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A Trial of Family Therapy v. a Relatives Group for Schizophrenia

Published online by Cambridge University Press:  02 January 2018

Julian Leff ,
Ruth Berkowitz ,
Naomi Shavit ,
Angus Strachan ,
Ilana Glass  and
Christine Vaughn
Julian Leff*
Affiliation:
MRC Social Psychiatry Unit
Ruth Berkowitz
Affiliation:
Institute of Psychiatry, London
Naomi Shavit
Affiliation:
Institute of Psychiatry, London
Angus Strachan
Affiliation:
Institute of Psychiatry, London
Ilana Glass
Affiliation:
Institute of Psychiatry, London
Christine Vaughn
Affiliation:
MRC Social Psychiatry Unit
*
∗Friern Hospital, London N11 3BP
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Abstract

Schizophrenic patients living in high contact with relatives having high expressed emotion (EE) were recruited for a trial of social interventions. The patients were maintained on neuroleptic medication, while their families were randomly assigned to education plus family therapy or education plus a relatives group. Eleven out of 12 families accepted family therapy in the home, whereas only six out of 11 families were compliant with the relatives group. Non-compliance was associated with a poorer outcome for the patients in terms of the relapse rate. The relapse rate over nine months in the family therapy stream was 8%, while that in compliant families in the relatives group stream was 17%. Patients' social functioning showed small, non-significant, gains. The data from the current trial were compared with data from a previous trial. The lowering of the relapse rate in schizophrenia appears to be mediated by reductions in relatives' EE and/or face-to-face contact, and is not explained by better compliance with medication. Reduction in EE and/or contact was associated with a minuscule relapse rate (5%). Very little change occurred in families who were non-compliant with the relatives group. On the basis of these findings, we recommend that the most cost-effective procedure is to establish relatives groups in conjunction with family education and one or more initial family therapy sessions in the home. It is particularly important to offer home visits to families who are unable to or refuse to attend the relatives groups.

Type
Papers
Information
The British Journal of Psychiatry , Volume 154 , Issue 1 , January 1989 , pp. 58 - 66
Copyright
Copyright © The Royal College of Psychiatrists 

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Footnotes

†

Now Adjunct Assistant, Professor of Psychology, University of California, Los Angeles

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