The Community Management of Schizophrenia

Tarrier, Nicholas; Barrowclough, Christine; Vaughn, Christine; Bamrah, JS; Porceddu, Kathleen; Watts, Susan; Freeman, Hugh

doi:10.1192/bjp.153.4.532

Cited by 401 publications

(25 citation statements)

References 23 publications

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“…FI was largely influenced by pioneering research showing that people with schizophrenia are more likely to experience relapse when they experience high levels of hostility, criticism or emotional over-involvement within the family [44]. Working in collaboration with the family to help them to understand schizophrenia and related psychoses and tackle their problems has been shown to alleviate stress and reduce the risk of relapse [45–47]. …”

Section: Methodsmentioning

confidence: 99%

Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability

Edge

Degnan

Cotterill

et al. 2016

Pilot Feasibility Stud

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BackgroundAfrican-Caribbeans in the UK have the highest schizophrenia incidence and greatest inequity in access to mental health services of all ethnic groups. The National Institute for Health and Care Excellence (NICE) highlights this crisis in care and urgent need to improve evidence-based mental healthcare, experiences of services and outcomes for this group. Family intervention (FI) is clinically and cost-effective for the management of schizophrenia but it is rarely offered. Evidence for FI with minority ethnic groups generally, and African-Caribbeans in particular, is lacking. This study aims to test the feasibility and acceptability of delivering Culturally-adapted Family Intervention (CaFI) to African-Caribbean service users diagnosed with schizophrenia.Methods/DesignThis is a feasibility cohort design study. Over a 12-month intervention period, 30 service users and their families, recruited from hospital and community settings, will receive ten one-hourly sessions of CaFI. Where biological families are absent, access to the intervention will be optimised through ‘family support members’; trusted individuals nominated by service users or study volunteers.We shall collect data on eligibility, uptake, retention and attrition and assess the utility and feasibility of collecting various outcome measures including readmission, service engagement, working alliance, clinical symptoms and functioning, perceived criticism, psychosis knowledge, familial stress and economic costs. Measures will be collected at baseline, post-intervention and at 3-month follow-up using validated questionnaires and standardised interviews. Admission rates and change in care management will be rated by independent case note examination. Variability in the measures will inform sample size estimates for a future trial. Independent raters will assess fidelity to the intervention in 10 % of sessions. Feedback at the end of each session along with thematically-analysed qualitative interviews will examine CaFI’s acceptability to service users, families and healthcare professionals.DiscussionThis innovative response to inequalities in mental healthcare experienced by African-Caribbeans diagnosed with schizophrenia might improve engagement in services, access to evidence-based interventions and clinical outcomes. Successful implementation of CaFI in this group could pave the way for better engagement and provision across marginalised groups and therefore has potentially important implications for commissioning and service delivery in ethnically diverse populations. This study will demonstrate whether the approach is feasible and acceptable and can be implemented with fidelity in different settings.

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Section: Methodsmentioning

confidence: 99%

Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability

Edge

Degnan

Cotterill

et al. 2016

Pilot Feasibility Stud

Self Cite

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“…Tarrier et al examined medication adherence as one of several outcome measures in a study of patients with schizophrenia and their families 102. Brief behavioral interventions were compared with extended family therapy programs (about 9 months).…”

Section: Psychosocial Interventionsmentioning

confidence: 99%

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

Haddad¹,

Brain²,

Scott³

2014

PROM

454

418

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Nonadherence with medication occurs in all chronic medical disorders. It is a particular challenge in schizophrenia due to the illness’s association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum. It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence. There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives. These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient. These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.

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“…[3] This has resulted in family interventions aimed at reducing the negative impacts of the caregivers on the patient’s rehabilitation and recovery. [45]…”

Section: Introductionmentioning

confidence: 99%

Understanding family functioning and social support in unremitting schizophrenia: A study in India

Sawant

Jethwani

2010

Indian J Psychiatry

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Context:This study aimed to clarify the difference in the perception of family functioning and social support by the schizophrenic patients and their principal caretakers, and whether the social support is related to healthy family functioning.Setting and Design:The study was set in the psychiatric outpatient department of a tertiary care hospital and data was collected by means of a semi-structured interview.Materials and Methods:Fifty unremitting schizophrenics diagnosed by diagnostic and statistical manual (DSM)-IV criteria and their family members were interviewed. Family functioning was assessed by the family assessment device (FAD) and the social support was assessed by the multidimensional scale of perceived social support (MSPSS).Statistical Analysis:Group differences were analyzed using unpaired ‘t’ test for comparison of FAD and MSPSS means and subscale scores. Pearson’s correlation coefficient was used to find the direction and magnitude of association between the various dimensions (subscales) of FAD and the social support from family.Results:Schizophrenic patients had more difficulty on problem solving as compared to their relatives, while no significant differences were noted on the other dimensions of FAD in the two groups. Also, schizophrenics perceived more social support from friends than from their families. All the dimensions of the family functioning correlated to the social support perceived from the family in the schizophrenic patients.Conclusions:Our study highlights the need to study the issues of perception of family functioning and social support so as to improve the prognosis in a disabling disorder like schizophrenia. Providing better social support and understanding the family functioning will result in strengthening the family as a unit, so as to provide better care to the patient.

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The Community Management of Schizophrenia

Cited by 401 publications

References 23 publications

Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability

Culturally-adapted Family Intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

Understanding family functioning and social support in unremitting schizophrenia: A study in India

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