AN OVERVIEW OF FAMILY INTERVENTIONS AND RELAPSE ON SCHIZOPHRENIA - METAANALYSIS OF RESEARCH FINDINGS

The purpose of this overview is to appraise the studies on the efficac y and effectiveness of family interventions in decreasing relapse in s chizophrenic patients. The studies were identified by means of a compu terized MEDLINE search, and the scanning of review articles and the re ference lists of the primary articles identified. More than 300 citati ons were reviewed, and the potentially relevant articles revealed six randomized controlled trials that were included in this meta-analysis. The criteria for selecting potential studies as well as for the meta- analysis were tested by means of an inter-rater reliability check that showed a good agreement between two independent raters (K = 0.83, and K = 0.82, respectively). There were independent assessments of the qu ality of the studies selected, and data extraction comprised a descrip tive information of the study population, the types of interventions, and the relevant outcome measurements. The total number of patients in cluded in the six trials was 350 (181 in the control group and 169 in the experimental group). Regarding the decrease of relapse in the expe rimental group, the pooled odds ratios and their 95% confidence interv als were: 0.30 (0.06, 0.71) for six months; 0.22 (0.09, 0.37) for nine months; and 0.17 (0.10, 0.35) for the 2-year follow-up. Two to five p atients needed to be treated to avert one episode of relapse in a nine -month follow-up. The changes in Expressed Emotion status between expe rimental and control group combining nine months and one year follow-u ps were shown to be marginally significant (P < 0.06), in favour of th e experimental group. Emotional over-involvement was also marginally s ignificant (P < 0.07), and there was no statistical difference in the distribution of criticism and hostility. In addition, the experimental group showed a significant increase with drug compliance and a reduct ion in hospitalization over time. These findings are discussed in ligh t of the potential ingredients in the efficacy of family interventions by focusing on the limitations of using relapse as primary outcome in the assessment of efficacy trials with schizophrenic patients.