Onderzoek dat de meerwaarde heeft bewezen

Betrekken van familie bij de zorg werkt!

 

Uit de richtlijn schizofrenie, update 2010

 

In 2006 heeft de Cochrane Library een update gepubliceerd over gezinstherapie (Pharoah, 2006). Er werden drieënveertig RCT’s geïncludeerd (N=4124) die het effect van gezinsinterventies vergeleken met standaardzorg. De belangrijkste conclusies waren dat gezinsinterventies mogelijk kunnen leiden tot een afname in het aantal relapses en het aantal ziekenhuisopnames. Deze laatste conclusie is een nieuwe 10 bevinding ten opzichte van hun eerder verschenen review in 2002. Tevens kunnen gezinsinterventies leidden tot verbeterde medicatie-trouw, maar heeft het geen effect op uitval in de zorg. Algemeen sociaal disfunctioneren en expressed emotion kunnen eveneens verbeteren. De Cochrane doet geen uitspraak over het effect van gezinsinterventies op suïcide. De auteurs concluderen dat het effect van 15 gezinsinterventies nog onvoldoende wetenschappelijk wordt ondersteund.

De NICE-guideline schetst een positiever beeld over het effect van gezinsinterventies. Er werden tweeëndertig RCT’s geïncludeerd (n=2429). Gezinsinterventies leidden in vergelijking met standaardzorg en welke controle-conditie dan ook tot een verminderd 20 risico op relapse aan het eind van de behandeling en twaalf maanden na de behandeling.

Beide meta-analyses zijn het eens over het feit dat gezinsinterventies leiden tot een verminderd risico op relapse en ziekenhuisopnames.

DE NICE-guideline heeft met behulp van subgroepanalyses nog specifieker gekeken hoe 25 de interventie het beste aangeboden kon worden. Het bleek dat de interventie het beste zoveel mogelijk samen met de patiënt aangeboden moest worden. Wat betreft de vergelijking tussen single- en multifamily groepen bleek er geen verschil in effect op symptomen, maar wel een gunstig verschil in ziekenhuisopnames ten voordele van de single family groepen.

Er zijn na de NICE nog twee relevante studies verschenen (Gutierrez, 2009 over psycho-educatie; Chien, 2008 + Chien 2006) over lotgenotengroepen voor familieleden. Beide studies ondersteunen de reeds eerder gevonden resultaten.

Conclusies

  • Het is aangetoond dat gezinsinterventies in vergelijking met de standaardzorg leidt tot minder heropnames aan het eind van de behandeling (NNT=4) en twaalf maanden na de behandeling (NNT=6). Het effect is niet meer aanwezig bij 24 maanden.

(Bressi, 2008; Carra, 2007; Li, 2005; Leavey, 2004; Kopelowicz, 2003; Dyck, 2000; Barrowclough, 1999; Bloch, 1995; Buchkremer, 1995; Xiong, 1994; Zhang, 1994; Glynn, 1992; Vuaghan, 1992)

  • Het is aangetoond dat gezinsinterventies in vergelijking met de standaardzorg leiden tot een kortere duur van de heropnames tot minstens achttien maanden na de behandeling.

(Chien, 2004a; Chien 2004b, Chien, 2007, Garety, 2008)

  • Het is aangetoond dat gezinsinterventies geen effect heeft op de ernst van positieve en negatieve symptomen, maar wel op andere algemene symptomen tot 24 maanden na de interventie.

(Garety, 2008; Chien, 2007; Bradley, 2006; Li, 2005; Kopelowicz, 2003)

  • Gezinsinterventies stellen terugval uit tot 12 maanden tijdens de behandeling en tot 5 jaar na het beëindigen van de interventie in de vergelijking met standaardzorg.

(Tarrier, 1988, Glynn, 1992; Goldstein, 1978; Leff, 1982; Xiong, 1994; Barrowclough, 1999; Ran, 2003; Bressi, 2008; Bradley, 2006)

  • Het is aannemelijk dat gezinsinterventies in vergelijking met de standaardzorg leiden tot een betere omgang met de symptomen en de medicatie, zowel tijdens de behandeling als 6 maanden na het beëindigen van de behandeling (Symptom Management Module en Medication Management Module)

    (Kopelowicz, 2003)
  • Het is aannemelijk dat gezinsinterventies in vergelijking met standaardzorg depressieve symptomen bij de patiënt verergeren aan het eind van de behandeling, maar bij de 12 maanden follow-up is dit negatieve effect verdwenen (BDI).

