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Hestmark L, Romøren M, Hansson KM, Heiervang KS, Pedersen R. Clinicians' perceptions of family involvement in the treatment of persons with psychotic disorders: a nested qualitative study. Front Psychiatry 2023; 14:1175557. [PMID: 37293406 PMCID: PMC10244542 DOI: 10.3389/fpsyt.2023.1175557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
Background Family involvement in mental health care ranges from basic practices to complex interventions such as Family psychoeducation, the latter being a well-documented treatment for psychotic disorders. The aim of this study was to explore clinicians' perceptions of the benefits and disadvantages of family involvement, including possible mediating factors and processes. Methods Nested in a randomised trial, which purpose was to implement Basic family involvement and support and Family psychoeducation in Norwegian community mental health centres during 2019-2020, this qualitative study is based on eight focus groups with implementation teams and five focus groups with ordinary clinicians. Using a purposive sampling strategy and semi-structured interview guides, focus groups were audio-recorded, transcribed verbatim, and analysed with reflexive thematic analysis. Results Four main themes were identified as perceived benefits: (1) Family psychoeducation-a concrete framework, (2) Reducing conflict and stress, (3) A triadic understanding, and (4) Being on the same team. Themes 2-4 formed an interconnected triad of mutually reinforcing elements and were further linked to three important clinician-facilitated sub-themes: a space for relatives' experiences, emotions and needs; a space for patients and relatives to discuss sensitive topics and an open line of communication between clinician and relative. Although far less frequent, three main themes were identified as perceived disadvantages or challenges: (1) Family psychoeducation-occasional poor model fit or difficulties following the framework, (2) Getting more involved than usual, and (3) Relatives as a potentially negative influence-important nonetheless. Conclusions The findings contribute to the understanding of the beneficial processes and outcomes of family involvement, as well as the critical role of the clinician in achieving these and possible challenges. They could also be used to inform future quantitative research on mediating factors and implementation efforts.
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Affiliation(s)
- Lars Hestmark
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Faculty of Health and Social Sciences, Center for Mental Health and Substance Abuse, University of South-Eastern Norway, Drammen, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Hansson KM, Romøren M, Hestmark L, Heiervang KS, Weimand B, Norheim I, Pedersen R. "The most important thing is that those closest to you, understand you": a nested qualitative study of persons with psychotic disorders' experiences with family involvement. Front Psychiatry 2023; 14:1138394. [PMID: 37255680 PMCID: PMC10225600 DOI: 10.3389/fpsyt.2023.1138394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/18/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Family interventions constitute effective treatment for persons with psychotic disorders. However, the active ingredients and beneficial processes of these interventions are insufficiently examined, and qualitative explorations of patients` experiences are lacking. This study was nested in a cluster randomised trial that implemented national guidelines on family involvement in Norwegian community mental health centres, including family psychoeducation and basic family involvement and support. The aim of this sub-study was to explore how patients with psychotic disorders experience systematic family involvement, and its significance. Methods We conducted semi-structured, individual interviews with 13 persons with a psychotic disorder after systematic family involvement. The participants were recruited through purposive sampling. Qualitative content analysis guided the analysis. Results Participants reported overall positive experiences with systematic family involvement. It was significant that the relatives increasingly understood more about psychosis and their situation, while they themselves also gained more insight into the relatives` situation. The participants emphasised the need to enable both patients and relatives to safely share experiences in a containing space, led by professionals. Shared understanding and awareness of each other's situation further improved communication, coping with the illness, reduced stress, and stimulated a more caring family environment. The therapist seemed crucial to facilitate these beneficial communication processes, and also to provide continuous support to the relatives. Reported challenges included that the participants felt vulnerable in the initial phase, a need for tailored approaches, and too late start-up. Conclusion Findings from this study suggest that persons with psychotic disorders may benefit greatly from participating in systematic family involvement. This study also gives new insight into possible mediators of positive outcomes both for the patients and the relatives. Systematic family involvement should be implemented a standard approach in the early phase of the disease, using a step-wise and tailored process.
