0
0

Chapter 24. Family Intervention for Psychotic and Severe Mood Disorders

William R. McFarlane, M.D.
DOI: 10.1176/appi.books.9781585623648.374986

Sections

Excerpt

Family intervention for the severe psychiatric syndromes—psychotic and severe mood disorders—has been established as one of the most effective treatments available, complementing but nearly doubling the treatment effects of medication. Often subsumed under the term family psychoeducation, it is a method for incorporating a patient's family members, other caregivers, and friends into the acute and ongoing treatment and rehabilitation process. The descriptor psychoeducation can be misleading: family psychoeducation includes many cognitive, behavioral, and supportive therapeutic elements; often uses a consultative framework; and shares characteristics with some types of family therapy. On the basis of a family–patient–professional partnership, the most effective models are essentially cognitive-behavioral therapy with consistent inclusion of family members as collaborators. Family psychoeducation can include any layperson or paraprofessional person who is providing support to persons with a severe mental illness. It combines providing clear and accurate education for family members about the psychobiology of the major disorders with training and ongoing guidance in problem-solving, communication, and coping skills, while providing and developing social support. The goals are both to markedly improve clinical and functional outcomes and quality of life for the patient and to reduce family stress and strain as an indispensable means of achieving those outcomes. Family psychoeducation combines the complementary expertise and experience of family members, patients, and professionals.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Figure 24-1. Risk for relapse over time in relation to positive and negative symptoms of schizophrenia.
Table Reference Number
Table 24–1. Empirically derived stressors in major psychotic disorders
Table Reference Number
Table 24–2. Guidelines for management of the disorder for patients and families: ways to hasten recovery and to prevent a recurrence
Table Reference Number
Table 24–3. Session program for ongoing family psychoeducation meetings

References

Amenson C: Schizophrenia: A Family Education Curriculum. Pasadena, CA, Pacific Clinics Institute, 1998
 
American Psychiatric Association: Practice Guidelines for the Treatment of Schizophrenia. Washington, DC, American Psychiatric Association, 1997
 
Anderson CM, Hogarty G, Bayer T, et al: Expressed emotion and social networks of parents of schizophrenic patients. Br J Psychiatry 144:247–255, 1984
[PubMed]
 
Anderson C, Reiss D, Hogarty G: Schizophrenia and the Family: A Practitioner's Guide to Psychoeducation and Management. New York, Guilford, 1986
 
Barrowclough C, Haddock G, Tarrier N, et al: Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. Am J Psychiatry 158:1706–1713, 2001
[PubMed]
 
Baucom DH, Shoham V, Mueser KT, et al: Empirically supported couple and family interventions for marital distress and adult mental health problems. J Consult Clin Psychol 66:53–88, 1998
[PubMed]
 
Bebbington P, Kuipers L: The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychol Med 24:707–718, 1994
[PubMed]
 
Becker T, Leese M, Clarkson P, et al: Links between social network and quality of life: an epidemiologically representative study of psychotic patients in south London. Soc Psychiatry Psychiatr Epidemiol 33:229–304, 1998
[PubMed]
 
Brewin CR, MacCarthy B, Duda K, et al: Attribution and expressed emotion in the relatives of patients with schizophrenia [published erratum appears in J Abnorm Psychol 101:313, 1992]. J Abnorm Psychol 100:546–554, 1991
[PubMed]
 
Brown GW, Birley JL, Wing JK: Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry 121:241–258, 1972
[PubMed]
 
Cook WL, Strachan AM, Goldstein MJ, et al: Expressed emotion and reciprocal affective relationships in families of disturbed adolescents. Fam Process 28:337–348, 1989
[PubMed]
 
Coursey R, Curtis L, Marsh DT, et al: Competencies for direct service staff members who work with adults with severe mental illness in outpatient public mental health managed care systems. Psychiatr Rehabil J 23:370–377, 2000
 
Cuijpers P: The effects of family interventions on relatives' burden: a meta-analysis. Journal of Mental Health 8:275–285, 1999
 
