CPG for Psychosocial Interventions in Severe Mental ... - GuíaSalud

5.1.5. Family interventions
There appears to be general consensus about the fact that SMI has a considerable effect on the
family relations of people who suffer from it, and that family relations can also, in some way or
another, affect the course of the disease.
Some studies show that people with schizophrenia that come from families with high levels
of “expressed emotion”, in other words, that show high levels of over-protection, criticism and
hostility, are more likely to suffer relapses than those people with the same type of pathology but
with lower levels of “expressed emotion” within the family 8 .
Nowadays, there is a great variety of methods to help people with mental diseases and their
families manage the disease in a more effective manner. These interventions are designed to improve
the relationships between family members, reduce the levels of “expressed emotion” and,
in some way, reduce the relapse ratios and improve the quality of life both of the patient and of
the families.
Pyschosocial interventions have been reviewed as well as the evidence that exists about their
efficiency in people with SMI with respect to their isolated application compared with standard
treatment or other interventions. However, studies have been found in the review where the experimental
group receives two or more interventions. The question of how these interventions must
be combined, not only together but also added to other types of interventions, is directly related
to the need to integrate treatments and to the debate on the artificial delimitation between treatment
and rehabilitation. No specific question has been contemplated in this CPG to define which
combination of psychosocial interventions is more efficient. It is, however, considered advisable
to indicate that there are studies that propose the application of interventions that combine family
therapy and other therapies.
For some authors there is an international agreement about the need to offer a combination of
three essential interventions in the treatment of patients with schizophrenia and related disorders:
optimal doses of antipsychotic medication, education of users and their caregivers to cope more
effectively with environmental stress, and Assertive Community Treatment that helps resolve
social needs and crisis, including symptomatic exacerbation 75 . Despite the evidence that supports
this, there are very few mental health plans that foresee these programmes in a routine manner.
However, for other authors, it is the combination of family treatment, social skills training and
pharmacological treatment that can be the appropriate treatment to avoid relapses 76 .
A combined psychosocial treatment project started up in 1994, which included family intervention
and other psychosocial interventions (Optimal Treatment Project, OTP). It was multicentre
(in 21 countries and with 35 venues) and its aim was to assess costs and benefits of applying
evidence-based optimal psychosocial and biomedical strategies, to treat schizophrenia and other
non-affective psychosis, through the implementation and assessment of optimal therapeutic interventions
in ordinary mental health resources –not investigators- after the adequate training of
multidisciplinary professionals teams and with a 5-year follow-up period 77 . Although the project
proposed incorporating patients as soon as possible after the onset of the disease (in the first ten
years), some venues incorporated patients with more than 10 years’ evolution, where the treatment
was focused on improving their quality of life through social and occupational skills training,
and on providing pharmacological and psychosocial strategies for persistent symptoms. The
interventions included pharmacological strategies, psychoeducation of patients and caregivers,
Assertive Community Treatment, social skills training, pharmacological and psychosocial handling
of persistent and residual symptoms.
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