Current Research on Family Interventions in Psychosis

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Questions and Answers

What aspect does the ABC model address in relation to distress?

The impact of relationships on caregiving

The appraisal of personal resources

The belief about the cause of events

The sequence of events leading to consequences (correct)

Which dimension of Leventhal’s Illness Perception Beliefs Model refers to how the illness affects various aspects of life?

Cure/control

Timeline

Consequences (correct)

Identity

How do carer beliefs about a situation affect their experience of burden?

They reflect the personal distress experienced directly by the client.

They are solely dependent on the client’s severity of illness.

They are independent of the actual experiences of the client. (correct)

They only relate to the duration of the caregiving role.

What is suggested by cognitive theory regarding distress?

The interpretation of events influences emotional outcomes. Signup and view all the answers

Which term best describes relationships characterized by high levels of hostility and criticism from caregivers?

Critical/Hostile Relationships Signup and view all the answers

What is the relapse rate for patients receiving family psychoeducation alone?

10% Signup and view all the answers

What does the NICE recommend for everyone in EIS?

Family Intervention Signup and view all the answers

According to Rodolico et al., 2022, what is unclear regarding psychoeducation interventions?

The need for more sessions Signup and view all the answers

What is the relapse rate in treatment as usual (TAU)?

37% Signup and view all the answers

What is a benefit of family interventions (FI) mentioned in the content?

Improved understanding of the patient's environment Signup and view all the answers

What is the primary benefit of engaging families early in the treatment process?

It leads to better outcomes for patients. Signup and view all the answers

Why is it important to have a shared message about family involvement across services?

It ensures consistency in how families are engaged. Signup and view all the answers

What challenges might arise from complex needs within a family during intervention planning?

Relationships may complicate decision-making. Signup and view all the answers

What is an important aspect of maintaining effective working relationships with families?

Using a single designated person for continuity of care. Signup and view all the answers

How can healthcare providers assist families who are busy in engaging with interventions?

By being flexible with meeting times and modes of communication. Signup and view all the answers

What is a primary benefit of having a carer for individuals experiencing psychosis?

Improved quality of life Signup and view all the answers

What are common outcomes reported by carers of individuals with psychosis?

High levels of burden and burnout Signup and view all the answers

Which of the following best describes Expressed Emotion (EE) in caregiving relationships?

It measures family interactions as either positive or negative. Signup and view all the answers

How does high Expressed Emotion (EE) relate to the risk of relapse in schizophrenia?

It predicts a higher rate of relapse. Signup and view all the answers

What is the link between high EE and carer outcomes?

High EE is correlated with poor carer outcomes. Signup and view all the answers

What factors contribute to the emotional and physical health challenges faced by carers?

High levels of burnout and stigma Signup and view all the answers

Which dimension is NOT part of the scoring for Expressed Emotion (EE)?

Financial support Signup and view all the answers

What percentage of carers reported experiencing clinical levels of depression?

30-40% Signup and view all the answers

What is one potential effect of high levels of Expressed Emotion (EE) on individuals with schizophrenia?

Greater risk of relapse Signup and view all the answers

What type of interventions has the clearest evidence for reducing relapse?

Comprehensive/sustainable interventions Signup and view all the answers

What is a key characteristic of Early Intervention Teams (EIT)?

All staff members are trained Signup and view all the answers

What emotional challenges are often faced by carers of individuals with psychosis?

High levels of grief and loss Signup and view all the answers

Why does discharge planning not work well on its own?

It requires community involvement for success Signup and view all the answers

What do family interventions aim to achieve according to the research?

Improve service user functioning and reduce relapse Signup and view all the answers

What is important for the implementation of family interventions according to the content?

Involvement of the entire team and continuity of care Signup and view all the answers

What is noted as a possible key future ingredient of family interventions?

Peer support Signup and view all the answers

Which approach requires specialist training among staff?

Systemic family therapy Signup and view all the answers

What is one challenge mentioned regarding family interventions?

Implementation difficulties Signup and view all the answers

What is a key barrier faced by family members of patients in involuntary care under the MHA?

Feeling isolated and unsupported by services Signup and view all the answers

What type of support is emphasized as necessary for informal carers of people detained under the MHA?

One-to-one and situation-specific support Signup and view all the answers

Why is peer support considered beneficial for informal carers?

Peer supporters have personal experience with similar situations Signup and view all the answers

What was a successful, evidence-based solution tested for supporting carers in England?

The OPAL project Signup and view all the answers

What aspect of family support was identified as lacking in care and discharge planning?

One-to-one and situation-specific interventions Signup and view all the answers

What is a common sentiment expressed by families regarding the legalities of the MHA?

They desire assistance to understand their rights Signup and view all the answers

What type of gatherings do families suggest for better support?

Regular get-togethers for one-to-one discussions Signup and view all the answers

What has been identified as a significant need for informal carers while dealing with situations under the MHA?

Tailored information and understanding of the MHA Signup and view all the answers

What is the minimum number of planned sessions required for family interventions according to the NICE recommendations?

10 planned sessions Signup and view all the answers

Which factor is NOT taken into account during family interventions for individuals with psychosis?