Dixon LB, Lehman AF: Family interventions for schizophrenia. Schizophr Bull 21:631–644, 1995
[PubMed]
 
Dixon L, Adams C, Lucksted A: Update on family psychoeducation for schizophrenia. Schizophr Bull 26:5–20, 2000
[PubMed]
 
Dixon L, McFarlane WR, Lefley H, et al: Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatr Serv 52:903–910, 2001
[PubMed]
 
Dyck DG, Short RA, Hendryx MS, et al: Management of negative symptoms among patients with schizophrenia attending multiple-family groups. Psychiatr Serv 51:513–519, 2000
[PubMed]
 
Dyck DG, Hendryx MS, Short RA, et al: Service use among patients with schizophrenia in psychoeducational multiple-family group treatment. Psychiatr Serv 53:749–754, 2002
[PubMed]
 
Emanuels-Zuurveen L, Emmelkamp PM: Spouse-aided therapy with depressed patients. Behav Modif 21:62–77, 1997
[PubMed]
 
Falloon IRH: Family Management of Mental Illness: A Study of Clinical Social and Family Benefits. Baltimore, MD, Johns Hopkins University Press, 1984
 
Falloon I, Liberman R: Behavioral family interventions in the management of chronic schizophrenia, in Family Therapy in Schizophrenia. Edited by McFarlane WR. New York, Guilford, 1983, pp 141–172
 
Falloon IRH, Pederson J: Family management in the prevention of morbidity of schizophrenia: the adjustment of the family unit. Br J Psychiatry 147:156–163, 1985
[PubMed]
 
Falloon I, Boyd J, McGill CW: Family Care of Schizophrenia. New York, Guilford, 1984
 
Falloon IR, Boyd JL, McGill CW, et al: Family management in the prevention of morbidity of schizophrenia: clinical outcome of a two-year longitudinal study. Arch Gen Psychiatry 42:887–896, 1985
[PubMed]
 
Fenton WS, Blyler CR, Heinssen RK: Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr Bull 23:637–651, 1997
[PubMed]
 
Frances A, Docherty J, Kahn D: Expert Consensus Guideline Series: treatment of schizophrenia. J Clin Psychiatry 57 (50, suppl 12B):5–58, 1996
 
Fristad MA, Gavazzi SM, Soldano KW: Multi-family psychoeducation groups for childhood mood disorders: a program description and preliminary efficacy data. Contemporary Family Therapy 20:385–402, 1998
 
Geist R, Heinmaa M, Stephens D, et al: Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa. Can J Psychiatry 45:173–178, 2000
[PubMed]
 
Goldstein M: Family factors that antedate the onset of schizophrenia and related disorders: the results of a fifteen year prospective longitudinal study. Acta Psychiatr Scand Suppl 319:7–18, 1985
[PubMed]
 
Goldstein MJ, Rosenfarb I, Woo S, et al: Intrafamilial relationships and the course of schizophrenia. Acta Psychiatr Scand Suppl 384:60–66, 1994
[PubMed]
 
Gunderson JG, Berkowitz C, Ruiz-Sancho A: Families of borderline patients: a psychoeducational approach. Bull Menninger Clin 61:446–457, 1997
[PubMed]
 
Harrington R, Kerfoot M, Dyer E, et al: Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves. J Am Acad Child Adolesc Psychiatry 37:512–518, 1998
[PubMed]
 
Hogarty G, Ulrich R: Temporal effects of drug and placebo in delaying relapse in schizophrenic outpatients. Arch Gen Psychiatry 34:297–301, 1977
[PubMed]
 
Hooley J, Richters JE: Expressed emotion: a developmental perspective, in Emotion, Cognition and Representation (Rochester Symposium on Developmental Psychopathology, Vol 6). Edited by Cicchetti D, Toth SL. Rochester, NY, University of Rochester Press, 1995, pp 133–166
 
