University of Melbourne Psychology Clinic, 14-20 Blackwood Street, The University of Melbourne, Victoria, Australia 3010.
J Clin Psychiatry. 2010 Apr;71(4):475-83. doi: 10.4088/JCP.08m04672yel. Epub 2009 Dec 15.
We have previously reported that our combined individual and family cognitive-behavioral therapy (CBT) relapse prevention therapy (RPT) was effective in reducing relapse rates compared to treatment as usual (TAU) within a specialist program for young, first-episode psychosis patients who had reached remission on positive symptoms. Here, we report the outcomes for family participants of DSM-IV-diagnosed first-episode psychosis patients recruited between November 2003 and May 2005 over a 2.5-year follow-up period. The primary hypothesis was that, compared to family members receiving TAU, family participants who received RPT would have significantly improved appraisals of stressors related to caregiving. Secondary hypotheses were that RPT would be associated with reduced expressed emotion and improved psychological distress.
Family members were assessed at baseline and at 7-month, 12-month, 18-month, 24-month, and 30-month follow-up on appraisal of caregiving, expressed emotion, and psychological distress using the Experience of Caregiving Inventory, The Family Questionnaire, and the General Health Questionnaire of 28 Items, respectively. The family component of RPT was based on family behavioral therapy for schizophrenia with a specific focus on psychoeducation and CBT for relapse prevention.
Thirty-two families received RPT, and 31 families received TAU. There were significant group effects for aspects of the appraisal of caregiving, including negative symptoms, positive personal experiences, and total positive score on the Experience of Caregiving Inventory. Time effects were evident for emotional overinvolvement and for aspects of the appraisal of caregiving. There were no significant effects for psychological distress.
The relatives of patients who received RPT perceived less stress related to their relative's negative symptoms and an increase in perceived opportunities to make a positive contribution to the care of their relative compared to carers in the TAU condition. Cognitive-behavioral therapy for relapse prevention showed promise in improving the experience of caregiving for family members of first-episode psychosis patients over a 2.5-year follow-up period.
anzctr.org.au Identifier: ACTRN12605000514606.
我们之前曾报道过，与常规治疗（TAU）相比，我们的个体化和家庭认知行为疗法（CBT）复发预防治疗（RPT）在针对达到阳性症状缓解的年轻首发精神病患者的专家计划中更有效，可降低复发率。在这里，我们报告了在 2.5 年的随访期间，于 2003 年 11 月至 2005 年 5 月招募的 DSM-IV 诊断为首发精神病患者的家庭参与者的结果。主要假设是，与接受 TAU 的家庭成员相比，接受 RPT 的家庭参与者对与护理相关的压力源的评估会有显著改善。次要假设是，RPT 与降低表达的情绪和改善心理困扰有关。
分别使用照顾体验量表、家庭问卷和 28 项一般健康问卷评估家庭参与者的照顾评估、表达的情绪和心理困扰，基线评估和 7 个月、12 个月、18 个月、24 个月和 30 个月时进行评估。RPT 的家庭部分基于精神分裂症的家庭行为疗法，特别侧重于心理教育和复发预防的 CBT。
32 个家庭接受了 RPT，31 个家庭接受了 TAU。在照顾体验量表的负面症状、积极个人体验和总分等方面，均有显著的组间效应。时间效应在情感过度卷入和照顾评估方面都很明显。心理困扰方面没有显著效果。
与接受 TAU 的照顾者相比，接受 RPT 的患者的家属感知到与亲属的负面症状相关的压力较小，并且感知到对亲属护理做出积极贡献的机会增加。复发预防的认知行为治疗在首发精神病患者家属的 2.5 年随访期间，在改善照顾体验方面显示出了前景。
anzctr.org.au 标识符：ACTRN12605000514606。
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