(Garety, 2008)

  • Psycho-educatieve interventies met gezinnen en familieleden leiden bij patiënten met schizofrenie tot significant minder terugval en opnames. Ook verbetert de medicatietrouw. Lange termijn interventies hebben een grotere impact op patiënten dan korte termijn interventies.

(Pfammatter e.a., 2006)

Literatuur

  • Barrowclough C, Tarrier N, Lewis S et al. Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia. British Journal of Psychiatry 1999;174:505-511.
  • Berkowitz R. Therapeutic intervention with schizophrenic patients and their families: a 20 description of a clinical research project. Journal of Family Therapy 1984;6:211-33.
  • Berkowitz R, Eberlein-Fries R, Kuipers L, Leff J. Educating relatives about schizophrenia. Schizophrenia Bulletin 1984;10:418-29.
  • Bloch S, Szmukler GI, Herrman H, Benson A, Colussa S. Counseling caregivers of relatives with schizophrenia: themes, interventions, and caveats. Family Process 25 1995;34:413-25.
  • Bradley G.M.; Couchman G.M.; Perlesz A.; Nguyen A.T.; Singh B.; Riess C. (2006) Multiple-family group treatment for English- and Vietnamesespeaking families living with schizophrenia. Psychiatric Services57: 521-530.
  • Bransen, E., Mierlo, F. van. (2007) Psycho-educatie voor familieleden van mensen met 30 schizofrenie. Een onderzoek naar de uitvoering, effectiviteit en implementatie van de psycho-educatie cursus in de preventieve GGZ. Utrecht: Trimbos-instituut.
  • Bressi,C.; Manenti,S.; Frongia,P.; Porcellana,M.; Invernizzi,G. (2008) Systemic family therapy in schizophrenia: A randomized clinical trial of effectiveness. Psychotherapy and Psychosomatics. 77(1) 35
  • Buchkremer G, Schulze Monking H, Holle R, Hornung WP. The impact of therapeutic relatives' groups on the course of illness of schizophrenic patients. European Psychiatry 1995;10:17-27.
  • Buchkremer G, Stricker K, Holle R, Kuhs H. The predictability of relapses in schizophrenic patients. European Archives of Psychiatry and Clinical Neuroscience 40 1991;240:292-300.
  • Carra,G.; Montomoli,C.; Clerici,M.; Cazzullo,C.L. (2007) Family interventions for schizophrenia in Italy: Randomized controlled trial. European Archives of Psychiatry & Clinical Neuroscience. 257(1): 23 - 30.
  • Casale,L.; Raffaeli,M.; Innocente,P.; Salmeri,R.; Cantone,R.; Scordato,M.; Campo,G.; 45 Curreli,R.; Miscali (2006) Patient functioning and family burden in a controlled, real-world trial of family psychoeducation for schizophrenia. PSYCHIATRIC SERVICES 57(12): 1784 - 1791.
  • Cheng LY;Chan S; (2005) Psychoeducation program for chinese family carers of members with schizophrenia. West journal of Nursing Research 27(5): 583-599.
  • Chien,W.T.; Norman,I.; Thompson,D.R. (2004) A randomized controlled trial of a mutual support group for family caregivers of patients with schizophrenia. International Journal of Nursing Studies 41(6): 637 - 649. 5
  • Chien,W.T.; Chan,S.W. (2004) One-year follow-up of a multiple-family-group intervention for Chinese families of patients with schizophrenia. Psychiatric Services 55(11): 1276 - 1284.
  • Chien, Wai Tong; Chan, Sally; Morrissey, Jean; Thompson, David (2005) Effectiveness of a mutual support group for families of patients with schizophrenia.. J Adv Nurs. 10 51(6): 595-608.
  • Chien,W.T.; Chan,S.-W.C.; Thompson,D.R. (2006) Effects of a mutual support group for families of Chinese people with schizophrenia: 18-Month follow-up. British Journal of Psychiatry 189: 41 - 49.