Johnson D: The family's experience of living with mental illness, in Families as Allies in Treatment of the Mentally Ill: New Directions for Mental Health Professionals. Edited by Lefley HP, Johnson DL. Washington, DC, American Psychiatric Press, 1990, pp 31–65
 
Leff J, Vearnals S, Brewin CR, et al: The London Depression Intervention Trial: randomised controlled trial of antidepressants v couple therapy in the treatment and maintenance of people with depression living with a partner: clinical outcome and costs. Br J Psychiatry 177:95–100, 2000 [Published erratum appears in Br J Psychiatry 177:284, 2000]
 
Lehman AF, Steinwachs DM: Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull 24:1–10, 1998
[PubMed]
 
Lehman AF, Carpenter WT Jr, Goldman HH, et al: Treatment outcomes in schizophrenia: implications for practice, policy, and research. Schizophr Bull 21:669–675, 1995
[PubMed]
 
Lin N, Ensel W: Depression-mobility and its social etiology: the role of life events and social support. J Health Soc Behav 25:176–188, 1984
[PubMed]
 
Link BG, Mirotznik J, Cullen FT: The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided? J Health Soc Behav 32:302–320, 1991
[PubMed]
 
Loveland-Cherry CJ, Ross LT, Kaufman SR: Effects of a home-based family intervention on adolescent alcohol use and misuse. J Stud Alcohol Suppl 13:94–102, 1999
[PubMed]
 
Marriott A, Donaldson C, Tarrier N, et al: Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. Br J Psychiatry 176:557–562, 2000
[PubMed]
 
Marsh D: A Family-Focused Approach to Serious Mental Illness: Empirically Supported Interventions. Sarasota, FL, Professional Resource Press, 2001
 
McFarlane WR: Multifamily Groups in the Treatment of Severe Psychiatric Disorders. New York, Guilford, 2002
 
McFarlane WR: Family expressed emotion prior to onset of psychosis, in Relational Processes and DSM-V: Neuroscience, Assessment, Prevention and Treatment. Edited by Beach SRH, Wamboldt MZ, Kaslow NJ, et al. Washington, DC, American Psychiatric Publishing, 2006, pp 77–87
 
McFarlane WR, Cook WL: Family expressed emotion during onset of psychosis. Fam Process 46:185–198, 2007
[PubMed]
 
McFarlane WR, Lukens EP: Insight, families, and education: an exploration of the role of attribution in clinical outcome, in Insight and Psychosis. Edited by Amador XF, David AS. New York, Oxford University Press, 1998, pp 317–331
 
McFarlane WR, Link B, Dushay R, et al: Psychoeducational multiple family groups: four-year relapse outcome in schizophrenia. Fam Process 34:127–144, 1995a
 
McFarlane WR, Lukens E, Link B, et al: Multiple-family groups and psychoeducation in the treatment of schizophrenia. Arch Gen Psychiatry 52:679–687, 1995b
 
McFarlane WR, Dushay RA, Stastny P, et al: A comparison of two levels of family-aided assertive community treatment. Psychiatr Serv 47:744–750, 1996
[PubMed]
 
McFarlane WR, Dushay RA, Deakins SM, et al: Employment outcomes in family aided assertive community treatment. Am J Orthopsychiatry 70:203–214, 2000
[PubMed]
 
McFarlane WR, Dixon L, Lukens EP, et al: Severe mental illness, in Effectiveness Research in Marriage and Family Therapy. Edited by Sprenkle DH. Alexandria, VA, American Association for Marriage and Family Therapy, 2002, pp 255–288
 
McFarlane WR, Dixon L, Lukens E, et al: Family psychoeducation and schizophrenia: a review of the literature. J Marital Fam Ther 29:223–245, 2003
[PubMed]
 
Miklowitz DJ, Goldstein MJ: Bipolar Disorder: A Family Focused Treatment Approach. New York, Guilford, 1997
 
Miklowitz DJ, Simoneau TL, George EL, et al: Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biol Psychiatry 48:582–592, 2000
[PubMed]
 
