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Are family-based interventions effective and safe for people with schizophrenia and their families, compared with standard care?
Family-based interventions may reduce the risk of relapse for people with schizophrenia by 34% at short-term follow-up, but the effect may not last long term. These interventions likely reduce caregiver burden and increase family members’ ability to shift from high to low expressed emotion. They might reduce hospital days in the short and medium term, but their impact on overall hospital admissions is uncertain. Family-based interventions can improve patients’ mental state, particularly positive symptoms and insight, and may increase functioning in the short and long term, but their effect on social functioning is minimal. For family members, these interventions likely improve social support and family functioning in the short term and may enhance caregiving competence.
Most patients ranged from age 25 to 40, with an average illness history of 2.5 to 13 years. Most included studies were conducted in outpatient or community settings by mental health nurses, psychiatrists or psychologists.
Schizophrenia is a severe, chronic mental illness affecting about 20 million people globally. Onset typically occurs between ages 18 and 24. The illness often leads to long-term impairments in social, cognitive and occupational functioning, and is a leading cause of disability. Antipsychotic medications (the primary treatment) are effective for managing positive symptoms but less so for negative and cognitive symptoms. High-stress family environments can increase the risk of relapse. Family-based interventions, which improve understanding and relationships, have been recommended to enhance care quality and reduce the burden on both patients and families. However, few individuals consent to family involvement in their care.
Chien WT, et al. Family-based interventions versus standard care for people with schizophrenia. Cochrane Database Syst Rev 2024;10:CD013541. This review contains 26 trials and 1985 people.
Pharmacist prescribers Linda Bryant and Leanne Te Karu discuss positive polypharmacy for heart failure. Current evidence shows the intensive implementation of four medications offers the greatest benefit to most patients with heart failure, with significant reductions in cardiovascular mortality, heart failure hospitalisations and all-cause mortality
