Abstract
Family interventions for psychosis (FIp) are effective in reducing service user relapse and carer distress in people with schizophrenia-spectrum conditions. Several treatment and best practice guidelines recommend FIp for all people with schizophrenia. However, outcome findings in relation to early psychosis groups have been inconsistent. The current paper reports a systematic review and meta-analyses of articles that evaluated FIp in early psychosis with a clearly defined comparison group. A combination of electronic database searches (using PsychINFO, Medline, and CENTRAL), citation searches and hand searches of key journals and reviews was conducted. Peer-reviewed articles published in English from database inception to June 2016 were included. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Seventeen papers from 14 studies met inclusion criteria for review, the overall quality of which was moderate. Meta-analytic synthesis showed that FIp improved service user functioning and reduced the likelihood of relapse by the end of treatment. Psychotic symptoms were significantly reduced in the FIp group at follow up, but this was not evident at end of treatment. In terms of FIp target mechanisms, carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused criticism or engage in conflict communication than carers randomized to standard care. Carer burden and well-being were improved by the end of treatment but gains were not sustained at follow up. FIp had no impact on carer emotional over-involvement. The findings indicate that FIp is an effective intervention for early psychosis service users and their relatives. However, further research is required to establish which key therapeutic components of FIp are most effective for whom, in addition to understanding the mechanisms by which FIp might affect positive change.
Highlights
The first episode of psychosis usually occurs in late adolescence to early adulthood (Mueser and McGurk, 2004)
Primary reasons for exclusion included: (1) the family intervention not being clearly defined in the method or analysis; (2) no comparison group; and (3) participants not meeting the “early psychosis” criteria
The findings suggested FIp may have an important role in reducing the number of relapses and increasing general functioning at the end of treatment for those with early psychosis
Summary
The first episode of psychosis usually occurs in late adolescence to early adulthood (Mueser and McGurk, 2004). The few years following the emergence of symptoms are considered to be a “critical period”; involving the greatest clinical deterioration (Lieberman et al, 2001), determining the future course and prognosis of the illness and offering a window for ensuring optimal support and treatment (Birchwood et al, 1997). An increased number of episodes (or relapses) during the early stages of psychosis is associated with poorer clinical (Birchwood et al, 1998; Emsley et al, 2008) and recovery outcomes (Shrivastava et al, 2010). There is a continued need for early identification and effective treatment options to support those who might be at risk of developing psychosis, as well as those in the early stages of the illness, in order to ensure optimum prognosis (McGlashan et al, 2007)
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