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

Question to be answered
• Do family interventions in their different formats, present benefits compared with nonintervention,
or other types of psychosocial intervention, in people with SMI?
• At what time, during the course of the illness, is it best to start family intervention for people
with SMI and their families?
• What is the most appropriate time framework for the family intervention programmes and/
or sessions for people with SMI and their families?
All the evidence found refers to SMI with schizophrenia and/or bipolar disorder. The NICE
Schizophrenia CPG 8 includes one SR 43 and 2 RCTs 78,79 (total of 18 RCTs; n = 1458). This CPG
assesses family intervention in different formats (individual, group or multi-family), as well as the
duration and frequency of the interventions. The sessions that are held with the family and with
specific support, based on systemic, cognitive-behavioural and/or psychoanalytical principles,
are considered as family intervention. The interventions included must have a psychoeducational
content, “crisis treatment” orientated work, and with a duration of 6 weeks at least.
In the systematic review by Pharoah et al 80 , which includes a total of 43 RCTs (n = 1765),
the effectiveness of family intervention is assessed in people with schizophrenia and is compared
with standard treatment (understood as normal psychiatric intervention levels that includes pharmacological
treatment). In the studies included in this review, family therapies have an educational
component with a view to improving the family atmosphere and reducing the relapse of
schizophrenia 81-86 .
The results from studies such as the study by Pharoah et al 80 must be taken with precaution
because they include a great variety of ages and people with a background of long-lasting
disease and first episodes, so they are partially applicable to the target population of the CPG.
Furthermore, it must be recalled that these studies come from different cultures and environments,
which must be taken into account when preparing strategies and taking decisions.
Bressi et al 87 performed a RCT (n = 40) which compared the effectiveness of the systematic
family therapy + standard treatment with standard treatment alone (which only consisted in pharmacological
treatment), in people with schizophrenia, in connection with readmissions, relapse
and treatment adherence, and with a two-year follow-up period. The family intervention consisted
in a series of 12 sessions with family members, lasting for one and a half hours, once a month and
over a one year period.
In our context, DA IGUAL in the study by Montero et al 88 , two family therapy techniques
are compared, one intervention in group format (group of families) and another individual intervention
of a cognitive-behavioural style. These interventions are applied to a sample of 87 people
with a diagnosis of schizophrenia and their families for 12 months (weekly the first 6 months, then
every two weeks for the following 3 months and finally during the last 3 months’ intervention,
every month).
Falloon, together with the OPT Collaborative Group 89 publish the preliminary results (n =
603) of one multicentre RCT after two years’ follow-up of their project. The results reached are
for groups of patients with a diagnosis of recent-onset non-affective psychosis, and with a majority
of patients with more than 10 years’ evolution of the disease, results which could be more
easily extrapolated to the criteria of our CPG.
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