The person's medication adherence Signup and view all the answers

Which statement correctly describes the essence of family intervention?

Family members are included directly in the therapy process Signup and view all the answers

What is the suggested duration for conducting family interventions, according to NICE recommendations?

3 months to 1 year Signup and view all the answers

Who can be classified as a carer for an individual with psychosis?

Friends and advocates who have close contact Signup and view all the answers

What is a significant barrier to the effective implementation of family interventions?

Training needs not being met Signup and view all the answers

How does organizational culture impact the implementation of family interventions?

It influences staff members' commitment to family interventions. Signup and view all the answers

What factor is important for engaging families in the treatment process?

Engaging them early in the intervention Signup and view all the answers

Which of the following approaches is primarily identified in family interventions?

Family Psychoeducation Signup and view all the answers

What should be shared among staff members for family interventions to be implemented effectively?

A shared focus on family involvement Signup and view all the answers

What is one of the challenges identified when engaging families during treatment?

Complex family dynamics can hinder engagement. Signup and view all the answers

What type of studies made up the vast majority of evidence identified in the review?

Cross-sectional and staff-focused studies Signup and view all the answers

What is a noted critical period for achieving better outcomes with families?

Upon early engagement with families Signup and view all the answers

What aspect related to a carer's perception can significantly influence the carer burden?

The resources available to the carer Signup and view all the answers

Which dimension of Leventhal's Illness Perception Beliefs Model refers to the perceived duration of the illness?

Timeline Signup and view all the answers

What is a fundamental reason for advocating one-to-one support for informal carers under the Mental Health Act?

To address sensitive issues with specific legal information. Signup and view all the answers

Which belief about psychosis can affect both emotional and practical responses of caregivers?

Beliefs about the management of symptoms Signup and view all the answers

Which intervention was found to be the most effective in reducing relapse by including carers in both hospital and community settings?

Psychoeducation with discharge planning and community follow-up. Signup and view all the answers

What type of family intervention can significantly benefit both clients and their caregivers?

Psychoeducation for the family Signup and view all the answers

What role does the OPAL project play in supporting informal carers?

It provides a peer support program tailored for specific needs. Signup and view all the answers

What is a major implication of comprehensive and sustained interventions mentioned in the content?

They can improve service user functioning and reduce relapse. Signup and view all the answers

Which factor might hinder the effectiveness of family interventions for psychosis?

High levels of expressed emotion among caregivers Signup and view all the answers

Which emotional challenge is commonly faced by caregivers of individuals with psychosis?

Feelings of isolation from the community Signup and view all the answers

What does the evidence suggest regarding the training of staff involved in family interventions?

All staff can benefit from being trained to deliver family psychoeducation. Signup and view all the answers

Why is peer support particularly valuable for informal carers as highlighted in the content?

It provides shared experiences and personal insights. Signup and view all the answers

What is an important part of the relationship between caregivers and the individual experiencing psychosis?

Understanding and empathy Signup and view all the answers

What is a key aspect that families desire in support settings for better assistance?

Private and organized regular get-togethers. Signup and view all the answers

Which cognitive theory suggests that the way individuals perceive events affects their emotional response?

Cognitive Theory Signup and view all the answers

What type of intervention has been shown to work minimally when focused solely on one aspect?

Discharge planning without additional support. Signup and view all the answers

What is crucial for ensuring continuity of care in interventions?

Having the same person deliver the intervention Signup and view all the answers

What should be included during the initial meeting with a patient, their carer, and clinician after admission?

The reason for admission and hospital processes Signup and view all the answers

Which of the following represents a practical challenge in carer involvement?

Assessing and obtaining patient consent Signup and view all the answers

How can healthcare providers better engage busy families in interventions?

By offering meetings via video calls or outside working hours Signup and view all the answers

What can help improve the implementation of family involvement in inpatient care?

Focusing on groups consisting of patients, carers, and staff Signup and view all the answers

What aspect should be valued in carer involvement in care planning?

The carer's personal knowledge of the patient's condition Signup and view all the answers

What is an important consideration when listening to families during interventions?

Understanding the individual and their cultural background Signup and view all the answers

Which of the following does NOT contribute to the systemic challenges of carer involvement?

Availability of healthcare staff for consultations Signup and view all the answers

What is one major advantage of having a carer for individuals experiencing psychosis?

Improved treatment adherence Signup and view all the answers

What percentage of carers report clinical levels of depression according to the provided content?

30-40% Signup and view all the answers

What does High Expressed Emotion (EE) commonly predict in the context of schizophrenia?

Higher relapse rates Signup and view all the answers

What is noted as a common consequence experienced by carers due to their caregiving roles?

Social isolation Signup and view all the answers

Which term best describes the emotional challenges that can occur in caregiving relationships characterized by excessive criticism and hostility?

Expressed Emotion (EE) Signup and view all the answers

What is the relationship between High Expressed Emotion and carer burden?

High EE correlates with increased carer burden Signup and view all the answers

In what way can 'overinvolvement' of a carer be perceived in early phases of psychosis?

