No abstract

No abstract

No abstract

A sample of 85 patients with schizophrenia, of whom 34 later dropped out, received randomised treatment. There were no significant differences between treatment-takers and drop-outs in the variables assessed. Patients received either standard-dose maintenance neuroleptic treatment or targeted maintenance pharmacotherapy and all patients received behavioural family therapy. Measures of psychopathology, social adjustment, side-effects, family burden, and expressed emotion were assessed at baseline and then periodically over an 18-month period. The study was designed to compare the two alternative pharmacological maintenance approaches, each of them supported by psychosocial intervention. Any evaluation of the impact of behavioural family treatment on relapse rates and other outcome criteria is exclusively descriptive. A significantly higher rate of relapse was observed at 18 months in patients randomised to targeted treatment compared to those randomised to standard-dose treatment (35% vs 4%). Although patients assigned to the targeted maintenance group received significantly lower mean doses of neuroleptics, there were no significant differences between the two groups with regard to side-effects, global measures of social function, and overall psychopathology. Family burden was higher in the targeted-treatment group at six months, but did not differ at the one-year and eighteen-month time points. However, both groups improved significantly from baseline to 12 or 18 months in almost all variables assessed. Thus, the behavioural family approach did not compensate for the problems associated with the targeted medication strategy.

As part of an open clinical trial currently underway at the Max Planck Institute of Psychiatry in Munich, the feasibility of behavioral family management (Falloon et al. 1984) for schizophrenia in combination with two different neuroleptic medication strategies was investigated. The treatment approaches were psychoeducational family management with a standard dose or with targeted medication. In this article the following questions were addressed: (1) What proportion of the total schizophrenia population admitted as inpatients might be eligible for psychoeducational family treatment (assessment based on n = 411 over a 33-month period)? (2) How representative of this population are the patients who were randomized to the experimental groups? (3) How many patients dropped out of treatment after entering the trial? The results show that about 60 percent (247) of the patients were eligible for a psychoeducational treatment approach. Of these, 34 percent (85) participated in the trial and were randomized to the treatments. Only 4 percent of the relatives but 20 percent of the patients refused to take part in the study. The 85 trial patients did not differ from the total eligible on the numerous socioeconomic and symptom variables assessed. The treatment dropout rate was 11 percent. Those patients who accepted treatment did not differ from those patients who dropped out on socioeconomic or illness variables. The results indicate that early identification of dropouts is not possible at least with the methods used in this study.

Process research in behavioral family therapy (BFT) is a hitherto neglected area with the notable exception of the work of Alexander and Patterson with their colleagues. However, the development of instruments to assess therapist's behavior during the treatment session seems timely for the following reasons: (a) to investigate the relationship between therapist behavior and outcome, (b) to improve therapist training/supervision, (c) to establish treatment integrity in comparative outcome studies, and (d) to monitor treatment progress. For these purposes two sets of instruments were developed: (a) a category system to describe the content of a session, which is rated every 30 seconds and (b) several rating scales to evaluate therapist behavior, including relationship competency, ability to structure a session, didactic competence, ability to initiate behavioral probes, use of appropriate intervention strategies, use of reinforcement, and dealing with uncooperativeness. Scales are described, and data on their reliability and utility are presented.

No abstract

Um Rückfälle im Verlauf schizophrener Psychosen zu verhindern, wird die Langzeitbehandlung mit Neuroleptika empfohlen. Wegen der unangenehmen Nebenwirkungen der Medikamente und der trotz neuroleptischer Behandlung noch hohen Rückfallraten muβ diese Behandlungsform jedoch mit psychosozialen Maβnahmen zur Rück-fallprävention kombiniert werden. Als ein wesentlichcr Rückfallprädiktor gilt das Familienklima («Expressed Emotion»; EE). In Familien mit einer kritischen oder emotional zu stark involvierten Haltung der Angehörigen (HEE) erleiden schizophrene Patienten eher einen Rückfall als bei vorwiegend gelassener Einstellung der Angehörigen (NEE). Ungünstige Interaktionsformen zwischen Patienten und Angehörigen, wie häufige Kritik aneinander. ein Mangel an konstrukliven Problemlöseversuchen sowie nonverbal negative Kommunikation, sind in HEE-Familien starker ausgeprägt als in NEE-Familien. Der Abbau negativer Kommunikationsformen und die Verbesserung des Problemlöseverhaltens innerhalb der Familie sind Möglichkeiten, ein emotional angespanntes Familienklima («High Expressed Emotion») zu entlasten, Streβ innerhalb der Familie zu reduzieren und die Rück-fallgefährdung der Patienten zu verringern. In der vorliegenden Studie wurde an 34 Familien überprüft, ob sich nach einem halbjährigen Kommunikations- und Problemlösetraining im Rahmen der «psychoedukativen Familienbetreuung» nach Falloon et al. (1984) die Interaktionsmuster von Familien mit einem schizophrenen Mitglied verbessern. Vor und nach der Therapie auf Video aufgenommene Konfliktdiskussionen der Familien wurden mit Hilfe eines Beobachtungs-systems kodiert und frequenzanalytisch ausgcwertet. Die Resultate zeigten, daβ nach 6 Monaten verhaltenstherapeutisch orientierter Familienbetreuung die erwarteten Veränderungen im Kommunikations-und Problemlöseverhalten eintraten und eine Entlastung der Familien erreicht werden konnte.