Family's Behavior Is Indeed Key to Schizophrenia Patients

According to a new Cochrane systematic review, changing family members’ behavior can effectively help avoid relapse in people with schizophrenia. Researchers, led by Fiona Pharoah, Oxford and Buckinghamshire Mental Health NHS Foundation Trust, UK, reviewed the latest evidence and found that when patients’ families received behavioral interventions, the patient was less likely to relapse.

Although it has been known for quite some time that relapse is more likely in patients with schizophrenia who come from families in which they experience a lot of criticism, hostility, and over involvement, the effectiveness of widely used psychological interventions for reducing levels of such potentially negative emotions has not been proved.

For the review, Pharoah and colleagues reviewed data from 53 trials looking at a total of 4,708 patients, whom received interventions—including a variety of psychosocial techniques aimed at reducing stress and expressed emotion levels, as well as helping family members solve patient problems—that lasted from six weeks to three years. Throughout the studies, control groups were provided standard care that included their usual drug therapy. A variety of scales for general and mental health, social functioning, behavior, and quality of life were used to assess participants.

After reviewing all the study data, the team found the biggest benefit of family intervention to be a decrease in relapses for patients with schizophrenia, with 32 trials showing that for every seven patients whose relatives received family intervention, one patient benefited compared to patients in the control group. But the benefits of family intervention don’t end there; significantly reduced hospital admissions over a year, improved social functioning on the part of the patient, and encouragement for patients to stick to drug therapy were also seen as benefits of family interventions.

"Prevention of relapse is a cornerstone of psychiatric care," said Pharoah. "If high quality family services are available, mental health professionals and managers may feel that family interventions are a worthwhile investment of time and effort for schizophrenic patients." The problem that may keep policy makers from investing in such interventions, however, is the number of patients needed to treat before seeing a benefit.

"We still need a better designed large study to settle arguments about this widely used therapy," said Co-author John Rathbone, Health Economics and Decision Science Department, University of Sheffield. "Some of the important data within the studies that were reviewed were poorly reported and patients might have reason to feel let down by the research community in these cases."

If behavioral therapy aimed at family members worth the potential benefits for the patient with schizophrenia? Do you suggest and/or offer it to the family members of your patients? If so, what have your experiences been? Share your thoughts with your colleagues; post a comment below.