Effectiveness of targeted intervention and maintenance pharmacotherapy in conjunction with family intervention in schizophrenia

Wiedemann, Georg; Hahlweg, Kurt; Müller, Ulrike; Feinstein, E.; Hank, G.; Dose, M.

doi:10.1007/s004060170056

Cited by 19 publications

(10 citation statements)

References 48 publications

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“…These trials suggest that FPE confers benefits over usual care participants in China, whereas results regarding treatment compliance and medication adherence remain unclear. That these effects are additive to, but not substitutive for, antipsychotic medication was illustrated in a German study (Wiedemann et al, 2001). The investigators found that behavioral family management did not compensate for the increased risk of relapse posed by "targeted" drug treatment, in which the patient did not use medication unless experiencing prodromal signs or symptoms of relapse.…”

Section: International Randomized Trialsmentioning

confidence: 99%

Family Interventions for Schizophrenia and the Psychoses: A Review

2016

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Family psychoeducation as a treatment for schizophrenia was developed 40 years ago almost simultaneously and independently by investigators who at the time were not family therapists. Although the original goal was to decrease high expressed emotion as a means of preventing relapse, later variations have gone beyond to focus on social and role functioning and family well-being. Explicitly disavowing the earlier assumptions that family pathology caused relapse and deterioration, family psychoeducation seeks to engage family members as more sophisticated partners, complementing interventions by clinicians with specialized interactions and coping skills that counter the neurologic deficits inherent to the disorder. It has proved to be one of the most consistently effective treatments available. Reports on outcome studies now number more than 100, while meta-analyses put relapse rate reduction at 50-60% over treatment as usual. The most recent application in first episode and prodromal psychosis, combined with other evidence-based interventions, is yielding perhaps the most promising results yet achieved-substantial return of functioning and avoidance of psychosis altogether. Reviewed here are its scientific, theoretical, and clinical sources, a description of the most commonly applied version-the multifamily group format, selected clinical trials spanning those four decades, international and ethnic adaptations, and studies on mechanisms of efficacy.

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Section: International Randomized Trialsmentioning

confidence: 99%

Family Interventions for Schizophrenia and the Psychoses: A Review

2016

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“…First, staff may not be adequately trained to implement the intervention. Second, as these interventions need to be implemented for 9–12 months, there may be insufficient resources to deliver and evaluate them adequately 18. Finally, there may be inadequate recognition and support from service managers in terms of the service strategy collaboration, resources, and time needed to embed these interventions in existing mental health services 4,19…”

Section: Psychosocial Interventions For People With Schizophreniamentioning

confidence: 99%

Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care

Chien¹,

Leung²,

Yeung³

et al. 2013

NDT

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Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients' long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major health care databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short-to medium-term clinical efficacy in terms of symptom control or reduction, level of functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, .2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services.

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“…Moreover, conventional community mental health teams and services are crucial but often not sufficient for the delivery of continuing and effective interventions to patients (Watkins 2001). Fuelled by public concern of violence, self-harm or self-neglect, there is now growing acceptance of the need for much more comprehensive, and if necessary supervisory, care of people with enduring mental illness who are living in the community (Wiedemann et al 2001). Conversely, many patients with an enduring course of schizophrenia or other mental illnesses have been discharged into the communities that are ill-prepared to care for them.…”

Section: Introductionmentioning

confidence: 99%