  • Chien,W.T.; Wong,K.F. (2007) A family psychoeducation group program for chinese 15 people with schizophrenia in Hong Kong. Psychiatric Services. 58(7): 1003 - 1006.
  • Chien WT, Thompson DR, Norman I. Evaluation of a peer-led mutual support group for Chinese families of people with schizophrenia. American Journal of Community Psychology 2008; 42:122-134.
  • Dyck DG, Short RA, Hendryx MS, Norell D, Myers M, Patterson T, McDonell MG, Voss 20 WD, McFarlane WR. Management of negative symptoms among patients with schizophrenia attending multiple-family groups. Psychiatric Services 2000;51(4):513-9.
  • Dyck,D.G.; Hendryx,M.S.; Short,R.A.; Voss,W.D.; McFarlane,W.R. (2002) Service use among patients with schizophrenia in psychoeducational multiple-family group treatment. Psychiatric Services 53(6): 749 - 754. 25
  • Doane JA, Falloon IR, Goldstein MJ, Mintz J. Parental affective style and the treatment of schizophrenia. Predicting course of illness and social functioning. Archives of General Psychiatry 1985;42:34-42.
  • Falloon IRH, Boyd JL, McGill CW, Razani J, Moss HB, Gilderman AM. Family management in the prevention of exacerbations of schizophrenia: a controlled study. 30 New England Journal of Medicine 1982;306:1437-40.
  • Falloon IRH, Jeffery LB, McGill CW, Williamson M, Razani J, Moss HB, Gilderman AM, Simpson GM. Family management in the prevention of morbidity of schizophrenia: clinical outcome of a two-year longitudinal study. Archives of General Psychiatry 1985;42:887-96. 35
  • Falloon IRH, Razani J, Moss HB, Boyd JL, McGill CW, Pederson J. Gemeindenahe Versorgung von Schizophrenen Eine einjaehrige Kontrolluntersuchung bei Familien- und Einzeltherapie. Partnerberatung 1983;20:73-9.
  • Falloon IR, McGill CW, Boyd JL, Pederson J. Family management in the prevention of morbidity of schizophrenia: social outcome of a two-year longitudinal study. 40 Psychological Medicine 1987;17:59-66.
  • Falloon IRH, McGill CW, Matthews SM, Keith SJ, Schooler NR. Family treatment for schizophrenia - The design and research application of therapist training models. Journal of Psychotherapy Practice and Research 1996;5:45-56.
  • Garety, P.A., Fowler, D.G., Freeman, D., Bebbington, P., Dunn, G. & Kuipers, E. (2008) 45 A randomised controlled trial of cognitive behavioural therapy and family intervention for the prevention of relapse and reduction of symptoms in psychosis. British Journal of Psychiatry 192: 412-423.
  • Glynn SM, Randolph ET, Eth S, Paz GG, Leong GB, Shaner AL, Van Vort W. Schizophrenic symptoms, work adjustment, and behavioral family therapy. Rehabilitation Psychology 1992;37:323-38.
  • Goldstein MJ, Rodnick EH, Evans JR, May PRA, Steinberg MR. Drug and family therapy in the aftercare of acute schizophrenics. Archives of General Psychiatry 1978;35:1169-5 77.
  • Goldstein MJ, Kopeiken HS. Short and long-term effects of combining drug and family therapy. In: Goldstein MJ, ed. New developments in interventions with families of schizophrenics. :5-26.
  • Gutierrez-Maldonado J, Caqueo-Urizar A, Ferrer-Garcia M. Effects of a 10 psychoeducational intervention program on the attitudes and health perceptions of relatives of patients with schizophrenia. Social Psychiatry and Psychiatric Epidemiology S2- Social Psychiatry 2009; 44:343-348.
  • Hazel,N.A.; McDonell,M.G.; Short,R.A.; Berry,C.M.; Voss,W.D.; Rodgers,M.L.; Dyck,D.G. (2004) Impact of multiple-family groups for outpatients with schizophrenia 15 on caregivers' distress and resources.Psychiatric Services 55(1): 35 - 41.
