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Family intervention for people with SMI and a diagnosis of schizophrenia and related disorders Family intervention vs. other interventions (standard treatment, psycho education, family support, supportive psychotherapy, etc.) Relapses SR (1+) SR (1+) RCT (1-) SR (1-) Family intervention, compared with other interventions, reduces relapses during treatment (n = 383; RR = 0.57, 95% CI: between 0.37 and 0.88)8, and 4 to 15 months after finishing the treatment (n = 305; RR = 0.67; 95% CI: between 0.52 and 0.88) 8 . It reduces the relapses after 12 months’ treatment, in people who had relapses during the 3 months prior to the intervention (n = 320; RR = 0.55; 95% CI: between 0.31 and 0.97; NNT = 5) 8 . Dyck et al 79 indicate that family intervention compared with standard intervention reduces persistent symptoms after 12 months’ treatment (n = 63; RR = 0.57, 95% CI: 0.33 to 0,97; NNT = 5). Family intervention of less than 5 sessions, or an unknown number of sessions, significantly reduces relapses (5 RCT; n = 600; RR = 0.41; 95% CI: between 0.31 and 0.53; NNT = 4) one year after intervention 80 . The relapse ratios after 2 years were also less in the intervention group (n = 225; RR = 0.45; 95% CI: between 0.28 and 0.71; NNT = 5) 80 . The results after 3 years (n = 326; RR = 0.31; 95% CI: between 0.20 and 0.49; NNT = 4) and after 10 years (n = 196; RR = 0.83, 95% CI: between 0.15 and 0.38; NNT = 2) indicate too that they significantly favoured family intervention compared with standard intervention 80 . Readmissions SR (1-) SR (1+) SR (1-) Family intervention of more than 5 sessions proves to be more effective in reducing hospitalisations after 18 months follow-up (3 RCT; n= 228; RR = 046; 95% CI: between 0.3 and 0.69; NNT = 4) 80 . Family intervention, compared with standard intervention, does not reduce the likelihood of readmission 2 years after having finished the treatment, (n = 330; RR = 0.01; 95% CI between 0.79 and 1.28) 8 . Effect of family intervention on users and caregivers In patients whose family members received a family intervention of more than 5 sessions, when compared with standard treatment, an improvement is observed in pharmacological treatment adherence (7 RCT, n = 369; RR = 0.74; 95% CI between: 0.6 and 0.9; NNT = 7) 80 . 58 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
A family intervention of more than 5 sessions indicates a significant reduction in the burden perceived by family caregivers (n = 48; WMD = -7.01; 95% CI between -10.8 and -3.3) 81 and (n = 60; WMD = -0.4; 95% CI: between -0.7 and -0.1) 82 . A family intervention of more than 5 sessions, compared with standard treatment, favours the reduction of expressed emotion levels within the family (3 RCT; n = 164; RR = 0.68; 95% CI: between 0.5 and 0.9; NNT = 4; 95% CI: between 3 and 10) 80 . Patients who have received family intervention have a higher quality of life than those who did not receive it (n = 213; WMD = 19.18; 95% CI between 9.8 and 28.6) after two years’ treatment 80 . There is not sufficient evidence to determine if family interventions reduce the levels of negative symptoms (MSANS: n = 41; WMD = -1.20; 95% CI: between -2.78 and 0.38) 79 or if they improve social functioning (Social Functioning Scale: n = 69; WMD = -1.60; 95% CI: between -7.07 and 3.87) 78 . Sufficient evidence has not been found, either, that determines if family intervention reduces the suicide rate (7 RCT, n = 377; RR = 0.79; 95% CI between 0.35 and 1.78) 80 . SR (1-) RCT (1-) SR (1-) Duration of the interventions When the programme is provided for a period of 6 months or more, or for more than 10 scheduled sessions, there is evidence that indicates that family intervention reduces relapses at 4 to 15 months’ follow-up after treatment (n = 165; RR= 0.65; 95% CI: between 0.47 and 0.90) 8 . SR (1+) Family intervention formats Single-family intervention vs. multi-family intervention There are no differences between multi-family intervention and single-family interventions with respect to relapses at 13 to 24 months (n = 508; RR = 0.97, 95% CI: between 0.76 and 1.25) 8 . No differences were found, either, between the two types of family interventions regarding experiencing greater pharmacological treatment adherence (n = 172; RR = 1.0; 95% CI: between 0.5 and 2.0) 84 . Leff et al 85 indicate that the people who received single-family intervention, compared with those who received multi-family intervention, were able to lead more independent lives (n = 23; RR = 2.18; 95% CI: between 1.1 and -4.4). In the study by Montero et al. 88 they indicate that (although both techniques improved the patient’s clinical situation), the families that received individual behavioural approach therapy had better results in social functioning, doses of antipsychotic medication and psychotic symptoms (p< 0.05), than the families that received group format (there were no differences in the relapse or readmission rates). SR (1+) RCT (1-) RCT (1-) CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 59
Page 1:
Clinical Practice Guidelines for Ps
Page 4 and 5:
This CPG is an aid for decision mak
Page 7 and 8:
Table of Contents Presentation 7 Au
Page 9 and 10: Presentation Healthcare practice is
Page 11 and 12: Authorship and collaborators CPG de
Page 13: José Manuel Lalana Cuenca. Special
Page 16 and 17: c) SERVICE LEVEL INTERVENTIONS •
Page 18 and 19: A B A A B B B C Psychosocial inter
Page 20 and 21: B B B C A C C 5.3. SERVICE LEV
Page 22 and 23: 20 CLINICAL PRACTICE GUIDELINES IN
Page 24 and 25: independence, quality of life, pers
Page 26 and 27: This guideline is aimed at mental h
Page 28 and 29: Figure 1. Search Strategy Search fo
Page 30 and 31: The highest evidence level found wa
Page 33 and 34: 4. Characteristics of the CPG 4.1.
