Glynn Shirley M, Cohen Amy N, Dixon Lisa B, Niv Noosha
Greater Los Angeles Healthcare System at West Los Angeles, California, USA.
Schizophr Bull. 2006 Jul;32(3):451-63. doi: 10.1093/schbul/sbj066. Epub 2006 Mar 8.
Many types of family interventions have been found to be effective in reducing exacerbations in schizophrenia; some also improve consumer social functioning and reduce family burden. Regardless of their origins, these interventions share a number of common features, such as showing empathy for all participants, providing knowledge about the illness, assuming a nonpathologizing stance, and teaching communication and problem-solving skills. Importantly, these family interventions have many characteristics that are consistent with the growing recovery movement in mental health in that they are community-based, emphasize achieving personally relevant goals, work on instilling hope, and focus on improving natural supports. Nevertheless, these interventions are generally reflective of older models of serious and persisting psychiatric illnesses that are grounded in a "patient being treated for a chronic illness" rather than a "consumer assuming as much responsibility as possible for his/her recovery" stance. These interventions could be made more consistent with recovery principles by (1) expanding the definition of family to include marital, parenting, and sibling relationships, (2) identifying better ways to match consumers with treatments, (3) broadening the research focus to include systems change that promotes making family members a part of the treatment team (with the consumer's consent), and (4) overcoming implementation obstacles that preclude access to effective family interventions for most consumers and their relatives.
已发现多种家庭干预措施在减少精神分裂症病情加重方面有效;有些还能改善患者的社会功能并减轻家庭负担。无论其起源如何,这些干预措施都有一些共同特征,比如对所有参与者表现出同理心、提供有关该疾病的知识、采取非病理化立场以及教授沟通和解决问题的技巧。重要的是,这些家庭干预措施有许多与心理健康领域日益兴起的康复运动相一致的特点,即它们以社区为基础,强调实现个人相关目标,致力于灌输希望,并专注于改善自然支持。然而,这些干预措施总体上反映的是严重和持续性精神疾病的旧有模式,其基于“患者接受慢性病治疗”而非“消费者尽可能为自身康复承担责任”的立场。通过以下方式可使这些干预措施更符合康复原则:(1)扩大家庭的定义,将婚姻、亲子和兄弟姐妹关系包括在内;(2)找到更好的方法,为患者匹配治疗方案;(3)拓宽研究重点,将促进家庭成员成为治疗团队一员(经患者同意)的系统变革包括在内;(4)克服实施障碍,这些障碍使大多数患者及其亲属无法获得有效的家庭干预措施。