Top

Social Psychiatry and Psychiatric Epidemiology

Published in:

01-03-2015 | Original Paper

How does family intervention improve the outcome of people with schizophrenia?

Authors: Manuel Girón, Francisco Nova-Fernández, Sonia Mañá-Alvarenga, Andreu Nolasco, Antonia Molina-Habas, Antonio Fernández-Yañez, Rafael Tabarés-Seisdedos, Manuel Gómez-Beneyto

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 3/2015

Abstract

Background

There is strong evidence of the efficacy of family psychosocial interventions for schizophrenia, but evidence of the role played by the attitudes of relatives in the therapeutic process is lacking.

Method

To study the effect of a family intervention on family attitudes and to analyse their mediating role in the therapeutic process 50 patients with schizophrenia and their key relatives undergoing a trial on the efficacy of a family psychosocial intervention were studied by means of the Affective Style Coding System, the Scale of Empathy, and the Relational Control Coding System. Specific statistical methods were used to determine the nature of the relationship of the relatives’ attitudes to the outcome of family intervention.

Results

Family psychosocial intervention was associated with a reduction in relatives’ guilt induction and dominance and an improvement in empathy. Empathy and lack of dominance were identified as independent mediators of the effect of family psychosocial intervention. The change in empathy and dominance during the first 9 months of the intervention predicted the outcome in the following 15 months.

Conclusion

Relatives’ empathy and lack of dominance are mediators of the beneficial effect of family psychosocial intervention on patient’s outcome.

Nadeem Z, McIntosh A, Lawrie S (2003) Schizophrenia. Clin Evid 10:1208–1237PubMed

Tienari P, Wynne LC, Sorri A, Lahti I, Läksy K, Moring J, Naarala M, Nieminen P, Wahlberg KE (2004) Genotype-environment interaction in schizophrenia-spectrum disorder. Long-term follow-up study of Finnish adoptees. Br J Psychiatry 184:216–222PubMedCrossRef

van Os J, Kenis G, Rutten BPF (2010) The environment and schizophrenia. Nature 468:203–2012PubMedCrossRef

Brown GW, Birley JL, Wing JK (1972) Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry 121:241–258PubMedCrossRef

Butzlaff RL, Hooley JM (1998) Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry 55:547–552PubMedCrossRef

Barrowclough C, Jhonston M, Tarrier N (1994) Attributions, expressed emotion, and patient relapse: an attributional model of relatives’ response to schizophrenic illness. Behav Ther 25:67–88CrossRef

Wuerker AM (1996) Communication patterns and expressed emotion in families of persons with mental disorders. Schizophr Bull 22:671–690PubMedCrossRef

Wuerker AM, Long JD, Haas GL, Bellack AS (2002) Interpersonal control, expressed emotion, and change in symptoms in families of persons with schizophrenia. Schizophr Res 58:281–292PubMedCrossRef

Girón M, Gómez-Beneyto M (1998) Relationship between empathic family attitude and relapse in schizophrenia: a 2 year follow-up study. Schizophr Bull 24:619–627PubMedCrossRef

10.

Girón M, Gómez Beneyto M (2004) Relationship between family attitudes and social functioning in schizophrenia: a 9 month follow-up perspective study. J Nerv Ment Dis 192:414–420PubMedCrossRef

11.

Leff J, Sharpley M, Chisholm D, Bell R, Gamble C (2001) Training community psychiatric nurses in schizophrenia family work: a study of clinical and economic outcomes for patients and relatives. J Ment Health 10:189–197CrossRef

12.

Pfammatter M, Ulrich MJ, Brenner HD (2006) Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophr Bull 32:S64–S80PubMedCentralPubMedCrossRef

13.

King S, Ricard N, Richon V, Steiger H, Nelis S (2003) Determinants of expressed emotion in mothers of schizophrenia patients. Psychiatry Res 117:211–222PubMedCrossRef

14.

Girón M, Fernández-Yañez A, Mañá-Alvarenga S, Molina-Habas A, Nolasco A, Gómez-Beneyto M (2010) Efficacy and effectiveness of individual family intervention on social and clinical functioning and family burden in severe schizophrenia: a 2-year randomized controlled study. Psychol Med 40:73–84PubMedCrossRef

15.

Kuipers L, Leff JP, Lam D (2002) Family work for schizophrenia: a practical guide. Gaskell, London

16.

Mañá S, Ivorra J, Girón M (1998) Adaptation and reliability of the disability Assessment Schedule in psychiatric patients (WHO) [in Spanish]. Revista de Psiquiatría de la Facultad de Medicina de Barcelona 25:43–48

17.

Bellack AS, Morrison RL, Mueser KT, Wade JH, Sayers SL (1990) Role play for assessing the social competence of psychiatric patients. Psychol Assess 2:248–255CrossRef

18.

Wing JK, Monck E, Brown GW, Carstairs GM (1964) Morbidity in the community of schizophrenic patients discharged from London Mental Hospitals in 1959. Br J Psychiatry 120:10–21CrossRef

19.

Doane JA, West KL, Goldstein MJ, Rodnick EH, Jones JE (1981) Parental communication deviance and affective style. Arch Gen Psychiatry 38:679–685PubMedCrossRef

20.