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Affiliation(s)
- Kristiane M. Hansson
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lars Hestmark
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bente Weimand
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Irene Norheim
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Grant A, Dargan P, Mather S. Exploring service user perspectives of behavioural family therapy in early intervention in psychosis. Early Interv Psychiatry 2023; 17:319-326. [PMID: 35932198 DOI: 10.1111/eip.13338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/25/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022]
Abstract
AIMS Family intervention (FI) is recommended in national guidance to be offered to all service users accessing an early intervention in psychosis (EIP) team, due to the consistent evidence base in reducing relapse and rehospitalisation rates. However, FI implementation is poor nationally. Although barriers have been identified at the level of staff member and the organisation, there is a paucity of research identifying service user perspectives. METHODS A qualitative questionnaire design was used to explore service user perspectives of behavioural family therapy (BFT) within a specialist EIP service in northwest England. RESULTS Most participants contacted reported they lacked knowledge and understanding of BFT, with 54% reporting that this intervention had not been offered to them. This finding was unexpected and is inconsistent with the offer of BFT documentation in their clinical notes. Reasons for accepting BFT included to increase understanding of family members and for them to also be supported. Reasons for declining BFT included a preference for one-to-one interventions and not wanting family involved in their care. CONCLUSIONS National guidance on FI for psychosis is not reliably being translated to clinical practice, with many participants reporting that they were not offered this intervention. A key factor in accepting or declining an offer of BFT appeared to be whether participants wanted family members to be involved in their care. A lack of understanding of the BFT approach was evident, it is recommended that the offer of FI in psychosis is improved for service users to make an informed decision.
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Affiliation(s)
- Ashley Grant
- Harry Blackman House, Peasely Cross Hospital, St Helens, UK
| | - Peter Dargan
- Harry Blackman House, Peasely Cross Hospital, St Helens, UK
| | - Stacey Mather
- Harry Blackman House, Peasely Cross Hospital, St Helens, UK
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Sidis AE, Moore A, Pickard J, Deane FP. “Always opening and never closing”: How dialogical therapists understand and create reflective conversations in network meetings. Front Psychol 2022; 13:992785. [PMID: 36275250 PMCID: PMC9580692 DOI: 10.3389/fpsyg.2022.992785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Tom Andersen’s reflecting team process, which allowed families to witness and respond to the talk of professionals during therapy sessions, has been described as revolutionary in the field of family therapy. Reflecting teams are prominent in a number of family therapy approaches, more recently in narrative and dialogical therapies. This way of working is considered more a philosophy than a technique, and has been received positively by both therapists and service users. This paper describes how dialogical therapists conceptualise the reflective process, how they work to engage families in reflective dialogues and how this supports change. We conducted semi-structured, reflective interviews with 12 dialogical therapists with between 2 and 20 years of experience. Interpretative Phenomenological analysis of transcribed interviews identified varying conceptualisations of the reflecting process and descriptions of therapist actions that support reflective talk among network members. We adopted a dialogical approach to interpretation of this data. In this sense, we did not aim to condense accounts into consensus but instead to describe variations and new ways of understanding dialogical reflecting team practices. Four themes were identified: Lived experience as expertise; Listening to the self and hearing others; Relational responsiveness and fostering connection; and Opening space for something new. We applied these themes to psychotherapy process literature both within family therapy literature and more broadly to understand more about how reflecting teams promote helpful and healing conversations in practice.
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Affiliation(s)
- A. E. Sidis
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
- *Correspondence: A. E. Sidis,
| | - A.R. Moore
- School of Humanities and Social Inquiry, University of Wollongong, Wollongong, NSW, Australia
| | - J. Pickard
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - F. P. Deane
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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Iyer SN, Malla A, Taksal A, Maraj A, Mohan G, Ramachandran P, Margolese HC, Schmitz N, Joober R, Rangaswamy T. Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada. Psychol Med 2022; 52:1538-1547. [PMID: 32981550 DOI: 10.1017/s0033291720003359] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement. METHODS Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender). RESULTS The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = -1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81-0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73). CONCLUSIONS This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes.
