Table 2.
Characteristic of Included Trials (N = 14).
| Primary author, publication year and country of origin | N* | Design | Patient characteristics | FIp description: delivered to individual or groups, key components, manual, n analyzed at assessment point(s) | Duration of FIp | Comparison Group (s) | Outcome measures extracted for current meta-analyses: (1)Service user symptoms; (2) Service user functioning; (3)Relapse/ hospitalization/transition; (4) Length of hospitalization; (5) Career from high to low EE; (6) EE: criticism; (7) EE: emotional over-involvement; (8) Conflict in communication; (9) Caregiver burden; (10)Career wellbeing | Treatment completion | Follow up |
|---|---|---|---|---|---|---|---|---|---|
| AT RISK / PRODROMAL PSYCHOSIS | |||||||||
| O'Brien et al. (2014) and Miklowitz et al. (2014) USA | 129 | RCT (from larger trial) | Patients (mean age 16.9 years) at risk of psychosis | Single family: Psychoeducation, Communication skills, Problem-solving, Stress management. Adapted Family-Focused Therapy for intervals at clinically high risk for psychosis) Caregiver n = 38, Patient n = 47 | 18 × 1 h sessions over 6 m | Enhanced Standard Care (including × 3 psychoeducation sessions over 1month) Caregiver n = 28, Patient = 55 | (1) SOPS (8) Assessment of family communication (clinician-rated based on Bellack et al., 1996) | 56%** | None |
| EARLY PSYCHOSIS | |||||||||
| Browning et al. (2013) UK | 30 | CCT | Inpatients, under 18 years, (mean age 16.9 years) psychotic symptoms on admission | Single family: Psychoeducation, Communication skills Based on manuals (Glick et al., 1993; Kuipers et al., 2002) n = 9 | 5 × 1 h sessions over 4–10 weeks | (i) CBT (n = 10) (ii) Standard Care (n = 9) | (1) BRPS, (2) CGAS | 100% | None |
| Primary author, publication year and country of origin | N* | Design | Patient characteristics | FIp description: delivered to individual or groups, key components, manual, n analyzed at assessment point(s) | Duration of FIp | Comparison Group (s) | Outcome measures extracted for current meta-analyses | Treatment completion | Follow up |
| Calvo et al. (2014, 2015) Spain | 55 | RCT | Adolescents 14–18 years (mean age 16.5 years) with very early onset psychosis. Max previous hosp admissions = 3 | Single family and Group: Psychoeducation, Problem-solving based on manual McFarlane et al. (1995) T1: n = 27, T2: n = 25 | 3 × 50-min individual sessions, then 12 × 90-min group sessions, bi-monthly for 6 months | Non-structured group intervention plus Enhanced standard care T1: n = 28, T2: n = 26 | (1) PANSS, (2) CGAS, (8) FES | 63.6% | 24 month |
| Chien et al. (2016a,b) Hong Kong | 116 | RCT | First episode psychosis, less than 6 months onset, mean age 25 years | Single family: Guided self-help, problem-solving based bibliotherapy based on translated manual (McCann et al., 2013) n = 56 | 5 modules completed over 5 m (plus 2 × 2 h engagement, 3 × 1.5 h review sessions and weekly phone calls) | Standard care n = 56 | (1) PANSS, (4) length of hospital admission, (3) number of patients re-hospitalized, (9) ECI | 98.2% | 6 month |
| Cozolino et al. (1988) USA | 29 | RCT (stratified for High/Low EE) | Patients admitted with psychosis, less than two years onset | Group: Psychoeducation (based on education syllabus. West et al. (1985)) n = 14 | 1 × 3 h session | Standard care n = 15 | (6) PRS, (8) FCS | 100% | None |
| De Giacomo et al. (1997) Italy | 38 | RCT | Schizophrenia; duration of less than 3 years | Single family: Systemic Family Therapy n = 19 | 10 sessions, weekly plus 2x follow-up sessions at 3 and 6 months). Final testing at the end of 12 months | Standard Care including pharmacological treatment (average 8.5 monthly sessions with psychiatrist over 1 years) n = 19 | (5) FMSS | 89% | None |