Ivey AE, Ivey MB, Simek-Morgan L (1993) Counseling and psychotherapy. Allen and Bacon, Needham Heights

21.

Ericson PM, Rogers LE (1973) New procedures for analyzing relational communication. Fam Process 12:245–267CrossRef

22.

MacKinnon DP (2008) Introduction to statistical mediation analysis. Lawrence Erlbaum Associates, New York

23.

Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40:879–891PubMedCrossRef

24.

Leff J, Kuipers L, Berkowitz R, Eberlein-Fries R, Sturgeon D (1985) A controlled trial of social intervention in the families of schizophrenic patients. Two years follow-up. Br J Psychiatry 141:121–134CrossRef

25.

Hogarty GE, Anderson CM, Reiss DJ, Kornblith SJ, Greenwald DP, Ulrich RF (1986) Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. One-year effects of a controlled study of relapse and expressed emotion. Arch Gen Psychiatry 48:340–347CrossRef

26.

Tarrier N, Barrowclough C, Vaughn C, Bamrah JS, Porceddu K, Watts S, Freeman H (1988) The community management of schizophrenia: a controlled trial of a behavioural intervention with families to reduce relapse. Br J Psychiatry 153:532–542PubMedCrossRef

27.

Nugter MA, Dingemans PM, Linszen DH, Van der Does AJ, Gersons BP (1997) Parental communication deviance: its stability and the effect of family treatment in recent-onset schizophrenia. Acta Psychiatr Scand 95:199–204PubMedCrossRef

28.

Merinder L-B, Viuff AG, Laugesen HD, Clemmensen K, Misfelt S, Espensen B (1999) Patient and relative education in community psychiatry: a randomized controlled trial regarding its effectiveness. Soc Psychiatry Psychiatr Epidemiol 34:287–294PubMedCrossRef

29.

Tomaras V, Mavreas V, Economou M, Ioannovich E, Karydi V, Stefanis C (2000) The effect of family intervention on chronic schizophrenics under individual psychosocial treatment: a 3-year study. Soc Psychiatry Psychiatr Epidemiol 35:487–493PubMedCrossRef

30.

Doane JA, Falloon IR, Goldstein MJ, Mintz J (1985) Parental affective style and the treatment of schizophrenia. Predicting course of illness and social functioning. Arch Gen Psychiatry 42:34–42PubMedCrossRef

31.

Zubin J, Spring B (1977) Vulnerability. A new view of schizophrenia. J Abnorm Psychol 86:103–126PubMedCrossRef

32.

Nuechterlein KH, Dawson ME, Gitlin M, Ventura J, Goldstein MJ, Snyder KS, Yee CM, Mintz J (1992) Developmental processes in schizophrenic disorders: longitudinal studies of vulnerability and stress. Schizophr Bull 18:387–425PubMedCrossRef

33.

Breitborde NJ, López SR, Nuechterlein KH (2009) Expressed emotion, human agency, and schizophrenia: toward a new model for the EE-relapse association. Cult Med Psychiatry 33:41–60PubMedCrossRef

34.

Corrigan PW, Larson JE, Rüsch N (2009) Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry 8:75–81PubMedCentralPubMed

35.

Lieberman JA, Drake RE, Sederer LI, Belger A, Keefe R, Perkins D, Stroup S (2008) Science and recovery in schizophrenia. Psychiatr Serv 59:487–496PubMedCrossRef

36.

Bohart AC, Elliot R, Greenberg LS, Watson JC (2002) Empathy. In: Norcross JC (ed) Ppsychotherapy relationships that work. Oxford University Press, Oxford

37.

Doane JA, Diamond D (1994) Affect and attachment in the family. Basic Books, New York

38.

Ivey AE (1971) Microcounselling, 2nd edn. Charles C. Thomas, Springfield

39.

Girón M, Sánchez García E (1998) Efficacy of a training technique concerning clinical interview skills associated with psychodiagnostic ability of the physician. Aten Primaria 21:125–130PubMed

40.

Steinglass P (1987) A systems view of family interaction and psychopathology. In: Jacob T (ed) Family interaction and psychopathology. Theories, methods and findings. Plenum Press, New York, pp 25–65CrossRef

41.

Gottman JM, Levenson RW (1999) How stable is marital interaction over time? Fam Process 38:159–165PubMedCrossRef

42.

Rogers LE (2001) Relational communication in the context of family. J Fam Commun 1:25–35CrossRef

Title: How does family intervention improve the outcome of people with schizophrenia?
Authors: Manuel Girón
Francisco Nova-Fernández
Sonia Mañá-Alvarenga
Andreu Nolasco
Antonia Molina-Habas
Antonio Fernández-Yañez
Rafael Tabarés-Seisdedos
Manuel Gómez-Beneyto
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 3/2015
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-014-0942-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

How does family intervention improve the outcome of people with schizophrenia?

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2015

Common mental disorders in primary health care: differences between Latin American-born and Spanish-born residents in Madrid, Spain

Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach

Erratum to: Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community?

The multilevel determinants of workers’ mental health: results from the SALVEO study

Disorders without borders: current and future directions in the meta-structure of mental disorders

Morbidity profile of first-degree relatives of probands with schizophrenia: a comparison with mood disorder and healthy control