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Affiliation(s)
- Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Anika Maraj
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
| | | | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis- McGill University Health Centre (PEPP-MUHC), Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
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McCluskey A, de Vries J. Help, I can't help: A qualitative study of psychiatric nurse's perspectives on their care for people who hear voices. J Psychiatr Ment Health Nurs 2021; 28:138-148. [PMID: 32348615 DOI: 10.1111/jpm.12642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 12/20/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: There are no studies on the perceptions of psychiatric nurses on interventions they provided to people hearing voices while in an acute psychiatric unit in Ireland. There are three studies focussed on psychiatric nurses' experiences of caring for people that hear voices, two based in England and one based in Australia. Only two of these studies is focussed on nurses working in an acute psychiatric unit. WHAT IS THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study used semi-structured interviews to explore perceptions of psychiatric nurses in the Republic of Ireland on interventions they provided people hearing voices while in an acute psychiatric unit. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further quantitative and qualitative research into the nursing practice for people experiencing auditory hallucinations, in both in-patient and community settings. Follow up supports and supervision after the completion training programmes should be implemented, to ensure the transition of skills and knowledge to the clinical environment. Further investigation into whether or not psychiatric nurses are well prepared for the developments outlined in national polices. ABSTRACT: Aims and Objectives To explore the perspectives and experiences of Irish psychiatric nurses working in acute care in regard to their role in addressing hearing voices in the people in their care, with a view to gain insight in the nurses' personal experiences, interventions they provide, attitudes, knowledge, facilitating factors and challenges. Background Treatment of auditory hallucinations often takes place in acute psychiatric care. Traditionally treatment was focused on medication, but this is no longer the sole approach, with psychosocial interventions gaining ground. Psychiatric nurses have the potential to provide these interventions. As part of the changing emphasis of mental health care in Ireland towards more responsibilities for psychiatric nurses, there is a need to establish whether psychiatric nurses are prepared to take up these added responsibilities. Design A qualitative study, comprising of semi-structured interviews (n = 16). Results Four themes emerged through thematic analysis. These included (a) the importance of therapeutic relationships; (b) reservations about the emphasis on medication; (c) limitations to interventions; and (d) the lack of focus/structure of interventions. Conclusions The use of systematic psychosocial interventions for people who hear voices is not well supported in the acute psychiatric settings the psychiatric nurses in the study worked in.
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Affiliation(s)
| | - Jan de Vries
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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7
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Fernandes JB, Fernandes SB, Almeida AS, Cunningham RC. Barriers to Family Resilience in Caregivers of People Who Have Schizophrenia. J Nurs Scholarsh 2021; 53:393-399. [PMID: 33780160 PMCID: PMC8359939 DOI: 10.1111/jnu.12651] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To explore the barriers to family resilience in caregivers of people who have schizophrenia. DESIGN A qualitative descriptive approach was used. METHODS Semistructured interviews were conducted with family caregivers of patients with schizophrenia registered at the psychiatry outpatient unit of a hospital center. Content analysis was performed on audio-recorded and verbatim-transcribed interviews. The consolidated criteria for reporting qualitative research (COREQ) checklist was applied to this study. RESULTS A total of 31 family caregivers participated, the majority of whom were female (71%) with an average age of 57.5 years. Most participants lived with and cared for their relative (90.3%). The caregiver role was assumed mostly by mothers (54.8%) and fathers (22.6%). Barriers to family resilience in caregivers of people experiencing schizophrenia broadly fall under five categories: lack of knowledge about the disease, social stigma, expressed emotion, involvement in the relationship, and blame. CONCLUSIONS In view of the paucity of studies exploring and understanding the barriers to family resilience, this study presents itself as one of the first in this area. There are different barriers to family resilience. This research provides an overview and an understanding of key barriers to family resilience in caregivers of people experiencing schizophrenia. CLINICAL RELEVANCE There is a need for nurses to help families to be resilient. By understanding the barriers to resilience, nurses are able to focus on these factors and help families to remove or reduce their influence.
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Affiliation(s)
- Júlio Belo Fernandes
- Professor, Department of Nursing, Escola Superior de Saúde Egas Moniz/CiiEM, Almada, Portugal
| | | | - Ana Silva Almeida
- Registered nurse, Department of Nursing, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Rhona Cruzet Cunningham
- Registered nurse, Department of Nursing, Whipps Cross University Hospital, London, United Kingdom
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Tseliou E, Burck C, Forbat L, Strong T, O'Reilly M. How is Systemic and Constructionist Therapy Change Process Narrated in Retrospective Accounts of Therapy? A Systematic Meta-synthesis Review. FAMILY PROCESS 2021; 60:64-83. [PMID: 32602564 DOI: 10.1111/famp.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
Despite the considerable potential of qualitative approaches for studying the systemic and constructionist therapy process due to shared theoretical and epistemological premises, to date there is lack of a comprehensive qualitative synthesis of how change process is experienced and conceptualized by clients and therapists. To address this evidence gap, we performed a systematic meta-synthesis review of 30 studies reporting clients' and therapists' retrospective narratives of change process across systemic and constructionist models and across a range of client configurations, including individuals, couples, families, and groups. The studies were identified following a systematic search in PsycINFO and MEDLINE resulting in 2,977 articles, which were screened against eligibility criteria. Thematic analysis led to the identification of four main themes: (1) navigating through differences, (2) toward nonpathologizing construction of problems, (3) navigating through power imbalances, and (4) toward new and trusting ways of relating. Findings illustrate the multifaceted aspects of systemic and constructionist change process, the importance for their reflexive appraisal, and the need for further research contributing to the understanding of the challenges inherent in the systemic and constructionist therapeutic context.