  • Hogarty G, Kornblith S, Greenwald D, Di Barry A, Cooley S, Ulrich R, Carter M & Flesher S. Three year trials of personal therapy among schizophrenic patients living with or independent of family, I: Description of study and effects on relapse rates. :11, 1504-1515. 20
  • Hogarty G, Greenwald D, Ulrich R, Kornblith S, Di Barry A, Cooley S, Carter M, Flesher S. Three year trials of personal therapy among schizophrenic patients living with or independent of family, II: Effects on adjustment of patients. :11, 1514-1524.
  • Jenner, J.A, Nienhuis, F.J, Wiersma, D, van de Willige, G. (2004) Hallucination focused integrative treatment: a randomized controlled trial. Schizophrenia Bulletin 30(1): 133 - 25 145.
  • Jenner,J.A., Nienhuis, F.J, van de Willige, G, Wiersma, D. (2006) "Hitting" voices of schizophrenia patients may lastingly reduce persistent auditory hallucinations and their burden: 18-month outcome of a randomized controlled trial. Canadian Journal of Psychiatry - Revue Canadienne de Psychiatrie 51(3): 169 - 177. 30
  • Keith SJ, Bellack A, Frances A, Mance R, Matthews SM. The influence of diagnosis and family treatment on acute treatment response and short term outcome in schizophrenia. Psychopharmacology Bulletin 1989;25:336-9.
  • Kopelowicz,A.; Zarate,R.; Gonzalez,SmithV; Mintz,J.; Liberman,R.P. (2003) Disease management in Latinos with schizophrenia: a family-assisted, skills training approach. 35 Schizophrenia Bulletin 29(2): 211 - 227.
  • Leavey,G.; Gulamhussein,S.; Papadopoulos,C.; Johnson-Sabine,E.; Blizard,B.; King,M. (2004) A randomized controlled trial of a brief intervention for families of patients with a first episode of psychosis.Psychological Medicine. 34(3): 423 - 431.
  • Leff J, Kuipers L, Berkowitz R, Eberlein-Fries R, Sturgeon D. A controlled trial of social 40 interventions in the families of schizophrenic patients. British Journal of Psychiatry 1982;141:121-34.
  • Leff J, Kuipers L, Berkowitz R, Sturgeon D. A controlled trial of social intervention in the families of schizophrenic patients: two-year follow-up. British Journal of Psychiatry 1985;146:594-600. 45
  • Leff J, Kuipers L, Berkowitz R, Eberlein-Fries R, Sturgeon D. Psychosocial relevance and benefit of neuroleptic maintenance: experience in the United Kingdom. Journal of Clinical Psychiatry 1984;45:43-9.
  • Leff J, Berkowitz R, Shavit N, Strachan A, Glass I, Vaughn C. A trial of family therapy versus a relatives group for schizophrenia. British Journal of Psychiatry 1989;154:58-66.
  • Leff J, Berkowitz R, Shavit N, Strachan A, Glass I, Vaughn C. A trial of family therapy versus a relatives group for schizophrenia: two year follow-up. British Journal of 5 Psychiatry 1990;157:571-7.
  • Lenior, M.E., Dingemans, P.M.A.J., Liszen, D.H., De Haan, L. & Schene, A.H. (2001) Social functioning and the course of early-onset schizophrenia. British Journal of Psychiatry 179: 53-58.
  • Li, Z, Arthur, D. (2005) Family education for people with schizophrenia in Beijing, 10 China: randomised controlled trial. British Journal of Psychiatry 187: 339 - 345.
  • Liberman RP. Behavioural family management in schizophrenia. Outcome of a clinic-based intervention. British Journal of Psychiatry. 1994;164:501-6.
  • Liberman RP, Cardin V, McGill CW, Falloon IR, et al. Behavioral family management of schizophrenia: Clinical outcome and costs. University of Maryland School of Medicine 15 Symposium: Economic issues in schizophrenia (1986, San Diego, California). Psychiatric Annals 1987;17:610-19.