Page 35 and 36: The main focus of rehabilitation is
Page 37 and 38: 5. Psychosocial type rehabilitation
Page 39 and 40: From another point of view, social
Page 41 and 42: defined as “standard care” or
Page 43 and 44: General global state In the short r
Page 45 and 46: Specific symptoms: when CBT was com
Page 47 and 48: In the systematic review by Kurtz a
Page 49 and 50: Summary of evidence 1- 1- 1- 1- 1-
Page 51 and 52: People with SMI and a diagnosis of
Page 53 and 54: 5.1.3. Interpersonal therapy The li
Page 55 and 56: weekly or fortnightly sessions. The
Page 57 and 58: 5.1.5. Family interventions There a
Page 59: In the RCT carried out by Hogarty e
Page 63 and 64: After two years’ treatment, and b
Page 65 and 66: Family intervention vs. other psych
Page 67 and 68: 1- 1- 1- 1- 1- 1- 1- 1- 1+ No diffe
Page 69 and 70: Question to be answered • Are pys
Page 71 and 72: Summary of evidence Pyschoeducation
Page 73 and 74: with schizophrenia and that the tre
Page 75 and 76: With reference to the type of train
Page 77 and 78: would normally receive and which in
Page 79 and 80: Hypnosis vs. relaxation No improvem
Page 81 and 82: Supervised fl ats are a community h
Page 83 and 84: 3 Programmes directed to leisure an
Page 85 and 86: SMI (schizophrenia, affective schiz
Page 87 and 88: When PVT is compared with standard
Page 89 and 90: Patients included in the individual
Page 91 and 92: 1+ 1+ 1++ 1+ 1+ 1+ 1+ The people in
Page 93 and 94: Music therapy Music therapy + stand
Page 95 and 96: A series of Case Management systems
Page 97 and 98: • The satisfaction data originati
Page 99 and 100: Loss of contact With respect to the
Page 101 and 102: There is not sufficient evidence, e
Page 103 and 104: 1+ 1+ 1+ 1+ Respect to ICM teams or
Page 105 and 106: Finally, in the RCT by Cheng et al
Page 107 and 108: 5.4.2. “Homeless” with SMI The
Page 109 and 110: Patients who access housing with no
Page 111:
ceptive disorders. This series of c
Page 115 and 116:
7. Recommendations for Future Resea
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Appendices
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Appendix 2. Information obtained fr
Page 122 and 123:
Appendix 4. Information for people
Page 124 and 125:
4. Regulatory and legal framework 1
Page 126 and 127:
Several protocols have been publish
Page 128 and 129:
The coordination of these resources
Page 130 and 131:
Social protection systems Pursuant
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Specifi c regulation • (SPANISH)
Page 134 and 135:
Service Management: The first anti-
Page 136 and 137:
on Mental Health and the future Eur
Page 138 and 139:
Spanish Society of Legal Psychiatry
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Appendix 5. Abbreviations ACT Asser
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Appendix 6. Glossary Therapy adhere
Page 144 and 145:
Appendix 7. Declaration of interest
Page 146 and 147:
15 Rossler W. Psychiatric rehabilit
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53 Graeber DA, Moyers TB, Griffi th
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86 Schooler NR, Keith SJ, Severe JB
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117 Sohlberg MM, Mateer CA. Effecti
Page 154 and 155:
154 López M, García-Cubillana P,
Page 156 and 157:
190 Bond GR, Drake RE. Predictors o
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225 Hurley AD. Individual psychothe
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