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Affiliation(s)
- Eleftheria Tseliou
- Laboratory of Psychology, Department of Early Childhood Education, University of Thessaly, Volos, Greece
| | - Charlotte Burck
- Family Therapy and Systemic Research Centre, Tavistock Clinic, London, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Tom Strong
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Michelle O'Reilly
- The Greenwood Institute of Child Health, University of Leicester, Leicester, UK
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Laskowski A, Lincoln TM. Network meta-analysis on the comparative efficacy of family interventions for psychotic disorders: a protocol. BMJ Open 2021; 11:e039777. [PMID: 33472774 PMCID: PMC7818829 DOI: 10.1136/bmjopen-2020-039777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Family interventions are effective and are strongly recommended for psychotic disorders. However, there is a variety of intervention types, and their differential efficacy is widely unclear. The aim of the planned network meta-analysis (NMA) is to compare the efficacy of family interventions that differ in content (eg, psychoeducation, mutual support, skills training) and format (eg, number of sessions, inclusion of patients, form of delivery). METHODS AND ANALYSIS We will include randomised controlled trials comparing psychosocial interventions directed at the adult relatives, friends or non-professional carers of people with a diagnosis of a psychotic disorder (schizophrenia spectrum) to any kind of control condition. The main outcomes will be global clinical state for the patients and coping with psychosis as well as attitudes towards psychosis for the relatives. Additional outcomes will be severity of symptoms, functioning, burden and compliance/drop-out. We conducted a comprehensive search of Cochrane Central Register of Controlled Trials, MEDLINE(R), PsycINFO, Cumulative Index to Nursing & Allied Health Literature (8 August 2019) and reference lists of review articles. Full-text assessment of eligibility, data extraction and risk-of-bias assessment will be done by two independent reviewers. An NMA will be conducted for any of the planned outcomes and intervention characteristics for which sufficient and appropriate data are available. The analyses will make use of a random effects model within a frequentist framework. Estimates for all pairwise treatment effects will be obtained using standardised mean differences for continuous outcomes and risk ratios for dichotomous outcomes. Interventions will be ranked according to their relative efficacy. We will address the assumption of transitivity, heterogeneity and inconsistency using theoretical and statistical approaches. The possibility of publication bias and the strength of evidence will also be examined. ETHICS AND DISSEMINATION There are no ethical concerns. Results will be published in peer-reviewed journals and presented at practitioners' conferences. PROSPERO REGISTRATION NUMBER CRD42020148728.
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Affiliation(s)
- Alina Laskowski
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
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Educational Response to a Student with Psychosis at the Secondary Level: A Non-Experimental Single-Case Study. Eur J Investig Health Psychol Educ 2020; 10:1080-1094. [PMID: 34542437 PMCID: PMC8314312 DOI: 10.3390/ejihpe10040076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
Students with psychosis in school within the ordinary education system are a reality in the classroom. To study their correct adaptation at school, it is necessary to consider numerous factors such as the personal characteristics of the student, environmental variables, educational measures put in place as well as emotional and cognitive aspects. The aim of this research was to monitor the teaching-learning process of a student diagnosed with psychosis and enrolled in a public school at the secondary level in the ordinary modality with support during an academic year, with the usual resources provided by a guidance department to assess the impact of the educational measures and plans on his emotional and academic fields. This was a single case study in which both qualitative and quantitative information was collected (N = 1). The participant was a student with special needs at the secondary level. An analysis of the results of psychometric tests, plan for diversity, observational analysis, academic file, scholastic history, and multiple interviews were carried out. The findings show how the educational curriculum can be adapted to improve the competences of a student with psychosis by encouraging an increase in social abilities and potential cognitive abilities through the counseling department. The conclusions of this research can provide a guideline for comparison of different educational systems, paying greater attention to the development of emotional aspects, and opting for inclusive measures. In this line, this study shows that students with psychosis can share classrooms and studies with their peers, thus fulfilling the principle of educational inclusion.