  • Megens, Y., Meijel, B. van, Grypdonck, M. (2007). Training Interactievaardigheden Schizofrenie. Een onderzoek naar de effecten en ervaringen. Intern onderzoeksverslag UMC Hogeschool InHolland. 20
  • Linszen,D.; Dingemans,P.; Van der Does,J.W.; Nugter,A.; Scholte,P.; Lenoir,R.; Goldstein,M.J. (1996) Treatment, expressed emotion and relapse in recent onset schizophrenic disorders. 26(2): 333 - 342.
  • Magliano,L.; Fiorillo,A.; Malangone,C.; De,Rosa C.; Maj,M.; Maresca,L.; Cavaliere,G.; Delcuratolo,V.; Giannini,M.; Ambra,L.; Malacarne,A.; Gentile,F.; McDonell MG, Short 25 RA, Berry CM, Dyck DG. (2003) Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality.. Family Process. 42(1): 91-103.
  • McDonell,M.G.; Short,R.A.; Hazel,N.A.; Berry,C.M.; Dyck,D.G. (2006) Multiple-family group treatment of outpatients with schizophrenia: impact on service utilization. 45(3): 359 - 373. 30
  • McFarlane WR, Link B, Dushay R, Marchal J, Crilly J. Psychoeducational multiple family groups: four-year relapse outcome in schizophrenia. Fam Process 1995;34(2):127-44.
  • McFarlane WR, Lukens E, Link B, Dushay R, Deakins S, Newmark M, Dunne E, Horen B, Toran J. Multiple-family groups and psychoeducation in the treatment of schizophrenia. Arch Gen Psychiatry. 1995;52(8):679-87. 35
  • McGill CW, Falloon IR, Boyd JL, Wood SC. Family educational intervention in the treatment of schizophrenia. Hospital and Community Psychiatry 1983;34:934-8.
  • Montero, I., Asencio, A., Hernandez, I., Masanet, M.J., Lacruz, M., Bellver, F., Iborra, M., Ruiz, I. (2001) Two strategies for family intervention in schizophrenia: A randomised trial in a Mediterranean environment. Schizophrenia Bulletin 27(4): 661- 40 670.
  • Montero,I.; Hernandez,I.; Asencio,A.; Bellver,F.; Lacruz,M.; Masanet,M.J. (2005) Do all people with schizophrenia receive the same benefit from different family intervention programs?. Psychiatry Research133: 187 - 195.
  • Montero,I.; Masanet,M.J.; Bellver,F.; Lacruz,M. (2006) The long-term outcome of 2 45 family intervention strategies in schizophrenia. Comprehensive Psychiatry 47(5): 362-367.
  • Pfammatter, M, Junghan, U.M., Brenner, H.D. (2006). Efficacy of psychosocial therapy in schizophrenia: conclusions from meta-analyses. Schizophrenia Bulletin, 32, S1, S64-S80.
  • Pharoah F, Mari J, Rathbone J, Wong W (2006). Family intervention for schizophrenia. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD000088. DOI: 5 10.1002/14651858.CD000088.pub2.
  • Posner CM, Wilson KG, Kral MJ, Lander S, Mcllwraith RD. Family psychoeducational support groups in schizophrenia. American Journal Orthopsychiatry 1992;62(2):206-218.
  • Ran,M.S.; Xiang,M.Z.; Chan,C.L.; Leff,J.; Simpson,P.; Huang,M.S.; Shan,Y.H.; Li,S.G. 10 (2003) Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia-a randomised controlled trial. Social Psychiatry & Psychiatric Epidemiology 38(2): 69 - 75.
  • Randolph ET, Eth S, Glynn SM, Paz GG, Leong GB, Shaner L, Strachan A, Van-Vort W, Escobar JI, Rea M, Strachan A, Goldstein M, Falloon I, Hwang S. Changes in patient 15 coping style following individual and family treatment for schizophrenia. British Journal of Psychiatry 1991;158:642-7.
  • Schooler NJ, Keith SJ, Severe JB, Matthews SM, Bellack A, Glick ID, Hargreaves WA, Kane JM, Ninan PT, Frances A, Jacobs M, Lieberman JA, Mance R, Simpson GM, Woerner MG. Relapse and rehospitalisation during maintenance treatment of schizophrenia. The 20 effects of dose reduction and family treatment. Archives of General Psychiatry 1997;54:453-63.
