Obiteljska intervencija za shizofreniju
Abstract
Background
People with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of emotions. Forms of psychosocial intervention, designed to reduce these levels of expressed emotions within families, are now widely used.
Objectives
To estimate the effects of family psychosocial interventions in community settings for people with schizophrenia or schizophrenia‐like conditions compared with standard care.
Search methods
We updated previous searches by searching the Cochrane Schizophrenia Group Trials Register (September 2008).
Selection criteria
We selected randomised or quasi‐randomised studies focusing primarily on families of people with schizophrenia or schizoaffective disorder that compared community‐orientated family‐based psychosocial intervention with standard care.
Data collection and analysis
We independently extracted data and calculated fixed‐effect relative risk (RR), the 95% confidence intervals (CI) for binary data, and, where appropriate, the number needed to treat (NNT) on an intention‐to‐treat basis. For continuous data, we calculated mean differences (MD).
Main results
This 2009‐10 update adds 21 additional studies, with a total of 53 randomised controlled trials included. Family intervention may decrease the frequency of relapse (n = 2981, 32 RCTs, RR 0.55 CI 0.5 to 0.6, NNT 7 CI 6 to 8), although some small but negative studies might not have been identified by the search. Family intervention may also reduce hospital admission (n = 481, 8 RCTs, RR 0.78 CI 0.6 to 1.0, NNT 8 CI 6 to 13) and encourage compliance with medication (n = 695, 10 RCTs, RR 0.60 CI 0.5 to 0.7, NNT 6 CI 5 to 9) but it does not obviously affect the tendency of individuals/families to leave care (n = 733, 10 RCTs, RR 0.74 CI 0.5 to 1.0). Family intervention also seems to improve general social impairment and the levels of expressed emotion within the family. We did not find data to suggest that family intervention either prevents or promotes suicide.
Authors' conclusions
Family intervention may reduce the number of relapse events and hospitalisations and would therefore be of interest to people with schizophrenia, clinicians and policy makers. However, the treatment effects of these trials may be overestimated due to the poor methodological quality. Further data from trials that describe the methods of randomisation, test the blindness of the study evaluators, and implement the CONSORT guidelines would enable greater confidence in these findings.
Laički sažetak
Obiteljska intervencija za shizofreniju
Osobe sa shizofrenijom, okružene obitelji, imaju veću vjerojatnost od relapsa ako unutar obitelji postoji visoka razina izražavanja emocija (neprijateljstvo, kritike ili pretjerana uključenost) u usporedbi s obiteljima koje manje izražavaju svoje emocije. Postoji nekoliko psihosocijalnih intervencija, koje uključuju edukaciju, potporu i liječenje, a koje su usmjerene smanjenju emocija unutar obitelji. U ovom sustavnom pregledu uspoređen je učinak obiteljskih psihosocijalnih intervencija u zajednici za skrb o osobama koje boluju od shizofrenije ili bolesti nalik na shizofreniju.
Uključene studije provedene su u Europi, Aziji i Sjevernoj Americi i uključivale su različite obiteljske intervencije, iako nije bilo jasnih razlika u ustroju studija. Rezultati su pokazali da intervencije usmjerene na obitelj mogu smanjiti rizik od relapsa i poboljšati suradljivost u uzimanju lijekova. Međutim, podatci su u analiziranim studijama često bili neprikladno navedeni i stoga neupotrebljivi. Kako se ova vrsta skrbi bude više primjenjivala, bit će potrebno više istraživanja da bi se propisno istražili njeni kratkoročni i dugoročni ishodi.