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11
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Mizzi A, Honey A, Scanlan JN, Hancock N. Parent strategies to support young people experiencing mental health problems in Australia: What is most helpful? HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2299-2311. [PMID: 32511853 DOI: 10.1111/hsc.13051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
Parents are a critical resource in supporting young people who live with mental health problems. Qualitative research has identified that parents use a wide range of strategies to provide support. However, parents report being unsure which strategies are likely to be helpful, so often struggle in this role. Presently, little empirical evidence exists to assist parents to decide which strategies are likely to be most helpful. This study aimed to explore the parent-perceived helpfulness of parental strategies to support young people living with mental health problems. Data were collected from February to July of 2018, using a cross-sectional, online, anonymous, self-report survey of participants who identified as parenting a young person (15-24 years) diagnosed with a mental health problem (n = 70). Overall, the strategies perceived as most helpful were practical assistance and personal interactions aimed at promoting positive thoughts and feelings and obtaining appropriate treatment. Least helpful strategies tended to be control-type strategies, aimed at behaviour change. Overall, there was good alignment between strategies' helpfulness and frequency of use, however, there were exceptions. These exceptions are likely reflections of the specific context of particular situations as well as parental uncertainty regarding alternative strategies. Generally, perceptions of strategies' helpfulness were unrelated to parent or child characteristics. However, helpfulness of strategies was associated with parents' satisfaction with their relationship with the young person. Parents' collective experience-based perceptions about the helpfulness of strategies used to support young people experiencing mental health problems can be harnessed to inform mental health practitioners' advice to parents and contribute to better mental health outcomes for young people.
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Affiliation(s)
- Andrea Mizzi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Anne Honey
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Justin N Scanlan
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Nicola Hancock
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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12
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Byrne R, Bird J, Reeve S, Jones W, Shiers D, Morrison A, Pyle M, Peters S. Understanding young peoples' and family members' views of treatment for first episode psychosis in a randomised controlled trial (MAPS). EClinicalMedicine 2020; 24:100417. [PMID: 32775967 PMCID: PMC7393652 DOI: 10.1016/j.eclinm.2020.100417] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is limited evidence to inform treatment decision-making in adolescents experiencing first episode psychosis (FEP). In the MAPS trial (Managing Adolescent first Episode Psychosis: a feasibility Study), adolescents with FEP received either antipsychotic medication (AP), psychological intervention (PI), or both. We investigated treatment views of young people and family members across each treatment arm of MAPS. METHODS Thirteen adolescents participating in MAPS and eighteen family members attended in-depth audio-recorded interviews to discuss trial treatments. Interviews were analysed using inductive Thematic Analysis, identifying salient themes across these accounts. FINDINGS Family members in particular reported an urgent need for treatment regardless of type. Both AP and PI were broadly viewed as acceptable treatment approaches, but for differing reasons which participants weighed against a range of concerns. AP were often seen to reduce symptoms of psychosis, though participants expressed concerns about side effects. PI were viewed as interactive treatment approaches that helped improve understanding of psychosis and enhanced coping, although some found PI emotionally and cognitively challenging. Combining treatments was seen to maximise benefits, with a perceived interaction whereby AP facilitated engagement with PI. INTERPRETATION Acceptability of and engagement with treatments for FEP may differ between individual young people and their family/carers. In order to be able to offer fully informed choices, and determine an optimum treatment approach for young people with FEP, definitive trial evidence should be established to determine wanted and unwanted treatment impacts. FUNDING NIHR HTA programme (project number 15/31/04).
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Affiliation(s)
- R.E. Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - J.C. Bird
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX4 7JX, UK
| | - S. Reeve
- Department of Clinical, Educational, and Health Psychology, University College London, WC1E 6BT, UK
| | - W. Jones
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - D. Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
| | - A.P. Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - M. Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - S. Peters
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
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13
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McCann E, Neill F. Impact of a Family Interventions Module on Students' Knowledge, Skills and Attitudes. Issues Ment Health Nurs 2019; 40:747-753. [PMID: 31021672 DOI: 10.1080/01612840.2019.1572252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Current evidence strongly supports the implementation of family interventions as a recognised approach to working with families. The aim of this study was to evaluate postgraduate students' learning experiences and skills development whilst undertaking a Master of Science module in family interventions. Questionnaires were used to elicit students' learning and experiences in relation to their work with families. Following analysis of students' responses, the key themes that emerged in relation to family interventions included: prior learning and experiences, changes in practice, skills development, supports in practice, and course strengths and challenges. Participants particularly valued the simulated learning and reflective elements of the module. The results of the study suggest that more staff should have access to education and training to enable practitioners to work more effectively with families. However, they will need to have support mechanisms in practice to effectively implement family interventions.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, University of Dublin , Trinity College , Dublin , Ireland
