Pharoah F M, Mari J J, Streiner D
Hinchingbrook Health Care, Park House, Nursery Road, Huntington, Cambridgeshire, UK, PE18 6RJ.
Cochrane Database Syst Rev. 2000(2):CD000088. doi: 10.1002/14651858.CD000088.
It has been showed that people with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of their emotions. Psychosocial interventions designed to reduce these levels of expressed emotions within families now exist for mental health workers. These interventions are proposed as adjuncts rather than alternatives to drug treatments, and their main purpose is to decrease the stress within the family and also the rate of relapse.
To estimate the effects of family psychosocial interventions in community settings for the care of those with schizophrenia or schizophrenia-like conditions compared to standard care.
Electronic searches of the Cochrane Library (Issue 2, 1998), the Cochrane Schizophrenia Group's Register (June 1998), EMBASE (1981-1995) and MEDLINE (1966-1995) were undertaken and supplemented with reference searching of the identified literature.
Randomised or quasi-randomised studies were selected if they focused on families of people with schizophrenia or schizoaffective disorder and compared community-orientated family-based psychosocial intervention of more than five sessions to standard care.
Data were reliably extracted, and, where appropriate and possible, summated. Peto odds ratios (OR), their 95% confidence intervals (CI) and number needed to treat (NNT) were estimated. The reviewers assume that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption.
Family intervention may decrease the frequency of relapse (one year OR 0.57 CI 0.4-0.8, NNT 6.5 CI 4-14). The trend over time of this main finding is towards the null and some small but negative studies may not have been identified by the search. Family intervention may decrease hospitalisation and encourage compliance with medication but data are few and equivocal. Family intervention does not obviously effect the tendency of individuals/families to drop out of care. It may improve general social impairment and the levels of expressed emotion within the family. This review provides no data to suggest that family intervention either prevents or promotes suicide.
REVIEWER'S CONCLUSIONS: Clinicians, researchers, policy makers and recipients of care cannot be confident of the effects of family intervention from the findings of this review. Further data from already completed trials could greatly inform practice and more trials are justified as long as their participants, interventions and outcomes are generalisable to routine care.
研究表明，来自表达高度批评、敌意或过度干涉的家庭的精神分裂症患者，比来自情感表达较少的类似家庭问题的患者更容易复发。现在有针对心理健康工作者的心理社会干预措施，旨在降低家庭中这些表达性情绪的水平。这些干预措施被提议作为药物治疗的辅助手段而非替代方法，其主要目的是减轻家庭压力以及降低复发率。
评估在社区环境中，与标准护理相比，家庭心理社会干预对精神分裂症或类精神分裂症患者护理的效果。
对Cochrane图书馆（1998年第2期）、Cochrane精神分裂症研究组登记册（1998年6月）、EMBASE（1981 - 1995年）和MEDLINE（1966 - 1995年）进行电子检索，并对已识别文献进行参考文献检索作为补充。
如果随机或半随机研究聚焦于精神分裂症或分裂情感性障碍患者的家庭，并将超过五次疗程的以社区为导向的家庭心理社会干预与标准护理进行比较，则纳入研究。
可靠地提取数据，并在适当且可行的情况下进行汇总。估计Peto比值比（OR）、其95%置信区间（CI）和需治疗人数（NNT）。综述作者假设死亡或退出的人没有改善，并测试了最终结果对该假设的敏感性。
家庭干预可能会降低复发频率（一年期OR 0.57，CI 0.4 - 0.8，NNT 6.5，CI 4 - 14）。这一主要发现随时间的趋势趋近于无效，搜索可能未识别出一些小型但呈阴性的研究。家庭干预可能会减少住院次数并鼓励患者遵医嘱服药，但数据较少且不明确。家庭干预对个体/家庭退出护理的倾向没有明显影响。它可能会改善总体社交功能障碍以及家庭中的表达性情绪水平。本综述没有提供数据表明家庭干预能预防或促进自杀。
从本综述的结果来看，临床医生、研究人员、政策制定者和护理接受者无法确定家庭干预的效果。已完成试验的更多数据可能会极大地为实践提供信息，只要其参与者、干预措施和结果能够推广到常规护理，就有理由进行更多试验。
