Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis

Rodolico, Alessandro; Bighelli, Irene; Avanzato, Chiara; Concerto, Carmen; Cutrufelli, Pierfelice; Mineo, Ludovico; Schneider‐Thoma, Johannes; Siafis, Spyridon; Signorelli, Maria Salvina; Wang, Hui; Wang, Dongfang; Furukawa, Toshi A; Pitschel-Walz, Gabriele; Aguglia, Eugenio; Leucht, Stefan

doi:10.1016/s2215-0366(21)00437-5

Cited by 60 publications

(54 citation statements)

References 29 publications

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“…In line with two recently published systematic reviews on relapse prevention in schizophrenia [ 4 , 7 ], we recommend that policy makers and clinicians give priority to family interventions such as FPE in resource allocation and treatment planning. Health educational institutions should incorporate basic training in family involvement to counteract professionals´ negative attitudes towards family involvement, and lack of competence and self-confidence when facing relatives of patients with psychotic disorders.…”

Section: Discussionmentioning

confidence: 60%

“…This approach enabled a stepwise consent, which worked better than an “all or nothing” approach. The efficiency also of less comprehensive models is supported by a recent systematic review [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…The uptake of family involvement in health care services for patients with psychotic disorders is poor [ 1 – 3 ] despite a robust evidence base of decreased rates of relapse and hospital admissions, and better adherence with medication among patients [ 4 – 7 ]. Moreover, family interventions are shown to reduce psychological distress and care burden, and to improve family functioning and quality of life among relatives [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Family psychoeducation (FPE), designed to engage, inform, and educate family members so that they can assist the person with severe mental illness in managing the illness, but also to reduce family distress and burden [ 18 ], is one such treatment. The scientific evidence of improvement in patient outcomes has been consistent [ 4 , 5 , 7 ], and research studies, policies, and guidelines have been calling for an increased uptake of FPE for decades [ 2 , 4 , 21 , 22 ]. In addition, moral and socio-economic arguments to involve and support relatives in the context of deinstitutionalisation and subsequent emergence of community care strengthens this appeal [ 8 , 9 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Barriers and facilitators when implementing family involvement for persons with psychotic disorders in community mental health centres – a nested qualitative study

Hansson

Romøren

Pedersen

et al. 2022

BMC Health Serv Res

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Background The uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders. Methods We performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis. Results Organisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals. Conclusions Implementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families. Trial registration ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Barriers and facilitators when implementing family involvement for persons with psychotic disorders in community mental health centres – a nested qualitative study

Hansson

Romøren

Pedersen

et al. 2022

BMC Health Serv Res

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“…have been rapidly developed in order to target cognitive and/or metacognitive deficits that can hamper the functional recovery of schizophrenic patients and in subjects at ultra-high risk of psychosis [ 203 , 207 , 208 , 209 , 210 ], even though they do not seem to be adequately integrated in the mental health services [ 24 , 203 ]. Similarly, family-based interventions and supported employment programs are seldom implemented in routine clinical practice [ 24 , 203 , 211 ]. In particular, there are also initiatives that are aimed at implementing and favoring social integration, regular employment, and reducing the social exclusion of all individuals who are affected by severe mental illnesses, including schizophrenia, such as the Individual Placement and Support (IPS) initiative [ 212 , 213 ].…”

Section: Schizophrenia Treatment and Interventionsmentioning

confidence: 99%

Schizophrenia: A Narrative Review of Etiopathogenetic, Diagnostic and Treatment Aspects

Orsolini¹,

Pompili²,

Volpe³

2022

JCM

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Although schizophrenia is currently conceptualized as being characterized as a syndrome that includes a collection of signs and symptoms, there is strong evidence of heterogeneous and complex underpinned etiological, etiopathogenetic, and psychopathological mechanisms, which are still under investigation. Therefore, the present viewpoint review is aimed at providing some insights into the recently investigated schizophrenia research fields in order to discuss the potential future research directions in schizophrenia research. The traditional schizophrenia construct and diagnosis were progressively revised and revisited, based on the recently emerging neurobiological, genetic, and epidemiological research. Moreover, innovative diagnostic and therapeutic approaches are pointed to build a new construct, allowing the development of better clinical and treatment outcomes and characterization for schizophrenic individuals, considering a more patient-centered, personalized, and tailored-based dimensional approach. Further translational studies are needed in order to integrate neurobiological, genetic, and environmental studies into clinical practice and to help clinicians and researchers to understand how to redesign a new schizophrenia construct.

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Behavioural family interventions versus structural family interventions for people with schizophrenia

Fai

Chien

Wong

2022

Cochrane Database of Systematic Reviews

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Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis

Cited by 60 publications

References 29 publications

Barriers and facilitators when implementing family involvement for persons with psychotic disorders in community mental health centres – a nested qualitative study

Barriers and facilitators when implementing family involvement for persons with psychotic disorders in community mental health centres – a nested qualitative study

Schizophrenia: A Narrative Review of Etiopathogenetic, Diagnostic and Treatment Aspects

Behavioural family interventions versus structural family interventions for people with schizophrenia

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