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Family Psychoeducation for Schizophrenia: a Clinical Review

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Family Psychoeducation for Schizophrenia: a Clinical Review MJP Online Early MJP-02-08-12 REVIEW PAPER Family Psychoeducation for Schizophrenia: A Clinical Review De Sousa A1, Kurvey A2, Sonavane S3 1Desousa Foundation, Mumbai 2Department of Psychology, LS Raheja College, Mumbai 3Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai Abstract Family psychoeducation is an integral part of schizophrenia treatment programmes. Recent shifts to briefer hospitalization and an emphasis on community care have emphasized the significance of relative education in this phase of treatment. Psychoeducational family programs designed to increase medication compliance and effectiveness in coping with stressors have been successful in reducing the risk of relapse in the first year following hospital discharge. They are aimed to provide correct information about the illness, treatments available and long term course and prognosis of the disease. Over the last three decades various models and different types of family psychoeducation programmes have been implemented to empower relatives of patients with schizophrenia. In the present paper different models for family intervention are discussed and their strengths and weaknesses evaluated. Keywords: Family, Psychoeducation, Schizophrenia Introduction and support.3 A variety of interventions referred to as ‘family psychoeducation’ Family members often play a vital role as programs, have been developed and caregivers in the lives of individuals with practiced all over the world in schizophrenia schizophrenia and other serious mental rehabilitation programmes.4 These programs illnesses. It has been estimated across are carried out along with an overall clinical studies that 30-85% of adults with treatment plan, and while the main focus is schizophrenia have a family member as a on improving the well-being and functioning caregiver.1 Recent trends point towards a of the patient, family members also community-based care for persons with experience significant benefits from such schizophrenia where family members would programs.5 assist with the care of these patients.2 Over the past 2 decades, a body of evidence-based The Use of the Term Psychoeducation practices have emerged to meet family member’s needs for education, guidance, The term ‘psychoeducation’ was first MJP Online Early MJP-02-08-12 employed to describe a behavioural Within the framework of psychotherapy, therapeutic concept consisting of four family psychoeducation refers to the elements viz. briefing the patients about components of treatment where active their illness, problem solving training, communication of information regarding the communication training, and self- illness and treatment methods along with a assertiveness training, whereby relatives treatment of general aspects of the illness were also included.6 are prominent.15 Indications for family psychoeducational groups are wide ranging. Psychoeducation often fulfilled less the There are only few mandatory function of an independent, self-contained contraindications, including relatives with therapeutic method and was viewed more as massive formal thought disorders, manic a combination of several therapeutic elevated mood, schizophrenia or acute elements contained within a complex suicidality with generally reduced stress psychosocial intervention.7-8 Various studies resilience.16 have demonstrated clear superiority of psychoeducational family interventions Family members can be integrated within when used in combination with standard the treatment as soon as they are capable of treatments in schizophrenia compared to taking part in a group for a period of 60 standard treatments being used alone.9-11 min.17 Ideally, only relatives of patients suffering from schizophrenic psychoses There has been an evident decline in should participate in the group, in order not duration of stay in medical institutions of to evoke unnecessary confusion in other patients with schizophrenia since caregivers through the schizophrenia- approximately 1990. The simultaneous specific informational content.18 Group necessity for an economic use of therapeutic sittings last approximately 1 hour, take place resources exists and the demand for compact once to twice a week, and consist of and yet efficient treatment methods exists.12 between 4 and 16 sessions. Group leaders Within this context, an independent are in most cases doctors or psychologists; understanding of psychoeducation began to co-leaders can be recruited from all relevant unfold. The working group and complementary mental health faculties ‘Psychoeducation of patients with or even may be caregivers who have been schizophrenia’ has formulated the following trained to disseminate this information.19 definition13 –“The term psychoeducation The superordinate goal can be seen in the comprises systemic, didactic relatives acquiring basic competency in psychotherapeutic interventions, which are order that they may reach well-informed and adequate for informing patients and their self-competent decisions as to which of the relatives about the illness and its treatment, modern therapeutic options viz. medications, facilitating both an understanding and electroconvulsive therapy, personally responsible handling of the psychotherapeutic and/or psychosocial are illness and supporting those afflicted in recommendable and suitable in their own coping with the disorder.” family member.20 The roots of psychoeducation are to be Therapeutic and Critical Factors in found in behaviour therapy, although current Psychoeducation conceptions also include elements of client centered therapy in various degrees.14 In accordance with the psychotherapeutic MJP Online Early MJP-02-08-12 nature of family psychoeducation, comprehensible concept of the illness and its therapeutic alliance, causal and control treatment (causal and control attribution).31 attributions are also of utmost importance In particular, the concrete elaboration of here.21 It is important that emotional, illness- ‘missing links’ which enables lay persons to related topics are deliberately discussed in more fully understand why mental problems family education sessions. Emotions with a can be successfully treated by ‘chemical’ positive overtone, such as pride in one’s interventions, is of great significance for own role as a caregiver or the feeling of increasing functionality.32 In this capacity, having used unique methods to manage the psychoeducation can be seen to serve an patient along with issues such as being out ‘interpreter’ function, pursuing the aim of of one’s depth or struggling with one’s fate, translating complicated ‘technical jargon’ are also addressed.22 Through the into common and everyday language, which employment of techniques such as can be understood by relatives and helps ‘positivation’ of prior experiences, them to become experts of their illness.33 normalization of relapses or systematic Relatives progress with the patient through depathologicalization of the patient, each stage of treatment feeling encouraged participants are to be sent the signal that, and full of hope. The cautious introduction given close cooperation, a viable solution of the topic of handicaps caused by the can be found for all difficulties.23 illness, which are often severely protracted and unpredictable in terms of duration, also The primary goal of family entails a great challenge for simultaneously psychoeducational interventions consists in working on feelings of guilt, anxiety and finding a common denominator between the grief that the relatives may harbour.34 objective, textbook medical knowledge with Relatives are to increasingly gain access to regards to background information of the positive thoughts and positive disorder and treatment measures, and the conceptualizations of themselves and their subjective viewpoint of the afflicted patient.35 patient.24 Carrying out this requires an extremely differentiated behavioral Psychoeducation is thus primarily a form of therapeutic approach, supported by a basic therapy conveying reassurance and hope, humanistic orientation.25 with the aim of optimally integrating empowerment of those whose close ones are Each session comprises a module which is affected, with professional therapeutic highly structured, whose informational techniques in a working and therapeutic contents are to be interactively compiled and alliance.36 The take-home-message of relatives are to gain access to information psychoeducational programs must be that concerning appropriate mental health schizophrenic psychoses are induced by behavior.26-28 While individual opinions are biological factors in combination with appreciated and respected, great value is psychosocial stress; therefore, they must be placed on clearly and comprehensibly treated with both medication and presenting current scientifically founded psychotherapeutic interventions.37 expert knowledge in the form of direct information and advice giving.29-30 It is less The Goals of Psychoeducation in about the absolute comprehensiveness of Schizophrenia transmitted textbook knowledge which is important and more the construction of a The formulation of realistic and coherent MJP Online Early MJP-02-08-12 therapeutic goals in family psychoeducation well as structured training in problem- is of particular importance for all involved solving and effective communication in the i.e. relatives, and professional auxiliaries. family. In behavioural family management, Here, the greatest danger within the active phase of intervention typically
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