Psychoeducational Family Intervention: Benefits and Obstacles Reported by Mental Health Professionals

Introduction

Despite several guidelines recommend the use of psychoeducational family interventions (PFIs) as add-on in the treatment of patients with bipolar I disorder (a), their implementation on a large scale remains limited (b).

Objectives

To identify benefits and obstacles in implementing a PFI in the clinical routine care.

Methods

This was a multicentre, real-world, controlled, outpatient trial, carried out in 11 randomly recruited Italian mental health centres. Mental health professionals received a training on PFI and provided the intervention to patients with bipolar I disorder and their relatives. Difficulties and benefits in performing PFI were collected through an ad-hoc schedule, which was administered at baseline and 5 times during the different stages of the intervention.

Results

Mental health professionals report significant improvements in the intervention-related benefits over time (T0 = 5.3 ± 2.0 vs. T5 = 7.9 ± 0.9; P < .0001), in particular in their professional skills (T0 = 6.5 ± 2.3 vs. T5 = 8.0 ± 0.8; P < .01). They also report to be more satisfied with their own work (T0 = 6.6 ± 2.3 vs. T5 = 8.0 ± 1.3; P < .05). The most relevant difficulties were related to the need to integrate the PFI with other work responsibilities and to the lack of time, which did not decrease overtime.

Conclusions

PFIs are feasible in routine care for the treatment of patients with bipolar I disorder and their relatives, and main obstacles are related to the organization of mental health centres, and not to the characteristics of the intervention itself.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Effectiveness of Psychoeducational Family Intervention on Coping Strategies of Relatives of Patients with Bipolar I Disorder

Background

Relatives’ coping strategies – an essential element for the recovery of patients with severe mental disorders – are grouped in problem-oriented and emotion-focused. The former include practical strategies to deal with the stressful situation and are associated with a better long-term outcome of patients and relatives; the latter are psychologically driven and are associated with a worse outcome. It has been reported that psychoeducational family intervention (PFI) can improve problem-oriented coping strategies, while few data are available on relatives of patients with bipolar disorder.

Objectives

To assess the impact of the PFI on promotion of problem-oriented coping strategies adopted by relatives of patients with bipolar I disorder.

Methods

This study was conducted in 11 Italian mental health centers. Patients and their relatives were allocated to the experimental group receiving PFI or to the control group (waiting list). Before starting the intervention and at the end of the PFI, coping strategies were assessed using the family coping questionnaire.

Results

Of the 139 recruited families, 72 families were allocated to the experimental group and 67 to the control group. Relatives from the experimental group reported a significant improvement in problem-oriented coping strategies, such as positive communication (P < .01) and searching for information (P < .05). On the other hand, a reduction in collusion (P < .0001), avoidance (P < .01) and resignation (P < .001) were found at the end of the intervention.

Conclusions

PFI is effective in promoting the coping strategies in relatives of patients with bipolar I disorder and it should be given routinely in mental health centers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Hyperbilirubinemia in the breast-fed newborn: a controlled trial of four interventions

A controlled clinical trial was conducted to compare the effect of four different interventions on hyperbilirubinemia in 125 full-term breast-fed infants. Of 1685 term infants who met the inclusion criteria, 126 (7.4%) had a serum bilirubin concentration > or = 291 mumol/L (17 mg/dL). When the bilirubin reached this level, babies were assigned at random to one of four interventions: (1) continue breast-feeding and observe; (2) discontinue breast-feeding, substitute formula; (3) discontinue breast-feeding, substitute formula and administer phototherapy; (4) continue breast-feeding, administer phototherapy. The serum bilirubin concentration reached 342 mumol/L (20 mg/dL) in 24% of infants in group 1, 19% in group 2, 3% in group 3, and 14% in group 4. When phototherapy was used, the decline in serum bilirubin was significantly larger and more rapid (compared with no phototherapy). In the majority of breast-fed infants whose serum bilirubin levels reach 291 mumol/L (17 mg/dL) the bilirubin will decline spontaneously and will not reach 342 mumol/L (20 mg/dL). If the infant is significantly jaundiced and a decision is made to intervene, parents can be given a number of options and can make an informed decision regarding which, if any, intervention they prefer.