Family Psychoeducation in Youth with First Episode Psychosis - Essay Example

A Critical Analysis of Family Psychoeducation in Youth with First Episode Psychosis Psychosis can be ified clinically as a mental condition thatmanifests with non specific initial signs and symptoms including loss of concentration, social isolation, delusional mood and emotional disturbances. International clinicians and researchers refer to this as the prodromal period which commonly precedes psychotic disorders. With that, professional intervention has been indicated in this early stage of psychosis to maximize treatment outcomes (Winter 2004, p. 159). However, the condition usually follows a pattern of relapse even after the treatment course if environment and society makes the individual susceptible into reacquiring the condition. Hence, extensive researches have been provided in the professional literature focusing on the prevention of psychosis, treatment and maintenance, as well as prevention of relapse across age- groups, gender, and cultural differences. On the other hand, intervention like family psychoeducation is challenged with its practical approach to the needs of the youth with first- episode psychosis (FEP). In this paper, family psychoeducation is reviewed in youth with first episode psychosis, including theoretical foundations and outcomes of clinical trials and empirical studies. Theoretical Foundations Family psychoeducation (FPE) endeavors patient- focused interventions utilizing members of family to address the needs of their youth member experiencing the first episodes of psychosis. The basis of family psychoeducation is that majority of the youth age- groups are still living with their families (O’Brien, 2007). Thus, the family provides the immediate environment of acceptance and care for these patients. Adoption, expressed emotion, and treatment studies provide evidence suggesting the key role of family environment in the evolution of psychiatric symptoms, with environments that are calm, supportive and low in criticism potentially serving a protective factor. Furthermore, family psychoeducation programs promotes problem-solving and coping skills training, not just as an exercise in a single workshop, but as an on-going part of family life. More often than not, family psychoeducation does not present as a single intervention. It is incorporated as part of the general comprehensive management program which may include the use of psychotropic drugs, psychodynamic approach, and cognitive- behavioral therapy. For example, family psychoeducation has been a part of Early Intervention (EI) programs in Canada, Prevention and Early Intervention Program for Psychoses (PEPP) in London, Early Detection and Intervention Programme (EDIP) in Germany, and Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia. Actually, FPE previously evolved from different models of management. For instance, the Behavioral Family model focused on the influence of family communication and problem- solving on behavioral changes in patients (Falloon, 1985). This model prioritizes behavioral perspectives of psychosis and attempts to address the whole situation by attempting to modify patient’s behavior. On the other hand, Family Educational model engages several families into an intensive evidence- based education about the causes, treatment and guidelines of recovery from the mental condition (Anderson, Hogarty, and Reiss, 1980). In this model, the concerned family is empowered by educating them on how they can cooperate with the patient’s recovery and successful reintegration to society. While these two models each targets one aspect of the wide- ranged interventions of psychosis, Psychoeducational Multifamily Group (PFMG) Approach integrates the behavioral and educational approach to come- up with a more comprehensive psychosocial management. Outcomes of Clinical Trials and other Empirical Studies Current management of the youth with first episode psychosis still relies on the efficacy of family psychoeducation, aside from the dynamic development of psychotropic drugs. According to Dixon et al. (2010), the assessment of the appropriateness of family psychoeducation for a particular patient and family should consider the interest of the family and patient, the extent and quality of family and patient involvement, the presence of patient outcomes that clinicians, family members, and patients can identify as goals, and whether the patient and family would choose family psychoeducation instead of alternatives available in the agency to achieve outcomes identified. The effectiveness of family psychoeducation has been demonstrated in a study by O’Brien et al. (2007). The feasibility and acceptability of a 9-month psychoeducational multifamily group (PMFG) intervention was examined among adolescents who are classified as “ultra-high–risk” (UHR) for developing psychosis. The term has been used for those individuals experiencing manifestations of early psychosis or having the highest risk of contracting the condition due to precipitating and aggravating factors present in their environment. The study utilized the existing PMFG program for adolescents. Thirty-five individuals (25 parents and 10 youth) completed evaluations of the psychoeducational workshops. The average rating was noted to be at 4.5 on a scale of 1 to 5 (1 being not useful at all, and 5 being extremely useful). This suggests that the assumed needs of the families and the adolescents having first episode psychosis have been adequately catered in the entire 9.5 months duration of the program. Also, each young person was always accompanied by at least one parent, and parents never attended group meetings alone. Verbal reports of feeling comfortable in meetings and benefiting from them have been documented. An average participation rate of 73% was also noted among the 16 participating families, which means roughly 3 out of 4 sessions were attended. Although adolescents demonstrated improvement in symptoms and functional outcome, positive changes cannot be attributed to the PMFG intervention alone since the study was not a randomized controlled trial and multiple interventions were introduced simultaneously. In fact, it is important to note that medication is not a variable in this study. The research design still considers medication adherence as a central part of the program interventions to promote recovery. To generate valid results, psychotropic drugs have been prescribed to both the control and experimental groups of participating families. Generally, psychoeducation among multiple families have been accepted by the community and thus reduced the social stigma accompanied by the