Chapter 24. Family Intervention for Psychotic and Severe Mood Disorders

William R. McFarlane, M.D.
DOI: 10.1176/appi.books.9781585623648.374986



Family intervention for the severe psychiatric syndromes—psychotic and severe mood disorders—has been established as one of the most effective treatments available, complementing but nearly doubling the treatment effects of medication. Often subsumed under the term family psychoeducation, it is a method for incorporating a patient's family members, other caregivers, and friends into the acute and ongoing treatment and rehabilitation process. The descriptor psychoeducation can be misleading: family psychoeducation includes many cognitive, behavioral, and supportive therapeutic elements; often uses a consultative framework; and shares characteristics with some types of family therapy. On the basis of a family–patient–professional partnership, the most effective models are essentially cognitive-behavioral therapy with consistent inclusion of family members as collaborators. Family psychoeducation can include any layperson or paraprofessional person who is providing support to persons with a severe mental illness. It combines providing clear and accurate education for family members about the psychobiology of the major disorders with training and ongoing guidance in problem-solving, communication, and coping skills, while providing and developing social support. The goals are both to markedly improve clinical and functional outcomes and quality of life for the patient and to reduce family stress and strain as an indispensable means of achieving those outcomes. Family psychoeducation combines the complementary expertise and experience of family members, patients, and professionals.

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Figure 24-1. Risk for relapse over time in relation to positive and negative symptoms of schizophrenia.
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Table 24–1. Empirically derived stressors in major psychotic disorders
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Table 24–2. Guidelines for management of the disorder for patients and families: ways to hasten recovery and to prevent a recurrence
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Table 24–3. Session program for ongoing family psychoeducation meetings


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