Montero I, Asencio A, Hernández I, et al: Two strategies for family intervention in schizophrenia: a randomized trial in a Mediterranean environment. Schizophr Bull 27:661–670, 2001
[PubMed]
 
Muela Martinez JA, Godoy Garcia JF: Family intervention program for schizophrenia: two-year follow-up of the Andalusia Study [in Spanish]. Apuntes de Psicología 19:421–430, 2001
 
Penninx BWJH, Kriegsman DMW, van Eijk JTM, et al: Differential effect of social support on the course of chronic disease: a criterion-based literature review. Fam Syst Health 14:223–244, 1996
 
Phelan JC, Bromet EJ, Link BG: Psychiatric illness and family stigma. Schizophr Bull 24:115–126, 1998
[PubMed]
 
Pickett-Schenk SA, Cook JA, Laris A: Journey of Hope program outcomes. Community Ment Health J 36:413–424, 2000
[PubMed]
 
Reiss D, Plomin R, Neiderhiser JM, et al: The Relationship Code: Deciphering Genetic and Social Influences on Adolescent Development. Cambridge, MA, Harvard University Press, 2000
 
Repetti RL, Taylor SE, Seeman TE: Risky families: family social environments and the mental and physical health of offspring. Psychol Bull 128:330–366, 2002
[PubMed]
 
Rund BR, Moe L, Sollien T, et al: The Psychosis Project: outcome and cost-effectiveness of a psychoeducational treatment programme for schizophrenic adolescents. Acta Psychiatr Scand 89:211–218, 1994
[PubMed]
 
Russell PSS, al John JK, Lakshmanan JL: Family intervention for intellectually disabled children: randomised controlled trial. Br J Psychiatry 174:254–258, 1999
[PubMed]
 
Sanders MR, McFarland M: Treatment of depressed mothers with disruptive children: a controlled evaluation of cognitive behavioral family intervention. Behav Ther 31:89–112, 2000
 
Solomon P, Draine J: Subjective burden among family members of mentally ill adults: relation to stress, coping, and adaptation. Am J Orthopsychiatry 65:419–427, 1995
[PubMed]
 
Steinglass P: Multiple family discussion groups for patients with chronic medical illness. Fam Syst Health 16:55–70, 1998
 
Strachan AM, Feingold D, Goldstein MJ, et al: Is expressed emotion an index of a transactional process? II: patient's coping style. Fam Process 28:169–181, 1989
[PubMed]
 
Tienari P, Wynne LC, Sorri A, et al: Genotype-environment interaction in schizophrenia-spectrum disorder: long-term follow-up study of Finnish adoptees. Br J Psychiatry 184:216–222, 2004
[PubMed]
 
Tompson MC, Rea MM, Goldstein MJ, et al: Difficulty in implementing a family intervention for bipolar disorder: the predictive role of patient and family attributes. Fam Process 39:105–120, 2000
[PubMed]
 
Van Noppen B: Multi-family behavioral treatment (MFBT) for OCD. Crisis Intervention and Time-Limited Treatment 5:3–24, 1999
 
Wagener DK, Hogarty GE, Goldstein MJ, et al: Information processing and communication deviance in schizophrenic patients and their mothers. Psychiatry Res 18:365–377, 1986
[PubMed]
 
Walker DW: The treatment of adult male child molesters through group family intervention. J Psychol Human Sex 11:65–73, 2000
 
Wynne LC: The rationale for consultation with the families of schizophrenic patients. Acta Psychiatr Scand Suppl 90:125–132, 1994
 
Zhao B, Shen J, Shi Y, et al: Family intervention of chronic schizophrenics in the community: a follow-up study. Chinese Mental Health Journal 14:283–285, 2000
 
Zubin J, Steinhauer SR, Condray R: Vulnerability to relapse in schizophrenia. Br J Psychiatry Suppl, October (18):13–18, 1992
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 11.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 34.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 21.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 26.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 19.  >
Topic Collections
Psychiatric News
PubMed Articles
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation