FALLOON Family Interventions for Mental Disorders

8/13/2019 FALLOON Family Interventions for Mental Disorders

1/35


2/35

(he fo!!o&ing popper user interface contro! may not )e accessi)!e. (a) to the net

)utton to re"ert the contro! to an accessi)!e "ersion.

2estroy user interface contro!$3. Led )y :eorge 9ro&n and ;ohn


3/35

Fortunate!y not a!! those &ho studied this !iterature conc!uded that the )est &ay for&ard

&as to see4 a!ternati"es to fami!y care for peop!e &ith serious menta! disorders. A sma!!

group !ed )y Ro)ert Li)erman set out on a different direction that aimed to he!p those

fami!ies &ho &ere so )urdened and stressed )y the care of their re!ati"es7 that they &ere

una)!e to demonstrate the positi"e caring )eha"iours that appeared to enhance the

prognosis of patients. 2etai!ed education a)out the nature of menta! disorders and theiroptima! treatment &as fo!!o&ed )y practica! pro)!em so!"ing a)out ho& to manage the

e"eryday difficu!ties they encountered &ith patientsB residua! symptoms and

interpersona! difficu!ties 0



2estroy user interface contro!3. Re!ati"es and patients &ere encouraged to use effecti"e

communication s4i!!s to epress their emotions in a manner not dissimi!ar to the

methods de"e!oped )y ear!ier fami!y systems therapists. (he focus &as on increasing

the epression of positi"e comments for efforts patients made7 no matter ho& tri"ia!they might seem7 and on reducing nagging and hosti!e criticism7 rep!acing this &ith

attempts to c!arify 4ey pro)!em issues in a &ay that &ou!d enhance patientsB efforts to

so!"e them. In simp!istic terms7 this psychoeducationa! approach aimed to con"ert

harmfu! high epressed emotion to he!pfu! !o& epressed emotion7 or to teach fami!y

mem)ers some of the core s4i!!s of effecti"e nursing and reha)i!itation strategies. From

these ear!y )eginnings in the mid 1?*s7 a series of random contro!!ed tria!s &as

instigated7 initia!!y &ith schi+ophrenic disorders7 )ut !ater &ith an increasing range of

menta! hea!th pro)!ems. In the remainder of this paper &e &i!! re"ie& the resu!ts of this

)ody of &or4 in terms of e"idence for the efficacy and the effecti"eness of fami!y

inter"entions in adu!t menta! hea!th.

:o to#

FAMILY INTERVENTIONS FOR

SCI!O"RENIC #ISOR#ERS

Optima! drug therapy remains the cornerstone of the c!inica! management of psychotic

disorders7 at !east in the periods after maor psychotic episodes. Ho&e"er7 su)stantia!

additiona! )enefits ha"e )een reported &hen optima! pharmacotherapy has )een

integrated &ith fami!y8)ased treatments 0



2estroy user interface contro!1*8



2estroy user interface contro!1'3. (he educationa! fami!y strategies attempt to reduce

the impact of en"ironmenta! stresses on the )io!ogica!!y "u!nera)!e indi"idua! &hi!st

promoting socia! functioning. (&o maor strategies ha"e )een de"e!oped. (he first7carer8)ased stress management7 deri"ed from cogniti"e )eha"ioura! therapy7 see4s to
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B9http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B10http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B15http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B9http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B10http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B15


4/35

enhance the pro)!em so!"ing efficiency of the patient and his or her socia! support

system and to acti"e!y promote the achie"ement of persona! !ife goa!s 0



2estroy user interface contro!53. (he second educates caregi"ers in stress reduction

strategies and to increase acceptance of )eha"iour associated &ith )oth positi"e and

negati"e symptoms 0



2estroy user interface contro!>7



2estroy user interface contro!1>3.

Fifty contro!!ed studies &ith ade=uate research methodo!ogy ha"e )een pu)!ished since

1/*. Fifteen &ere of )rief duration and cou!d not )e considered an ade=uate tria! of

integrated )iomedica! and psychosocia! treatment for serious menta! disorders. -ost of

these studies &ere menta! hea!th education on!y 0



2estroy user interface contro!1?8



2estroy user interface contro!5$3. (&o ear!y pioneering studies of )rief fami!y

inter"ention &ere a!so ec!uded 0



2estroy user interface contro!5%7



2estroy user interface contro!5'3. ight other studies had serious methodo!ogica! f!a&s

and &ere ec!uded from the detai!ed ana!ysis. (hey &ere main!y studies of the )enefits

of app!ying fami!y approaches in c!inica! practice 0

(he fo!!o&ing popper user interface contro! may not )e accessi)!e. (a) to the net)utton to re"ert the contro! to an accessi)!e "ersion.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B16http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B17http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B23http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B24http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B16http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B17http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B23http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B24http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B25


5/35

2estroy user interface contro!5>8



2estroy user interface contro!$$3. One ece!!ent study &as ec!uded on the )asis thatthe eperimenta! Bre!apse pre"ention programB in"estigated consisted of a comp!e )!end

of indi"idua!7 group and fami!y strategies 0



2estroy user interface contro!$%37 &hi!e another compared )rief and !ong8term fami!y

education 0



2estroy user interface contro!$'3.

(he remaining 5' studies &ere genera!!y of a high =ua!ity. One maor deficit7 common

to a!! psychosocia! research7 is the ina)i!ity to de!i"er psychosocia! treatments in a

manner that &as B)!indB to the patients and associates7 inc!uding the c!inicians and

independent assessors. Re!ati"e!y fe& studies contro!!ed for non8specific "aria)!es7 such

as therapist contact7 s4i!!s and enthusiasm7 or the anci!!ary treatment strategies used in

the case management.

(he studies "aried considera)!y in the specific inter"ention strategies eamined. (he

most )asic mere!y pro"ided se"era! sessions gi"ing information a)out drug treatments 0



2estroy user interface contro!$>7



2estroy user interface contro!$?3. Others etended for se"era! years7 &ith continued

education7 stress management strategies7 socia! s4i!!s training7 "ocationa! training7

specific cogniti"e )eha"ioura! strategies and home8)ased crisis management &hen

necessary 0



2estroy user interface contro!$/8



6/35

2estroy user interface contro!%>3. It is important to rea!ise that not a!! fami!y

inter"entions are the same7 and for that reason the )enefits may )e epected to differ.

A!most a!! studies in"o!"ed patients &ith a diagnosis of schi+ophreniform7

schi+ophrenic or schi+oaffecti"e psychoses. (reatment &as usua!!y initiated after crisis

management had produced a remission of the acute symptoms of a maor psychoticepisode. (he methods of outcome assessment "aried su)stantia!!y. -ost studies focused

on pre"ention of maor eacer)ations of psychotic symptoms7 using c!inica! udgments

of Bre!apseB that &ere not a!&ays &e!! standardi+ed 0



2estroy user interface contro!%?3. Some studies a!so used standardi+ed rating sca!es to

measure c!inica!7 socia!7 fami!y and economic )enefits7 so it is possi)!e to eamine a

)roader range of re!e"ant outcomes. 2ifferentia! dropouts from the treatment

approaches &ere rare!y e"a!uated. Ho&e"er7 &e ha"e endea"ored to use the Bintention8to8treatB approach to ana!y+ing the )enefits. Furthermore7 in our consideration of c!inica!

efficacy7 &e ha"e de"ised an inde of outcome that com)ines not mere!y maor

psychotic episodes7 )ut maor episodes of any psychiatric symptoms7 such as suicida!

ideationD attempts or affecti"e distur)ances7 hospita! admissions for any reason7 and

&ithdra&a! from the a!!ocated treatment for c!inica! reasons. (his pro"ides a high!y

conser"ati"e portraya! of the )enefits that might )e epected in c!inica! practice.

Clinical $enefits

ighteen tria!s compared indi"idua!i+ed case management and maintenance medication&ith or &ithout the addition of a fami!y8)ased stress management strategy. Of these7 1%

sho&ed a significant ad"antage for the stress management approaches 0









2estroy user interface contro!%*7



2estroy user interface contro!%17
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B46http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B47http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B36http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B38http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B40http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B41http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B46http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B47http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B36http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B38http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B40http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B41


7/35



2estroy user interface contro!%%7


2estroy user interface contro!%>7



2estroy user interface contro!%/8



2estroy user interface contro!'%37 t&o no significant differences 0



2estroy user interface contro!''7



2estroy user interface contro!'>37 and t&o sho&ed greater ad"antages for indi"idua!

case management 0



2estroy user interface contro!$7



2estroy user interface contro!%*3.

(he proportion of cases maintained in treatment for one year &ithout any maor

eacer)ations of any form of psychopatho!ogy sho&ed a 5'E ad"antage for the stress

management strategies# >5E had a successfu! outcome during the 158month period7

compared to $?E of those not recei"ing carer8)ased stress management. (hese resu!ts

are high!y significant )oth from a statistica! as &e!! as a c!inica! "ie&point 0


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B46http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B48http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B54http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B55http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B56http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B39http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B40http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B46http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B48http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B54http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B55http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B56http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B39http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B40


8/35

2estroy user interface contro!'/3.

Remission of resid%al sym&toms

(he a)sence of maor episodes is not the on!y goa! of !ong8term treatment. -ost

patients eperience continuing psychotic and deficit symptoms for some time after amaor psychotic episode 0



2estroy user interface contro!'3. (he )enefits of fami!y strategies in reducing this

residua! psychopatho!ogy7 and there)y enhancing the trend to&ards fu!! remission of

schi+ophrenia7 &as assessed in 1$ studies 0





















2estroy user interface contro!'17
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B58http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B59http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B39http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B40http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B46http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B48http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B51http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B58http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B59http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B39http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B40http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B46http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B48http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B51


9/35





2estroy user interface contro!'%7



2estroy user interface contro!''7



2estroy user interface contro!>*7



2estroy user interface contro!>13. (hese studies compared ratings of psychopatho!ogy

at the )eginning of the study &ith those o)tained up to a year !ater. In of these studies

an o"era!! trend to&ards reco"ery &as o)ser"ed7 )oth &ith eperimenta! and contro!

treatments. hang et a! 0



2estroy user interface contro!'%3 noted this trend on!y for those patients recei"ing the

stress management &ho did not ha"e any symptom eacer)ations. One study that used a

)!ind assessor to conduct standardised inter"ie&s of psychopatho!ogy )efore treatment7

and again at and 5% months7 sho&ed that >'E of cases recei"ing the fami!y8)ased

approach achie"ed fu!! remissions of )oth psychotic and deficit schi+ophrenic

symptoms at t&o years7 in contrast to 1'E associated &ith indi"idua! asserti"e case

management 0




Social o%tcome

Fu!! socia! reco"ery from menta! disorders may )e more difficu!t to achie"e than

c!inica! remission. (hirteen studies emp!oyed standardi+ed assessments of socia!

functioning7 a!though three emp!oyed methods that !ac4ed ade=uate scientific rigor7 andone pro"ed too comp!e to inc!ude 0


10/35



2estroy user interface contro!$3. Fi"e of the remaining studies sho&ed significant!y

greater )enefits for stress management strategies 0



2estroy user interface contro!5>7



2estroy user interface contro!$?7











2estroy user interface contro!'$37 one a c!ear trend 0



2estroy user interface contro!%%3 and three sho&ed no significant )enefits &hen

compared &ith drug treatment and case management 0$>7'17''3. 2espite the difficu!ties

of measuring gains on in"entories that inc!ude a )road range of socia! goa!s7 many of

&hich are not persona!!y re!e"ant to e"ery patient7 ad"antages for the fami!y8)ased

approaches &ere e"ident. One study that eamined this issue carefu!!y &ith )!ind ratings

sho&ed that %*E of patients in the fami!y treated group had no signs of socia! disa)i!ity

after t&o years of comprehensi"e treatment that a!so integrated socia! s4i!!s training and

indi"idua!i+ed "ocationa! reha)i!itation &ithin the treatment program 0



11/35

2estroy user interface contro!%*3. (his contrasted &ith >E of cases that had recei"ed

indi"idua! asserti"e case management of simi!ar intensity.

Family $enefits

An important goa! of fami!y stress management strategies is to enhance fami!yfunctioning and reduce stresses7 particu!ar!y those associated &ith caring for the patient.

A mean reduction in the stress of caregi"ing of $%E &as reported in four studies that

eamined this outcome 0









2estroy user interface contro!%'7



2estroy user interface contro!'$3. (his &as contrasted &ith a reduction of E in the

drugs and case management conditions. Fi"e of the si studies that compared

standardi+ed fami!y stress ratings associated &ith stress management "s. drugs and case

management sho&ed significant ad"antages for the stress management approach 0



2estroy user interface contro!$?7









12/35




2estroy user interface contro!'$3. (he se!f8he!p mu!tip!e8fami!y group approach of9uch4remer et a! 0



2estroy user interface contro!''3 sho&ed no change in a measure of fami!y pro)!ems

associated &ith the patientsB i!!ness7 )ut &as associated &ith increased &armth and

reduced hosti!ity to&ards the patients.

Economic $enefits

Impro"ements in c!inica!7 socia! and fami!y functioning &ou!d )e epected to reduce the

need for intensi"e medica! and socia! care and there)y produce economic )enefits for

ser"ice pro"iders. Si studies reported such )enefits7 a!)eit in re!ati"e!y unsophisticated

assessments of costs 0



2estroy user interface contro!57















13/35

2estroy user interface contro!>53. It is important to note that no study sho&ed that the

addition of fami!y approaches costs more to the ser"ices. In most instances the cost

sa"ings to the ser"ices of integrating fami!y assistance in this &ay &ere su)stantia!.

Further7 the additiona! cost to the fami!y &as usua!!y minima!7 particu!ar!y as most

treatment sessions &ere arranged f!ei)!y to minimi+e !oss of earnings or the cost of

transport.

End%rin' $enefits

(he duration o"er &hich programmes &ere app!ied "aried from > months to four years7

&ith most pro"iding this treatment for 815 months. It &as apparent that )enefits

endured7 and trends to&ards c!inica! and socia! reco"ery continued7 &hen the treatment

approach &as continued &ithout maor modifications throughout the study period 0















2estroy user interface contro!>$3.


14/35

















2estroy user interface contro!>$8



2estroy user interface contro!>'3.

A!! four studies that fo!!o&ed up cases for at !east % years ha"e sho&n !ong8term

e"idence of c!inica! )enefits 0






2estroy user interface contro!>>8

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B36http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B38http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B40http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B42http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B63http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B65http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B42http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B66http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B36http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B38http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B40http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B42http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B63http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B65http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B42http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B66


15/35

2estroy user interface contro!>/3. Ho&e"er7 the methodo!ogy of !ong8term fo!!o&8up

studies is !ess than optima!7 and it is c!ear that for indi"idua! cases the )enefits tend to

diminish once acti"e treatment is stopped. As &ith a!! maor hea!th pro)!ems7

comprehensi"e treatment needs to )e continued unti! a!! residua! impairments7

disa)i!ities and handicaps ha"e )een reso!"ed7 and then fo!!o&ed )y monitoring of ear!y

signs of recurrences and the pro"ision of )ooster treatment &hen this is indicated 0






2estroy user interface contro!>?3. Studies of !ong8term optima! programmes of this

nature are essentia! 0



2estroy user interface contro!>3.

Effectiveness of family treatment in ro%tine clinical &ractice

One maor concern raised )y many o)ser"ers has )een the a)i!ity to rep!icate the

)enefits of contro!!ed tria!s in c!inica! practice. In this fie!d there has )een a tendency todi!ute the methods7 using mere!y part of the inter"ention program7 usua!!y on!y the

menta! hea!th education component 0



2estroy user interface contro!1?7



2estroy user interface contro!5$7



2estroy user interface contro!$'7



2estroy user interface contro!?*8


16/35


17/35

asserti"e crisis inter"ention.

At present there ha"e )een fe& studies that ha"e attempted to compare different

com)inations of strategies.


18/35

maor episodes as effecti"e!y as continuous mu!tifami!y treatment7 it &as !ess successfu!

in achie"ing socia! )enefits7 particu!ar!y in the fie!d of emp!oyment 0



2estroy user interface contro!%%3. Further comp!e studies that compare the ingredients

of comprehensi"e treatment programmes are essentia! to refine these approaches.

Sin'le family vers%s m%lti)family 'ro%&s

A series of / studies that compared stress management conducted predominant!y in

mu!ti8fami!y groups &ith that conducted main!y in indi"idua! sessions sho&ed a mean

ad"antage of on!y $E greater c!inica! success for the sing!e fami!y approach 0$?E "s.

$%E3 in the first year of treatment 0











2estroy user interface contro!>$7



2estroy user interface contro!1*5 8



2estroy user interface contro!1*' 3. (&o further studies ha"e compared a mu!tip!e

fami!y group &ith a medication and case management contro! 0




19/35




2estroy user interface contro!''3. (he first study of se!f8he!p re!ati"esB groups did notin"o!"e the patients and sho&ed a higher rate of hospita! admissions than the contro!

condition 0



2estroy user interface contro!''37 &hi!e the second sho&ed reduction in ser"ice use7

inc!uding hospita! admissions7 associated &ith mu!ti8fami!y treatment 0



2estroy user interface contro!%/3. -cFar!ane et a! 0



2estroy user interface contro!%53 ha"e sho&n that there may )e ad"antages for the

mu!ti8fami!y approach &hen it is used as a !ong8term maintenance strategy7 )ut this

&or4 has not yet )een rep!icated fu!!y7 a!though t&o other studies used mu!ti8fami!y

approaches in the second year of the programs &ith good maintenance of c!inica!

)enefits 0






2estroy user interface contro!1*> 3. (he comp!e methodo!ogy of these comparati"estudies pre"ents any c!ear conc!usions a)out the re!ati"e merits of these approaches7

particu!ar!y &hen the psychosocia! strategies used ha"e differed in the sing!e and

mu!tip!e fami!y settings. A current mu!ti8centered study nearing comp!etion in Ita!y has

contrasted identica! methods in sing!e and mu!tifami!y settings. (he ear!y resu!ts seem

to support the findings that simi!ar c!inica! )enefits are achie"ed in )oth settings 0



2estroy user interface contro!1*% 3. Ho&e"er7 this study has again high!ighted a

some&hat greater rate of &ithdra&a! from the mu!ti8fami!y groups 0


20/35








2estroy user interface contro!1*1 7



2estroy user interface contro!1*5 3. A!though mu!ti8fami!y settings may appear more

cost8effecti"e7 it is important that a!! costs are considered7 not mere!y the time spent

conducting the treatment itse!f7 )efore conc!uding that this strategy shou!d )e the

method of choice for ser"ices. It is un!i4e!y that any one training format &i!! meet the

needs of a!! cases7 and a comprehensi"e ser"ice &i!! inc!ude a range of efficacious

fami!y and indi"idua! approaches7 tai!ored to the needs of indi"idua! cases at different

stages in their c!inica! and socia! reco"ery.

Inte'ration *it( social and *or+ s+ills trainin' strate'ies

(he addition of socia! s4i!!s training strategies to assist patients to cope more effecti"e!y

&ith stresses in community settings outside the fami!y appears to confer an added

)enefit to those methods that focus more on stresses &ithin the patientBs immediate

socia! net&or4. Si studies that com)ined socia! s4i!!s training strategies &ith carer8

)ased stress management appear to ha"e achie"ed the )est c!inica! outcomes 0











21/35





2estroy user interface contro!1*> 3. On!y 1E of patients recei"ing this integrated

approach had poor outcomes during the first year of treatment. (he precise manner in

&hich these strategies are integrated has not )een studied. In some programs the socia!

and &or4 s4i!!s training has )een an integra! part of the fami!y pro)!em so!"ing sessions

0









2estroy user interface contro!%>37 in others the t&o approaches are conducted in

separate sessions 0









2estroy user interface contro!1*' 3. It is noted that the )enefits of conducting socia!

s4i!!s training &ithout the co!!a)orati"e support of 4ey caregi"ers appears to ha"e

!imited !ong8term )enefits in the &e!!8contro!!ed studies that ha"e )een comp!eted 0




22/35

2estroy user interface contro!$/3.

Inte'ration of ot(er &syc(osocial strate'ies for resid%al sym&toms

Se"era! groups ha"e used a cogniti"e )eha"ioura! approach that inc!udes specific

strategies for residua! psychotic7 deficit7 affecti"e and aniety symptoms7 a!! of &hichare common in functiona! psychotic disorders 0






2estroy user interface contro!%13. (hese strategies ha"e )een demonstrated as high!y

efficacious &hen studied in non8schi+ophrenic popu!ations 0



2estroy user interface contro!1*? 3. (o date there ha"e )een no contro!!ed studies that

ha"e compared fami!y programs that inc!ude such strategies &hen indicated7 &ith those

that use on!y the generic pro)!em so!"ing methods. One study that emp!oyed a &ide

range of cogniti"e )eha"ioura! strategies sho&ed an impro"ement in the rates of

affecti"e and aniety episodes in the second year of treatment 0




#oes family)$ased stress mana'ement red%ce t(e level of medication

needed to &revent rec%rrences,

Attempts to su)stantia!!y !o&er dosages of drugs )e!o& those deemed c!inica!!y optima!

ha"e pro"en re!ati"e!y unsuccessfu! 0






2estroy user interface contro!1*' 3. Ho&e"er7 in these studies the dose of drugs &as

rapid!y and su)stantia!!y !o&ered7 rather than gradua!!y reduced in the manner

recommended in c!inica! practice. Hah!&eg et a! 0


23/35



2estroy user interface contro!%'3 sho&ed a re!ati"e!y !o& rate of maor episodes &ith a

targeted dose strategy throughout the period that regu!ar stress management sessions

&ere conducted. Schoo!erBs co!!a)orati"e study did not rep!icate this finding7 )ut didsupport the hypothesis that fami!y8)ased strategies may ena)!e !o&er doses of

medication to )e used &ithout increasing the ris4 of maor episodes 0



2estroy user interface contro!1*' 3.

:o to#

FAMILY INTERVENTIONS FOR AFFECTIVE#ISOR#ERS

Fami!y education and stress management is fre=uent!y used in treatment programmes

for maor affecti"e disorders7 )ut re!ati"e!y fe& studies ha"e )een conducted to assess

the )enefits of these approaches. Contro!!ed studies of )ipo!ar disorders that ha"e

in"o!"ed fami!ies in the treatment process ha"e sho&n added )enefits7 simi!ar to those

o)tained in the studies on schi+ophrenic disorders 0



2estroy user interface contro!1*/ 8



2estroy user interface contro!11$ 3. Such )enefits in a condition &here pharmacotherapy

is often unsatisfactory suggests that carer8)ased approaches shou!d )e more &ide!y

a"ai!a)!e 0


2estroy user interface contro!11% 3.

2espite su)stantia! e"idence for the association )et&een fami!y and marita! factors and

the onset and course of maor depressi"e disorders 0



2estroy user interface contro!11' 37 most psychosocia! strategies ha"e focused on stressand "u!nera)i!ity from the indi"idua! perspecti"e. (here is !imited e"idence that fami!y
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B45http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B105http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B108http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B113http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B114http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B115http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B45http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B105http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B108http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B113http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B114http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B115


24/35

or marita! strategies achie"e some&hat greater )enefits than the indi"idua! cogniti"e

)eha"ioura! or interpersona! approaches7 particu!ar!y &here marita! conf!ict is an

ongoing maor stressor 0



2estroy user interface contro!11> 8



2estroy user interface contro!15% 3.

ar!y inter"ention using a fami!yoriented approach &hen depressi"e or manic

symptoms first emerge may pro"e high!y efficacious in pre"enting maor affecti"e

episodes7 associated socia! mor)idity and potentia! suicide ris4 0



2estroy user interface contro!15' 7



2estroy user interface contro!15> 3.


25/35

One contro!!ed study of chronic post8traumatic stress disorder sho&ed no )enefits from

adding cogniti"e )eha"ioura! fami!y strategies to a programme of graduated eposure 0



2estroy user interface contro!1$% 3.

:o to#

FAMILY INTERVENTIONS FOR EATIN0

#ISOR#ERS

Fami!y in"o!"ement in the treatment of anoreia ner"osa is common to most

programmes 0


2estroy user interface contro!1$' 3. Ho&e"er7 fe& contro!!ed studies ha"e )een

conducted 0



2estroy user interface contro!1$> 8



2estroy user interface contro!1$/ 3. (he resu!ts do not sho& any consistent )enefits for

fami!y therapies &hen they ha"e )een compared to "arious indi"idua! psychotherapeutic

approaches. (he fami!y treatment strategies ha"e "aried considera)!y and there is no

e"idence to support the superiority of any one approach 0



2estroy user interface contro!1$ 7



2estroy user interface contro!1%* 3.

:o to#

FAMILY INTERVENTIONS FOR ALCOOL AN#

S/.STANCE A./SE
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B134http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B135http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B136http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B138http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B139http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B140http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B134http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B135http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B136http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B138http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B139http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B140http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/


26/35

"idence for the )enefits of fami!y strategies is accumu!ating in the treatment of a!coho!

and su)stance a)use. (his inc!udes the engagement of unmoti"ated su)ects 0



2estroy user interface contro!1%1 37 and the treatment of su)stance use in patients &ith

schi+ophrenic disorders 0



2estroy user interface contro!1%5 3.

:o to#

CONCL/SIONS(here is sufficient scientific e"idence to conc!ude that strategies that enhance the

caregi"ing capacity of fami!y mem)ers and other peop!e in"o!"ed in the day to day care

for peop!e &ith menta! disorders ha"e a c!inica!!y significant impact on the course of

maor menta! disorders. (his e"idence is strongest for schi+ophrenic and )ipo!ar

affecti"e disorders. (he )est resu!ts appear to )e associated &ith comprehensi"e

methods that integrate carers into the therapeutic team through education and training in

stress management strategies7 &ith continued professiona! support and super"ision o"er

a period of at !east t&o years. A!though education a)out menta! disorders and their

)iomedica! and psychosocia! treatment is a "a!ua)!e component of these approaches7

and may impro"e engagement and adherence to treatment programmes7 it does not seemsufficient to reduce the ris4 of maor episodes or to promote c!inica! and socia!

reco"ery.

(here is gro&ing e"idence for the )enefits of carer8)ased methods for depressi"e and

eating disorders. Ho&e"er7 it is not c!ear &hich cases )enefit more from fami!y or

indi"idua! approaches7 or ho& )est to com)ine the t&o formats of treatment. Fina!!y7

a!though fami!y mem)ers are a!most a!&ays in"o!"ed in programmes for aniety

disorders and su)stance a)use7 research is needed to c!arify the merits of this

in"o!"ement.

In addition to the )enefits in terms of impro"ed prognosis7 there is e"idence that socia!mor)idity is reduced7 particu!ar!y &hen treatment continues for at !east t&o years and

integrates persona! goa! setting and aspects of socia! and &or4 s4i!!s training. 2espite

e"idence that the )enefits of fami!y &or4 are not &e!! sustained once the intensi"e

training phases ha"e )een comp!eted7 there is a !ac4 of research into ho& impro"ements

can )e maintained. -u!ti8fami!y group formats offer promise as a !ong8term strategy for

parenta! fami!ies. 9ut carers &ho are spouses7 partners7 si)!ings7 chi!dren and c!ose

friends may prefer other formats.

9enefits from fami!y approaches are a!so e"ident for the carers themse!"es7 &ith

reduced stress associated &ith their caregi"ing ro!es. Ho&e"er7 e"en &hen e"idence8

)ased fami!y programmes are app!ied7 the stress associated &ith continued fami!y care
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B141http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B142http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B141http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/#B142http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525058/


27/35

of chronic cases remains considera)!e and a!ternati"e supporti"e caregi"ing

arrangements are essentia! 0



2estroy user interface contro!1%$ 3. fforts to de"e!op and e"a!uate simi!ar therapeutic

programmes in residentia! ser"ices must )e gi"en a high priority.

2espite the c!ear e"idence of efficacy and efficiency7 fe& ser"ices ha"e incorporated

these carer8)ased strategies into their routine practice 0



2estroy user interface contro!1%% 3. (his pro)!em is shared &ith most noncommercia!

ad"ances in c!inica! practice. In addition to ade=uate training in educationa! andpsycho!ogica! strategies7 asserti"e management of ser"ices is needed to ensure that the

efforts of 4ey caregi"ers of a!! patients are fu!!y integrated into c!inica! programmes at

a!! times. A!most a!! patients ha"e some)ody &ho cares for them7 or at !east some)ody

&ho cares a)out them.


28/35

15. ,e44a!a . -erinder L. (he Cochrane Li)rary. Issue $. Oford# 6pdate Soft&are

5**1. ,sychoeducation for schi+ophrenia 0Cochrane Re"ie&3. .

1$. ,enn 2L. -ueser (. Research update on the psychosocia! treatment of

schi+ophrenia. Am ; ,sychiatry. 1>1'$#>*?>1?. J,u)-edK

1%. ,haroah F-. -ari ;;. Streiner 2. (he Cochrane Li)rary. Issue 5. Oford# 6pdate

Soft&are 5***. Fami!y inter"ention for schi+ophrenia.1'. Fa!!oon IRH. Roncone R. He!d (7 et a!. An internationa! o"er"ie& of fami!y

inter"entions# de"e!oping effecti"e treatment strategies and measuring their )enefits to

patients7 carers7 and communities. In# Lef!ey H,7 ;ohnson 2L7 editors. Fami!y

inter"entions in menta! i!!ness# internationa! perspecti"es. . Anderson C-. Reiss 2;. Hogarty :. Schi+ophrenia and the fami!y. Ne& Gor4#

:ui!ford ,ress 1/>.

1?. At4inson ;-. Coia 2A. :i!mour 1>/#15*%. J,u)-edK

1/. 9Mum! ;. iss!ing /??'. J,u)-edK

51. -acpherson R. ;errom 9. Hughes A. A contro!!ed study of education a)out drug

treatment of schi+ophrenia. 9r ; ,sychiatry. 1>1>/#?*?1?. J,u)-edK

55. ,osner C-. 5#5*>51/. J,u)-edK

5$. @aughan . 2oy!e -. -cConaghy N7 et a!. (he Sydney inter"ention tria!# a

contro!!ed tria! of re!ati"esB couse!!ing to reduce schi+ophrenic re!apse. Soc ,sychiatry

,sychiatr pidemio!. 155?#1>51. J,u)-edK

5%. :o!dstein -;. Rodnic4 H. "ans ;7 et a!. 2rug and fami!y therapy in the aftercare

of acute schi+ophrenics. Arch :en ,sychiatry. 1?/$'#11>11??. J,u)-edK

5'. :!ic4 I2. C!ar4in ;F. Haas :L7 et a!. C!inica! significance of inpatient fami!y

inter"ention# conc!usions from a c!inica! tria!. Hosp Commun ,sychiatry. 1$%%#/>

/?$. J,u)-edK

5>. 9arro&c!ough C. (arrier N. Le&is S7 et a!. Randomised contro!!ed effecti"eness

tria! of a needs8)ased psychosocia! inter"ention ser"ice for carers of peop!e &ithschi+ophrenia. 9r ; ,sychiatry. 11?%#'*''11. J,u)-edK

5?. 9erg!und N. Ho& ear!y inter"ention in psychiatric !ong8term i!!ness patients and

their fami!ies inf!uences re!apse7 medication and fami!y )urden. 6npu)!ished

manuscript 1>.

5/. 9ertrando ,. 9ressi C. C!erici -7 et a!. (erapia fami!iare sistemica ed emoti"itP

espressa ne!!a schi+ofrenia cronica. 6no studio pre!iminare. . Attra"erso !o Specchio.

1/5'#'11'>5. 0Ita3.

5. He!d (. Fran4furt# ,eter Lang 1'. Schi+ophrenie)ehand!ung in der Fami!ie.

0:er3.

$*. Le"ene ;. Ne&man F. ;effries ;;. Foca! fami!y therapy outcome study I# patient

and fami!y functioning. Can ; ,

Documents

FALLOON Family Interventions for Mental Disorders