As an adaptive response Signup and view all the answers

What is a significant emotional effect that can result from the caregiving experience?

Feelings of negativity towards the person being cared for Signup and view all the answers

Which factor is directly associated with high levels of Expressed Emotion in caregiving relationships?

Frequent family conflicts and criticism Signup and view all the answers

What percentage of carers are reported to be victims of violence and aggression?

52.9% Signup and view all the answers

Study Notes

Current Research for Working with Families with Psychosis

Family intervention is an evidence-based psychological intervention for people experiencing psychosis and their families.
Different types of family intervention exist but all aim to include family members in therapy.
Clinicians, family members, and service users have sessions together, often in the person's home.
NICE recommendations include:
- Involving the person with psychosis if practical.
- Intervention duration between 3 months and 1 year.
- At least 10 planned sessions, usually every other week.
- Considering single-family or multi-family group intervention based on family preference.
- Considering the relationship between the main carer and the person with psychosis.
- A specific role for support, education, or treatment, including problem-solving or crisis management.

Who is a Carer?

Carers can be various individuals including advocacy groups, friends, or relatives who regularly interact with those experiencing psychosis or schizophrenia.
A carer may or may not be a family member.
Family members, who live with or are in close contact with the person with psychosis or schizophrenia, are also considered carers.

Carers as a Resource

People with psychosis who have carers often have better outcomes and quality of life.
Early access to relevant services during the early stages of psychosis is important (for better outcomes).
Improving medication adherence is beneficial.
Identifying early relapse signs improves treatment.
Reducing hospital admissions and relapse rates through psychological therapy and improved reasoning skills.

Experience of Caregiving in Psychosis

Caregivers experience high levels of burden (approximately 80%).
Caring roles negatively impact other aspects of life, such as emotional well-being, social functioning, and financial stability.
High rates of burnout, exhaustion, and negativity towards the person being cared for.
High levels of clinical depression (30-40%) and PTSD symptoms (30-40%) in carers.
High prevalence of loss and grief experiences.
Social isolation and stigma associated with mental health.

Expressed Emotion (EE)

EE measures the family environment regarding interactions as either positive or negative.
Negative aspects like criticism, hostility, and emotional over-involvement are common.
High EE can be detrimental to prognosis and carer well-being.
Over-involvement can be an adaptive response in early psychosis.
High EE is related to carer burden as well as a predictor of worse outcomes.
High EE can be associated with poorer carer outcomes including stress, distress, low self-esteem, and less effective coping strategies.
EE impacts both the individual with psychosis and the carer involved.

Beliefs about Psychosis

The Cognitive model of caregiving suggests carers' beliefs about the diagnosis significantly affect their stress response.
Carers' appraisals of the situation, resources available, and perceived impact influence carer burden.
Leventhal's Illness perception model outlines the key dimensions of illness perception that can affect carers and those affected. For example:
- Identity, causes of the illness, perceived control or cure, perceived consequences, and estimated time course of the illness.

Family Interventions for Psychosis

Models of Family Interventions, evidence of family interventions' effectiveness, and practice implementation in mental health services are important aspects.
System-oriented, psychoeducational, and integrated interventions are key treatment modalities, though implementing them effectively is challenging.

Critical/Hostile Relationships

Carers often blame the person with psychosis.
Carers display avoidant coping mechanisms.
Addressing such relationships requires re-attribution of responsibility and psychoeducation regarding psychosis, family intervention, and emotional processing strategies.

Positive Relationships

Carers are supportive and emotionally available.
Carers display adaptive responses to the condition and circumstances
These approaches include providing emotional support, re-attribution of responsibility, and psychoeducation about psychosis-related issues.

Implementation in Inpatient Settings

Carer involvement in inpatient settings requires special attention to understanding carer needs regarding their roles and time involved with the patient.
It's essential to engage carers early and on a regular ongoing basis. Carer involvement should include the right time, support, and information.
Challenges in implementing family interventions in inpatient care settings include accessing carers, obtaining consent, and managing the dynamic environments.

Family Support - Involuntary Care Admittance

Carer involvement in situations where individuals are admitted under mandatory mental health laws is a complex issue.
Effective communication and support are essential to ensure positive relationships between carers, clinicians, and hospital staff.
Carers' rights, needs, legal rights, and information regarding hospital procedures should be considered.

Family Involvement in Transitions

Implementing interventions for carers and patients undergoing hospital care transitions (inpatient to outpatient care) and community settings is crucial.
Psychoeducation, discharge planning, and community follow-up interventions.
Multi-dimensional support that includes communication, family interventions, and continuity of care demonstrate positive results for carers' well-being.

Final Reflection

Family interventions reduce relapse and improve service user functioning.
Implementation challenges include training, team approaches, and a cohesive, sustained continuity of care.
Peer support and comprehensive intervention programs are key in improving outcomes.

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Description

Explore the latest evidence-based practices for family interventions in treating psychosis. This quiz examines the roles of clinicians, family members, and service users in therapy sessions and the guidelines set by NICE recommendations for effective interventions. Test your knowledge on the importance of involving the main carer and the duration of treatment plans.