  • Schulze Monking H. Self-help groups for families of schizophrenic patients: formation, development and therapeutic impact. Social Psychiatry and Psychiatric Epidemiology 1994;29:149-54. 25
  • Sellwood W, Barrowclough C, Tarrier N, Quinn J, Mainwaring J, Lewis S. Needs-based cognitive-behavioural family intervention for carers of patients suffering from schizophrenia: 12 month follow-up. Acta Psychiatrica Scandinavia 2001;104:346-355.
  • Sellwood, W., Wittkowski, A., Tarrier, N., Barrowclough, C. (2007) Needs-based cognitive behavioural family intervention for patients suffering from schizophrenia: 5-30 year follow-up of a randomised controlled effectiveness trial. Acta Psychiatrica Scandinavica 116: 447-452.
  • So, H.W.; Chen,E.Y.H.; Chan,R.C.K.; Wong,C.W.; Hung,S.F.; Chung,D.W.S.; Ng,S.M.; Chan,C.L.W. (2006) Efficacy of a brief intervention for carers of people with first-episode psychosis: A waiting list controlled study. Hong Kong Journal of Psychiatry. 35 16(3).
  • Strang JS, Falloon IRH, Moss HB, Razini J, Boyd JL. Drug treatment and family intervention during the aftercare treatment of schizophrenics. Psychopharmacology Bulletin 1981;17:87-8.
  • Szmukler, G., Kuipers, E., Joyce, J., Harris, T., Leese, M., Maphosa, W., Staples, E. 40 (2003) An exploratory randomised controlled trial of a support programme for carers of patients with a psychosis. Social Psychiatry & Psychiatric Epidemiology 38: 411-418.
  • Tarrier N, Barrowclough C, Vaughn C, Bamrah JS, Porceddu K, Watts S, Freeman H. The community management of schizophrenia: a controlled trial of a behavioural intervention with families to reduce relapse. British Journal of Psychiatry 1988;153:532-45 42.
  • Tarrier N, Barrowclough C, Vaughn C, Bamrah JS, Porceddu K, Watts, Freeman H. Community management of schizophrenia: a two-year follow up of a behavioural intervention with families. British Journal of Psychiatry 1989;154:625-8.
  • Tarrier N, Lownson K, Barrowclough C. Some aspects of family interventions in schizophrenia. II. Financial considerations. British Journal of Psychiatry 1991;159:481-5 4.
  • Tarrier N, Barrowclough C, Proceddu K, Fitzpatrick E. The Salford family intervention project: Relapse rates of schizophrenia at five and eight years. British Journal of Psychiatry 1994;165:829-32.
  • Valencia, Rascon, Juarez, Murow (2007) A psychosocial skills training approach in 10 Mexican out-patients with schizophrenia. Psychological Medicine 37(10): 1393-1402.
  • Van Busschbach J, Wolters K, Boumans, H. (2009) Betrokkenheid in kaart gebracht, Groningen, RGOc-reeks, 20.
  • Vaughan K, Doyle M, McConaghy N, Blaszczynski A, Fox A, Tarrier N. The Sydney intervention trial: a controlled trial of relatives' counselling to reduce schizophrenic 15 relapse. Social Psychiatry and Psychiatric Epidemiology 1992;27:16-21.
  • Xiong W, Phillips MR, Hu X, Wang R, Dai Q, Kleinman J, Kleinman A. Family-based intervention for schizophrenic patients in China: a randomised controlled trial. British Journal of Psychiatry 1994;165:239-47.
  • Zhang M, Wang M, Li J, Phillips MR. Randomised-control trial of family intervention for 20 78 first-episode male schizophrenic patients: an 18-month study in Suzhou, Jiangsu. British Journal of Psychiatry 1994 (Suppl. 24):96-102.

Laatste bewerking: 17-05-2011 09:30