| | - Freda Neill
- School of Nursing and Midwifery, University of Dublin , Trinity College , Dublin , Ireland
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14
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Lo HHM, Ho WC, Lau ENS, Lo CW, Mak WWS, Ng SM, Wong SYS, Wong JOY, Lui SSY, Lo CSL, Lin ECL, Poon MF, Choi K, Leung CWC. A Brief Mindfulness-Based Family Psychoeducation Intervention for Chinese Young Adults With First Episode Psychosis: A Study Protocol. Front Psychol 2019; 10:516. [PMID: 30915004 PMCID: PMC6421292 DOI: 10.3389/fpsyg.2019.00516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/21/2019] [Indexed: 12/21/2022] Open
Abstract
Family psychoeducation (FPE) has been recommended as a major component in the treatment of psychosis. Many previous studies have implemented an intensive program design that often only emphasized improvements in patients' illness outcomes but the benefits for caregivers were limited. There have been calls for a time-limited but cost-effective FPE program to mitigate the looming reality of the suffering of people with psychosis and their families. A Brief Mindfulness-Based Family Psychoeducation for psychosis program is developed to reduce caregivers' burden and promote young adult's recovery. A randomized controlled trial will be conducted to compare this intervention with an ordinary FPE intervention. Both arms will involve six sessions, with a total contact time of 12 h. 300 caregivers of young adults who have experienced first episode psychosis within last 3 years will be recruited. Program effectiveness will be assessed by comparing outcomes measuring the caregivers' burden, mental health symptoms, positive well-being, and the young adult's mental health symptoms during the study and at 9-month post-randomization. The role of expressed emotions, interpersonal mindfulness, and non-attachment in mediating these outcomes will be explored. An additional qualitative approach Photovoice is selected to explore the complex family experiences and the benefits of mindfulness from the caregivers' personal perspectives. Trial Registration: The trial is registered with the United States Clinical Trials Registry (ClinicalTrials.gov): NCT03688009.
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Affiliation(s)
- Herman Hay-Ming Lo
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Wing-Chung Ho
- Department of Social and Behavioural Sciences, The City University of Hong Kong, Kowloon, Hong Kong
| | - Elsa Ngar-Sze Lau
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Chun-Wai Lo
- Specialist in Psychiatry, Private Practice, Hong Kong, Hong Kong
| | - Winnie W. S. Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, China
| | - Siu-Man Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Simon S. Y. Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, Hong Kong
| | - Cola Siu-Lin Lo
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, Hong Kong
| | | | - Man-Fai Poon
- Integrative Community Centre for Mental Wellness, Baptist Oi Kwan Social Service, Hong Kong, Hong Kong
| | - Kong Choi
- Integrative Community Centre for Mental Wellness, Richmond Fellowship of Hong Kong, Hong Kong, Hong Kong
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15
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The coping process of Japanese parents who experience violence from adult children with schizophrenia. Arch Psychiatr Nurs 2018; 32:549-554. [PMID: 30029746 DOI: 10.1016/j.apnu.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
Abstract
With the acceleration of deinstitutionalization might increase families' chances of suffering violence by patients. This study clarified parents' coping processes with violence experienced from patients with schizophrenia. The grounded theory approach was used, and 26 parents were interviewed. We identified a four-stage coping process: (1) hope for treatment, (2) living with violence, (3) trying to solve violence, and (4) last solution for violence. This coping process had two illness-related characteristics: (1) a process of coping with two main stressful events (the illness and violence), and (2) the need for long-term appraisal of violence because of its unclear causes.
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16
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Ma CF, Chien WT, Bressington DT. Family intervention for caregivers of people with recent-onset psychosis: A systematic review and meta-analysis. Early Interv Psychiatry 2018; 12:535-560. [PMID: 29076263 DOI: 10.1111/eip.12494] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/19/2017] [Accepted: 08/20/2017] [Indexed: 11/29/2022]
Abstract
AIM We aimed to systematically review the evidence of the effectiveness of family interventions for caregivers of people with recent-onset psychosis compared with usual psychiatric care. A secondary objective was to directly compare the effects of different types of family interventions. METHODS MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Complete and EBSCOhost were searched to identify relevant randomized controlled trials. Trial data were extracted following the procedures described in the Cochrane Handbook of systematic reviews. Random-effects models were used to pool the intervention effects. RESULTS Twelve studies including 1644 participants were included in this review. With the exception of a high risk of performance bias inherent to the nature of the psychosocial interventions, the studies had an overall low or unclear risk of bias, suggesting that sources of bias are unlikely to lower confidence in the estimate of intervention effects. Meta-analyses were conducted for 4 different participant outcomes reported in 9 studies. Compared with usual psychiatric care, family intervention was more effective in reducing care burden over all follow-up periods. Family intervention was also superior to usual care with regards to caregiving experience in the short term and improved utilization of formal support and family functioning over longer-term follow up. Mutual support is more effective than psychoeducation in improving family functioning when measured 1 to 2 years after the intervention but had equivalent effects on utilization of formal support services. CONCLUSIONS This review provides evidence that family intervention is effective for caregivers of recent-onset psychosis, especially for care burden where the positive effects are enhanced over time.