| Gleeson et al. (2010) Australia | 63 | RCT (From a larger trial) | First episode psychosis, less than 6 months of treatment and remission of positive symptoms | Single family: Psychoeducation, Communication skills, Problem-solving, Relapse prevention. Based on manuals (Falloon I. R., 1988 and Mueser and Glynn (1999)) T1: n = 23, T2: n = 10 | Minimum of 18 months FIp | Enhanced Standard Care T1: n = 25, T2: n = 11 | (6) FQ, (7) FQ, (9) ECI, (10) GHQ-28 | 71% | 30 month |
| Goldstein et al. (1978) USA | 104 | RCT | Early psychosis; all first (69%) and recent second admissions (within a year). Mean age 23.6 years | Single family: Psychoeducation, Relapse prevention n = 47 (high drug/low drug) | 6 sessions, weekly | Standard Care and randomly assigned to low drug/high drug n = 49 (high drug/low drug) | (3) Number of patients re-hospitalized | 92% | None |
| Leavey et al. (2004) UK | 106 | RCT | First episode of psychosis, less than 6 months onset | Single family: Psychoeducation, Problem-solving, Coping skills (incorporating ideas from manual: Falloon (1984)) n = 57 | 7 × 1 h sessions (at home or convenient place) | Standard care n = 49 | (3) Number of patients re-hospitalized | 42% (full completion), 57.9 % (partial completion) | 9 month |
| Linszen et al. (1996) The Netherlands | 76 | RCT | Recent onset Schizophrenia; 15–26 years (mean age 20.7 years) | Single family: Psychoeducation, Communication skills, Problem-solving n = 37 | 18 sessions over 12 months (delivered as flexibly as possible) | Enhanced Standard care n = 39 | (3) Number of patients re-hospitalized | 100% | 12 month, 5 year |
| McCann et al. (2013) Australia | 124 | RCT | First episode psychosis (duration of 2–3 years treatment) 15–25 years | Single family: Problem-solving Bibliotherapy (based on manual written by authors) n = 56 | 5 × Bibliotherapy modules, weekly | Enhanced Standard Care n = 58 | (6) FQ, (7) FQ, (9), (9)ECI, (10) K-10 | 100% | 4 month |
| Rossberg et al. (2010) Norway | 301 | Cohort analytic | First episode psychosis, actively psychotic and no previous treatment (15–65 years) | Group: Psychoeducation, Communication skills, Problem-solving n = 147 | 90 min sessions Bi-monthly over 2 years. | Not offered (e.g., no family) or refused FIp. Enhanced standard Care n = 153 | (3) Number of patients re-hospitalized | 55%** | 5 year |
| Rund et al. (1994) Norway | 24 | Cohort analytic | Adolescents inpatients (13–18 years) with early onset psychosis | Single family and Group: Psychoeducation, problem-solving plus a “low EE” environment on the inpatient unit n = 12 | Parent seminars (whole day 2–3 per year), problem solving sessions, over 2 years | Standard care from historic cohort: Patients treated at the same hospital but at an earlier point in time (from 1980 to 1987) n = 12 | (2) GAS, (4) length of readmission, (5) CFI and Clinical Rating | 100% | None |
| Zhang et al. (1994) China | 83 | RCT | First admission patients with schizophrenia, mean illness duration 2.8 years, males only, mean age 24 years | Group: Psychoeducation and supportive counseling n = 39 | Minimum × 1 session once every 3 months for 18 months | Standard care n = 39 | (1) BRPS, (2) GAS | 100% | None |
*
Number of participants randomized or enrolled in trial;
**
Patients who completed at least 50% of the intended intervention; BPRS, Brief Psychosis Rating Scale; CCT, Controlled Clinical Trial, (C) GAS, (Children's) General Assessment Scales; CFI, Camberwell Family Interview, ECI, Experience of Caregiving Questionnaire; FES, Family Environment Scale; FCS, Family Conflict Scale; FMSS, Five Minute Speech Sample; FQ, Family Questionnaire, GHQ-28, General Health Questionnaires; K-10, Kessler Psychological Distress Scale; PANNS, Positive and Negative symptoms Scales; PRS, Patient Rejection Scale; SOPS, Scale of Psychosis-Risk Symptoms.