統合失調症に対する家族介入
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.
一般語訳
統合失調症に対する家族介入
統合失調症を持つ人々は、家族の高いレベルの感情表出（敵意や批判、過剰な感情的巻き込まれ）がある場合、それが低い傾向の家族と比較して、より再発を経験しやすい。家族内の感情表出を減らすために利用可能な、いくつかの心理社会的介入（教育、支援、マネジメントなど）が存在する。このレビューでは、統合失調症や統合失調症様の疾患を持つ人々のケアのための、地域における家族向けの心理社会的介入の効果を調べた。
研究はヨーロッパ、アジア、北アメリカで行われ、研究によって家族介入の形式は異なっていたが、研究デザインに明確な違いは無かった。結果は、家族介入が再発のリスクを減らし、服薬コンプライアンスを向上させる可能性を示していた。しかし、データの報告がしばしば不十分だったため、そのようなデータは使用できなかった。このケアの形式は広く用いられているため、短期的および長期的なアウトカムを正しく明らかにするための、さらなる研究を行うべきである。
