Family Intervention Helps Prevent Relapse in First-Episode Psychosis

Psychiatry Advisor Contributing Writer
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Researchers in Spain conducted analyses of studies that were limited to published English and Spanish studies finding that within the first few years after treatment begins for schizophrenia family intervention for psychosis is effective to prevent relapse. Researchers suggest sending reminders to relative of patients with first episode of psychosis to prevent future relapses.

Family intervention for psychosis (FIp) reduced relapse rates, hospitalization duration, and psychotic symptoms along with increasing functionality in first-episode psychosis (FEP) up to 24 months, according to a recent review published in Schizophrenia Bulletin.

As relapse risk during the early years of FEP increases the risk for chronicity and other complications considerably, researchers conducted a literature review and meta-analysis of published randomized controlled trials to assess the effectiveness of FIp until 24 months of follow-up. A total of 2109 records were retrieved and 14 (11 randomized controlled trials) were included. Effectiveness of FIp vs conventional treatment and other psychosocial interventions were compared with respect to outcomes such as relapse rates, duration of hospitalization, psychotic symptoms, and functionality. Meta-analyses were performed for the 2 main comparisons: FIp vs conventional treatment and FIp vs conventional treatment plus alternative psychotherapy approaches.

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Duration of hospitalization was measured as the number of days admitted to hospital following second-episode psychosis. The severity of psychotic symptoms was scored according to the Brief Psychiatric Rating Scale and the Positive and Negative Syndrome Scale. Relapse was defined as hospitalization in 4 trials; as ratings from 3 (mild) or below increasing to 6 or 7 (severe and very severe) on any of the following 3 items: unusual thought content, hallucinations, or conceptual disorganization meeting 1-week duration criterion in 1 trial; and as the presence of all these 3 criteria: recurrent or exacerbated psychotic symptoms explicitly recorded in psychiatric notes; a significant increase in antipsychotic medication; and psychotic symptoms persisting for at least 1 week in 1 trial.

Pooled results showed that FIp was effective for preventing relapse (risk ratio [RR] 0.42; 95% CI, 0.29-0.61) compared with conventional treatment and/or other psychosocial interventions. It also was effective when compared with conventional treatment alone (RR 0.36) and conventional treatment plus other psychosocial interventions (RR 0.48). FIp showed benefits in reducing the duration of hospitalization (conventional treatment, mean difference [MD] −3.31; other interventions, MD −4.57) and psychotic symptoms (conventional treatment, standardized MD [SMD] −0.68), and increased functionality (conventional treatment, SMD 1.36; other interventions, SMD 1.41).

Limitations of the study included the inclusion of published results only; none of the authors were contacted for additional or missing data; and that trials included in the meta-analysis varied substantially in terms of design and follow-up, participants’ clinical characteristics, relapse criteria employed, and the outcome assessment instruments used. The pooling of treatment effects remedied this to some extent. Studies also differed in the timing between baseline assessment and FIp intervention initiation, which may have influenced the relapse rates and only English and Spanish publications were considered, thereby ruling out other relevant trials published in other languages. Finally, only a small number of trials were entered into the funnel plot to find evidence of publication bias.

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The researchers concluded that “FIp for FEP is effective at reducing not only relapse but also episode severity in terms of duration of hospitalization, psychotic symptoms, and functionality up to 24 months after treatment initiation.” Also, FIp was found to be more effective than conventional treatment and conventional treatment plus other psychosocial interventions.

Reference

Camacho-Gomez M, Castellvi P. Effectiveness of family intervention for preventing relapse in first-episode psychosis until 24 months of follow-up: a systematic review with meta-analysis of randomized controlled trials [published online May 3, 2019]. Schizophr Bull. doi: 10.1093/schbul/sbz038