mental condition. Furthermore, Mcfarlane et al. (2003) study demonstrated a significant reduction of the rates of symptom relapse requiring hospital admission between 20 to 50% using PMFG model. Collaboration with professionals, families and patients were essential part of the program. In McFarlane model, semi- structured interventions in which 5 to 8 families attended a closed group over a period of time ranging from 2 months to 2 years. The approach is characterized by three broad phases of group development: join and collaborate, work to improve patients’ functioning, and expand the intervention into a support network that can continue after the group concludes. Short- term goals geared towards promoting recovery from the losses and preventing secondary relapses, with the ultimate long- term goal of complete recovery and successful social reintegration. This model emphasizes the active involvement of the families in the interventions, not just mere participants. That is, families are brought together to form a mini support organization. Biological, psychological, and social perspectives are incorporated into the four cornerstones of PMFG treatment: education, joining, problem solving, and networking. Alternatively, Ruffolo et al. (2005) conducted a randomized controlled trial using PMFG intervention as the treatment variable. In this research design, 94 parents of youth with first episode psychosis were assigned in either a PMFG intervention (experimental group) that focused on support, empowerment, and education or in the standard intensive case management (ICM) services (usual treatment as control group). Five to nine parents met for 2 hours twice monthly for 6 months, while their children (mean age 11.68 years) met in separate groups. The key variables of parent social support network use, parent problem solving, parent coping skills, and youth behavior symptoms were measured at baseline, 9 months, and 18 months. Unlike O’Brien et al. (2007) and McFarlane et al. (2003) studies, results did not show statistical differences on the key variables. Yet, improvement was noted in youth behavior, both in the treatment and control groups. With the significant positive results, it implies that the needs of the youth with first episode psychosis, particularly socialization and coping skills, were catered both in the ICM and PMFG. An ingenious research design by Pollio et al. (2005) used the natural society of the youth with first episode psychosis, in which the patients’ schools were utilized as the setting for family psychoeducation. Results showed that aside from the positive effects on symptom management and preventing relapse, the use of school environment was indeed helpful to reduce social difficulties of the involved youth and their families. In fact, it was found out that 13 of the 15 families who completed the brief school-based psychoeducational intervention rated the experience as positive and helpful. Research on the feasibility of family psychoeducation on youth having first episode psychosis has saturated the literature of mental health professionals, psychologists and primary care givers. While it is fundamental for every research study to take into consideration various settings and policy modifications, results may vary depending on how the study was done. There is virtually no perfect policy on the standardization of psychosocial interventions for the youth with FEP. However, most of the researchers agree that the catering the needs of the concerned population group should be a vital component of the study. Bibliography Anderson, CM, Reiss, DJ & Hogarty, GE, 1980, ‘Family treatment of adult schizophrenic patients: a psycho-educational approach’, Schizophrenia Bulletin, vol. 6, no. 3, pp. 490- 505. Bechdolf, A, Rhurman, S, Wagner, M, Khun, KU, Janssen, B, Bottlender, R, Wieneke, A, Schulze- Lutter, F, Maier, W & Klosterkotter, J, 2005, ‘Interventions in the initial prodromal states of psychosis in Germany: concept and recruitment’, British Journal of Psychiatry, vol. 187, pp. 45- 48. Blanch, CG, Muñoz, VM, Garcia, GP, Garcia, OM, Jimenez, MA, Sanchez, JMR, Barquero, JLV & Facorro, BC, 2010, ‘Effects of family psychoeducation on expressed emotion and burden of care in first- episode psychosis: A prospective observational study’, The Spanish Journal of Psychology, vol. 13, no. 1, pp. 389- 395. Conus, P, Cotton, S, Schimmelmann, BG, McGorry, PD, Lambert, M, 2007, ‘The first- episode psychosis outcome study: premorbid and baseline characteristics of an epidemiological cohort of 661 first-episode psychosis patients’, Early Intervention in Psychiatry, vol. 1, pp.191–200. Dixon, L, McFarlane, WR & Lefley, H, 2001, ‘Evidence-based practices for services to families of people with psychiatric disabilities’, Psychiatric Services, vol. 52, pp. 903- 910. Dixon, L, Adams, C & Lucksted, A, 2000, ‘Update on family psychoeducation for schizophrenia’, Schizophrenia Bulletin, vol. 26, pp. 5- 20. Falloon, IRH, 1985, ‘Family management in the prevention of morbidity of schizophrenia: clinical outcome of a two- year longitudinal study’, Archives of General Psychiatry, vol. 42, pp. 887- 896. McFarlane, WR, 1997, ‘Fact: Integrating family psychoeducation and assertive community treatment’, Administration and Policy in Mental Health, vol. 25, no. 2, 191- 197. McFarlane, WR, Dixon, L, Lukens, E & Lucksted, A, 2003, ‘Family psychoeducation and schizophrenia: a review of the literature’, Journal of Marital & Family Therapy, vol. 29, no. 2, pp. 223- 245. O’Brien, MP, Zinberg JL, Bearden, CE, Daley, M, Niendam, TA, Kopelowicz, A &Cannon, TD, 2007, ‘Psychoeducational multi-family group treatment with adolescents at high risk for developing psychosis’, Early Intervention in Psychiatry, vol. 1, pp. 325- 332. Pollio, DE, McClendon, JB, North, CS, Reid, D, & Jonson-Reid, M, 2005, ‘The promise of school-based psychoeducation for parents of children with emotional disorders’, Children & Schools, vol. 27, no. 2, pp. 111-115. Ruffolo, MC, Kuhn, MT & Evans, ME, 2005, ‘Support, empowerment, and education: A study of multiple family group education’, Journal of Emotional and Behavioral Disorders, vol. 13, no. 4, pp. 200-212. Singh, SP & Fisher, HL, ‘Early intervention in psychosis: obstacles and opportunities’, Advances in Psychiatric Treatment, vol. 11, pp. 71- 78. Spencer, E, Birchwood, M & McGovern, D, 2001, ‘Management of first- episode psychosis’, Advances in Psychiatric Treatment, vol. 7, pp. 133- 142. Yung, AR, McGorry, PD, McFarlane CA, Jackson, HJ, Patton, GC & Rakkar, A, 2004, ‘Monitoring and care of young people at incipient risk of psychosis’, FOCUS Journal of Lifelong Learning in Psychiatry, vol. 2, no. 1, pp. 158- 173. Read More