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

In the RCT carried out by Hogarty et al. (they included 103 patients with a diagnosis of
schizophrenia or schizoaffective disorder and who come from homes with high expressed emotion),
were randomised to four treatment conditions: family psychoeducation (FP) and pharmacology
treatment (FP+PT); social skills training and pharmacological treatment (SST+PT); family
psychoeducation, social skills training and pharmacological treatment (FP+SST+PT), and
pharmacological treatment (PT) 76 . The same author publishes the results of the same study two
years after the treatment 90 .
In the Spanish study by Lemos et al 91 they submit to verification the effectiveness of psychosocial
therapy programmes added to the pharmacological treatment in the prevention of relapses,
the control of symptoms and the functional improvement of patients with schizophrenia
after 4 years’ follow-up. The 46 initial patients were assigned by order of arrival at the centre to
the standard treatment control group (n = 15) and to the psychosocial intervention programme (n
= 20), consisting in psychoeducation and integrated psychological therapy, IPT of Brenner and
Roder 92-93 for patients, and psychoeducation and family therapy (improvement of communication,
problem-solving and stress handling) for family members.
With respect to the people who suffer from SMI and a diagnosis of bipolar disorder, the
NICE Bipolar Disorder CPG 7 which includes 3 RCT 94-96 (n = 246), from which the development
group of this CPG rejected the study by Rea et al 96 because 40% of the sample corresponds to
people with a first episode of the disease, from a sample of n = 53, and does not satisfy the inclusion
criteria established in this CPG. The studies observe different family intervention formats
and compare them with other interventions or with standard treatment. 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 psychoeducational content, and/or “crisis treatment” orientated work.
Justo et al 97 , in the SR that they perform, analyse the effectiveness of family intervention
compared with non-intervention or other psychosocial interventions in people who suffer bipolar
disorder. The search period lasts until 2006 and includes 7 RCTs (n = 393), which provided data
to respond to this section from 6 RCT 98-103 . All the people were taking medication at the time of
the study. The family psychosocial interventions include any type of psychological therapy or
psychoeducational method (about the disease and the possible strategies to cope with it) to treat
people and their families or carers (partners or family members of a bipolar person, or group of
families of different bipolar people, with the attendance or not of the bipolar person) They also
include couple therapies and therapies with groups of families, and they can be administered by
psychiatrists, psychologists or other health professionals.
Reinares et al 104 performed a study (RCT, n = 113) with the aim of evaluating the efficiency
of a group of psychoeducational intervention for families of people with a diagnosis of bipolar
disorder in euthymic phase and with a 12 month follow-up period.
Up to two family members per patient of the 113 were randomised between a group of
twelve 90-minute sessions where they were offered information and coping guidelines compared
with the control group. The assignation, when they were randomised, was not concealed, but the
evaluation was blind. The condition of SMI is not specified, but the description of the sample
indicates clinical severity and prolonged course: 10 years’ evolution, 82% type I, 66% had had
psychotic symptoms, with an average of 7 episodes and 1.5 hospitalisations per patient.
The interventions with families and users can be applied to the National Health System.
However, and for them to be effective, a considerable amount of time must be invested as well as
training of the professional who are going to use them.
No study indicates or analyses possible adverse effects of these types of intervention.
CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 57