Family Psychoeducation in Clinical High Risk and First-Episode Psychosis

William R.      McFarlane; Sarah      Lynch; Ryan      Melton

Abstract

Seventy percent of those who will have an episode of psychosis will have done so by age 25 (Kirkbride et al., 2006). Data from clinical trials of intervention during the clinical high risk period of psychosis have determined that the mean age is in mid-adolescence, 16-18 years of age (Amminger et al., 2010; McFarlane et al., 2010; McGlashan et al., 2006). For those reasons, early intervention inherently involves adolescents, and by extension their parents and other family members and supports. Regarding the type of intervention, it is relevant that the current empirically-derived standard of treatment for schizophrenia, as concluded by the Agency for Health Care Policy and Research survey of the treatment outcome literature, includes family psychoeducation, supported employment, assertive community treatment and antipsychotic medication,; i.e., a combination of psychosocial and pharmacologic interventions (Lehman et al., 2004; 1998). Combinations of all four of these treatments, as in Family-aided Assertive Community Treatment (FACT), achieve very low rates of relapse, substantial reductions of symptoms and remarkable functional outcomes, particularly in the domain of competitive employment (Cook et al., 2005; McFarlane et al., 2000; McFarlane, Dushay, Stastny, Deakins, & et al., 1996; McFarlane, Stastny, & Deakins, 2002; McFarlane, Stastny, Deakins, Dushay, & Link, 1995). Furthermore, a large comparative study of outcomes in community settings found that psychoeducational multifamily groups were more effective than single-family psychoeducation specifically in the first episode and in high-risk-for relapse cases, suggesting that particular psychosocial treatments may be especially effective in early phases of illness (Fjell et al., 2007; McFarlane et al., 1995; Petersen et al., 2005).

Keywords: Clinical high-risk, early intervention, family intervention, family psychoeducation, multifamily groups, prodromal psychosis, psychosis, schizophrenia