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Affiliation(s)
- Chak Fai Ma
- Kwai Chung Hospital, Kwai Chung, New Territories, Hong Kong
| | - Wai Tong Chien
- The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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17
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Grácio J, Gonçalves-Pereira M, Leff J. Key Elements of a Family Intervention for Schizophrenia: A Qualitative Analysis of an RCT. FAMILY PROCESS 2018; 57:100-112. [PMID: 27896805 DOI: 10.1111/famp.12271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Schizophrenia is a complex biopsychosocial condition in which expressed emotion in family members is a robust predictor of relapse. Not surprisingly, family interventions are remarkably effective and thus recommended in current treatment guidelines. Their key elements seem to be common therapeutic factors, followed by education and coping skills training. However, few studies have explored these key elements and the process of the intervention itself. We conducted a qualitative and quantitative analysis of the records from a pioneering family intervention trial addressing expressed emotion, published by Leff and colleagues four decades ago. Records were analyzed into categories and data explored using descriptive statistics. This was complemented by a narrative evaluation using an inductive approach based on emotional markers and markers of change. The most used strategies in the intervention were addressing needs, followed by coping skills enhancement, advice, and emotional support. Dealing with overinvolvement and reframing were the next most frequent. Single-family home sessions seemed to augment the therapeutic work conducted in family groups. Overall the intervention seemed to promote cognitive and emotional change in the participants, and therapists were sensitive to the emotional trajectory of each subject. On the basis of our findings, we developed a longitudinal framework for better understanding the process of this treatment approach.
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Affiliation(s)
- Jaime Grácio
- Chronic Diseases Research Center (CEDOC), Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Clínica Psiquiátrica de S. José, Sisters Hospitallers, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- Chronic Diseases Research Center (CEDOC), Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Julian Leff
- King's College London, London, UK
- University College London, London, UK
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18
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Lebow JL. Editorial: The Multidisciplinary World of Couple and Family Therapy and Family Science. FAMILY PROCESS 2017; 56:795-798. [PMID: 29205341 DOI: 10.1111/famp.12324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Jay L Lebow
- Family Institute at Northwestern, Evanston, IL
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19
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Kageyama M, Yokoyama K, Nakamura Y, Kobayashi S. Changes in Families' Caregiving Experiences through Involvement as Participants then Facilitators in a Family Peer-Education Program for Mental Disorders in Japan. FAMILY PROCESS 2017; 56:408-422. [PMID: 28591461 DOI: 10.1111/famp.12194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A family peer-education program for mental disorders was developed in Japan, similar to existing programs in the United States and Hong Kong. Families that serve as facilitators in such programs may enhance their caregiving processes and, thereby, their well-being. This study's aim was to describe how families' caregiving experiences change, beginning with the onset of a family member's mental illness, through their involvement in a family group or peer-education program as participants then facilitators. Thus, this study was conducted in a family peer-education program for mental disorders in Japan. Group interviews were conducted with 27 facilitators from seven program sites about their experiences before, during, and after becoming facilitators. Interview data were coded and categorized into five stages of caregiving processes: (1) withdrawing and suppressing negative experiences with difficulty and regret; (2) finding comfort through being listened to about negative experiences; (3) supporting participants' sharing as facilitators; (4) understanding and affirming oneself through repeated sharing of experiences; and (5) finding value and social roles in one's experiences. The third, fourth, and fifth stages were experienced by the facilitators. The value that the facilitators placed on their caregiving experiences changed from negative to positive, which participants regarded as helpful and supportive. We conclude that serving as facilitators may improve families' caregiving processes.
