Integrated treatment of first-episode psychosis: Effect of treatment on family burden: OPUS trial

Bispebjerg Hospital, Department of Psychiatry, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark.
The British journal of psychiatry. Supplement 09/2005; 48(48):s85-90. DOI: 10.1192/bjp.187.48.s85
Source: PubMed


The families of patients with first-episode psychosis often play a major role in care and often experience lack of support.
To determine the effect of integrated treatment v. standard treatment on subjective burden of illness, expressed emotion (EE), knowledge of illness and satisfaction with treatment in key relatives of patients with a first episode of schizophrenia-spectrum disorder.
Patients with ICD-10 schizophrenia-spectrum disorders (first episode) were randomly assigned to integrated treatment or to standard treatment. Integrated treatment consisted of assertive community treatment, psychoeducational multi-family groups and social skills training. Key relatives were assessed with the Social Behaviour Assessment Schedule (SBAS, burden of illness), the 5-min speech sample (EE), and a multiple choice questionnaire at entry and after 1 year.
Relatives in integrated treatment felt less burdened and were significantly more satisfied with treatment than relatives in standard treatment. There were no significant effects of intervention groups on knowledge of illness and EE.
The integrated treatment reduced family burden of illness and improved satisfaction with treatment.

Download full-text


Available from: Merete Nordentoft, May 22, 2015
  • Source
    • "Multi-element intervention studies in FEP were excluded as the current review aims at understanding the evidence of a single intervention (family intervention). To clarify, family interventions were given in many early intervention trials along with patient-oriented pharmacological and non-pharmacological interventions such as social skill training, cognitive–behavioral therapy (CBT) and crisis intervention (Bertelsen et al., 2008; Craig et al., 2004; Grawe, Falloon, Widen, & Skogvoll, 2006; Jeppesen et al., 2005; Kuipers, Holloway, Rabe-Hesketh, & Tennakoon, 2004; Petersen et al., 2005; Tempier, Balbuena, Garety, & Craig, 2012). Such study reports were not included because it was difficult to isolate the efficacy of any single intervention (family intervention) effectiveness. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Family interventions have produced benefits on clinical and family outcomes in long standing psychosis. However, little is known about the efficacy of such interventions in the early stages of psychosis. This article reviews published research over the last two decades on family intervention in first-episode psychosis. Electronic databases, such as PubMed, PsycINFO, and ScienceDirect, have been systematically searched. In addition, an exhaustive Internet search was also carried out using Google and Google Scholar to identify the potential studies that evaluated family interventions in first-episode psychosis. We have identified seven reports of five randomized controlled trials (RCTs) and five non-randomized and uncontrolled studies of family intervention. Our review on 12 reports of family intervention studies has shown mixed effects on outcomes in first-episode psychosis. Most of the reports showed no added benefits or very short-term benefits on primary clinical or family outcome variables. There is a dearth of family intervention studies in first-episode psychosis. More RCTs are needed to reach reliable conclusions.
    Full-text · Article · Nov 2015 · SAGE Open
  • Source
    • "However, it was noted that in the absence of other primary caregivers, they play an important role in caring for their affected sibling.11,12) In this context, it is important to note that many psychosocial intervention studies with caregivers of psychosis have shown that the number of siblings who participated in the interventions are less compared to the parent and spouse caregivers.13,14,15,16,17,18,19,20,21,22) "
    [Show abstract] [Hide abstract]
    ABSTRACT: Research on caregivers of psychosis has predominantly focused on parents and spouses. Issues related to siblings of persons with psychosis (SOPP) are yet to be evaluated comprehensively. Like parents and spouses, SOPP also share the caregiver burden and have their own issues and needs. This systematic descriptive review aims to identify the types of needs of SOPP in the published literature and gives implications for further practice and research. The primary data search was carried out with predefined protocol in PubMed database and an additional hand search was done in EBSCOhost, ProQuest, Scopus, and PsychINFO. All the searches yielded a total of 862 titles. After screening for necessary inclusion criteria, seven studies were included in the final review. The results are discussed under six major themes that emerged from this review. Six out of seven studies highlighted the need for information on siblings' illness and participation in caregiver support group. Other important needs were illness management or rehabilitation needs; help in managing their own psychosocial issues; treatment related informational needs; and inclusion in treatment process. The socio-demographic details of these studies showed that majority of the participants were female siblings of Caucasian or white British ethnicity and from developed countries. SOPP predominantly have specific needs such as informational and support group needs, which are different in the priority of other primary caregiver needs. Paucity of literature from developing countries and the limitations of the existing studies warrant further systematic research.
    Full-text · Article · Aug 2014 · Clinical Psychopharmacology and Neuroscience
  • Source
    • "There have been cultural differences in the approach to such group work, with a family therapy approach more prevalent in the United States and Europe and a psychoeducation approach more prevalent in China, Brazil, and various developing countries (Mueser, 2011). The most highly investigated approach to group work for carers with a family member experiencing serious mental illness has been the multifamily group approach (Dyck, Hendryx, Short, Voss, & McFarlane, 2002; Hazel et al., 2004), based on the McFarlane model (McFarlane et al., 1995), incorporating the presence of the person experiencing mental illness; an approach now being utilized with people experiencing FEP and their families (Fjell et al., 2007; Jeppesen et al., 2005; Mullen, Murray, & Happell, 2002). In many FEP services, however, there has been a decision to provide a separate space for carers to voice their experiences and seek information in their own right (McWilliams et al., 2010; Pickett-Schenk et al., 2000; Sin et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Families play an important role in relapse-prevention following a person's first psychotic episode. To evaluate an open-ended family group intervention within a public adult mental health service, semi-structured interviews were conducted with: (1) carers who continually attended; (2) carers who attended once only; (3) carers who never attended; (4) case managers and (5) early psychosis clinicians. Benefits to group participation included: reduced isolation, sense of collective experience, opportunity to feel heard, reduced stigma and shame, increased knowledge about mental illness, and enhanced skills in supporting the care recipient. Barriers included: competing family and work commitments, applicability to own experiences of caring, discomfort with social situations and revealing and hearing emotions, and a belief that experiences are private. While attending the group increased knowledge, the benefits most emphasized were in the social connection with other carers and sharing one's story in a safe and reassuring environment.
    Full-text · Article · Mar 2014 · Social Work in Mental Health
Show more