, B., Kuipers, L., Hurry, J., Harper, R. & Lesage, A. (1989). Counselling the relatives of the long-term adult mentally ill. I. Evaluation of the impact on relatives and patients. British Journal of Psychiatry 154, 768–775.Google Scholar
Marder, S. R., Van Putten, T., Mintz, J., Lebell, M., McKenzie, J. & Philip, R. A. M. (1987). Low and conventional dose maintenance therapy with fluphenazine decanoate: two year outcome. Archives of General Psychiatry 44, 518–521.CrossRefGoogle ScholarPubMed
Meltzer, H. Y., Bastani, B., Kwon, K. Y., Ramirez, L. F., Burnett, S. & Sharpe, J. (1989). A prospective study of clozapine in treatment-resistant schizophrenic patients. I. Preliminary report. Psychopharmacology 99, S68–S72.Google Scholar
Spencer, J. H., Glick, I. D., Haas, G. L., Clarkin, J. F., Lewis, A. B., Peyser, J., DeMane, N., Good-Ellis, M., Harris, E. & Lestelle, V. (1988). A randomized clinical trial on inpatient family intervention. III. Effects at 6-month and 18-month follow-ups. American Journal of Psychiatry 145, 1115–1121.Google Scholar
Strang, J. S., Falloon, I. R., Moss, H. B., Razani, J. & Boyd, J. L. (1981). Drug treatment and family intervention during the aftercare treatment of schizophrenics. Psychopharmacology Bulletin 17, 87–88.Google Scholar
Strauss, J. S. (1989). Subjective experiences of schizophrenia: Toward a new dynamic psychiatry II. Schizophrenia Bulletin 15, 179–187.CrossRefGoogle Scholar
Streiner, D. L. (1991). Using meta-analysis in psychiatric research. Canadian Journal of Psychiatry 36, 357–362.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, 532–542.CrossRefGoogle ScholarPubMed
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, 625–628.CrossRefGoogle ScholarPubMed
Tarrier, N., Lownson, K. & Barrowclough, C. (1991). Some aspects of family interventions in Schizophrenia. II. Financial considerations. British Journal of Psychiatry 159, 481–484.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976 a). The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry 129, 125–137.CrossRefGoogle ScholarPubMed
Vaughn, C. E. & Leff, J. P. (1976 b). The measurement of Expressed Emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology 15, 167–165.CrossRefGoogle ScholarPubMed
Vaughn, K., Doyle, M., McConaghy, N., Blaszcynski, A., Fox, A. & Tarrier, N. (1992). The Sydney intervention trial: a controlled trial of relatives' counselling to reduce schizophrenic relapse. Social Psychiatry and Psychiatric Epidemiology 26, 16–21.CrossRefGoogle Scholar
Wilkinson, G., Balestrieri, M., Ruggeri, M. & Bellantuono, C. (1991). Meta-analysis of double-blind placebo-controlled trials of antidepressants and benzodiazepines for patients with panic disorders. Psychological Medicine 21, 991–998.Google Scholar