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Affiliation(s)
- Masako Kageyama
- Department of Community Health Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiko Yokoyama
- Department of Nursing, Faculty of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Sayaka Kobayashi
- National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
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20
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Cherry MG, Taylor PJ, Brown SL, Rigby JW, Sellwood W. Guilt, shame and expressed emotion in carers of people with long-term mental health difficulties: A systematic review. Psychiatry Res 2017; 249:139-151. [PMID: 28095335 DOI: 10.1016/j.psychres.2016.12.056] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/14/2016] [Accepted: 12/17/2016] [Indexed: 11/30/2022]
Abstract
Expressed emotion (EE) is a global index of familial emotional climate, whose primary components are emotional over-involvement (EOI) and critical comments (CC)/hostility. There is a strong theoretical rationale for hypothesising that carers' guilt and shame may be differentially associated with their EOI and CC/hostility respectively. This systematic review investigates the magnitude of these theorised associations in carers of people with long-term mental health difficulties. Electronic searches (conducted in May 2016 across Medline, CINAHL, Embase, PsycINFO and ProQuest) were supplemented with iterative hand searches. Ten papers, reporting data from eight studies, were included. Risk of bias was assessed using a standardised checklist. Relevant data were extracted and synthesised narratively. EOI was positively associated with both guilt and shame, whereas CC/hostility was positively associated with shame. The strength of associations varied depending on whether or not guilt and shame were assessed within the context of the caring relationship. Based on these data, an argument can be made for the refinement, development and evaluation of systemic and individual interventions designed to target carers' guilt and shame. However, more research is needed to clarify the strength of these associations and their direction of effect before firm conclusions can be drawn.
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Affiliation(s)
- Mary Gemma Cherry
- Division of Clinical Psychology, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK.
| | - Peter James Taylor
- Division of Clinical Psychology, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK.
| | - Stephen Lloyd Brown
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK.
| | - Jake Wilfred Rigby
- Mersey Care NHS Trust, V7 Building, Kings Business Park, Prescot, Liverpool L34 1PJ, UK
| | - William Sellwood
- Division of Health Research, Furness Building, University of Lancaster, Bailrigg, Lancaster LA1 4YW, UK.
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21
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Caqueo-Urízar A, Rus-Calafell M, Craig TKJ, Irarrazaval M, Urzúa A, Boyer L, Williams DR. Schizophrenia: Impact on Family Dynamics. Curr Psychiatry Rep 2017; 19:2. [PMID: 28097634 DOI: 10.1007/s11920-017-0756-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Escuela de Psicología y Filosofía, Universidad de Tarapacá, Avenida 18 de Septiembre 2222, Arica, Chile.
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA.
| | - Mar Rus-Calafell
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Thomas K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matias Irarrazaval
- Departamento de Psiquiatría, Facultad de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | - Alfonso Urzúa
- Universidad Católica del Norte, Avda. Angamos 0610, Antofagasta, Chile
| | - Laurent Boyer
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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22
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Andreou C, Moritz S. Editorial: Non-pharmacological Interventions for Schizophrenia: How Much Can Be Achieved and How? Front Psychol 2016; 7:1289. [PMID: 27621717 PMCID: PMC5002417 DOI: 10.3389/fpsyg.2016.01289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/12/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-EppendorfHamburg, Germany; Center for Gender Research and Early Detection, University of Basel Psychiatric ClinicsBasel, Switzerland
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf Hamburg, Germany
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23
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McFarlane WR. Family Interventions for Schizophrenia and the Psychoses: A Review. FAMILY PROCESS 2016; 55:460-82. [PMID: 27411376 DOI: 10.1111/famp.12235] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Family psychoeducation as a treatment for schizophrenia was developed 40 years ago almost simultaneously and independently by investigators who at the time were not family therapists. Although the original goal was to decrease high expressed emotion as a means of preventing relapse, later variations have gone beyond to focus on social and role functioning and family well-being. Explicitly disavowing the earlier assumptions that family pathology caused relapse and deterioration, family psychoeducation seeks to engage family members as more sophisticated partners, complementing interventions by clinicians with specialized interactions and coping skills that counter the neurologic deficits inherent to the disorder. It has proved to be one of the most consistently effective treatments available. Reports on outcome studies now number more than 100, while meta-analyses put relapse rate reduction at 50-60% over treatment as usual. The most recent application in first episode and prodromal psychosis, combined with other evidence-based interventions, is yielding perhaps the most promising results yet achieved-substantial return of functioning and avoidance of psychosis altogether. Reviewed here are its scientific, theoretical, and clinical sources, a description of the most commonly applied version-the multifamily group format, selected clinical trials spanning those four decades, international and ethnic adaptations, and studies on mechanisms of efficacy.
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Affiliation(s)
- William R McFarlane
- Tufts University School of Medicine, Maine Medical Center Research Institute, Portland, ME.
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24
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Affiliation(s)
- Jay L Lebow
- Family Process and Family Institute at Northwestern, Evanston, IL
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