Scottish Intercollegiate Guidelines Network (SIGN)

Psychosocial Interventions in the Management of Schizophrenia
Summary of recommendations

PSYCHOSOCIAL INTERVENTIONS IN THE MANAGEMENT OF SCHIZOPHRENIA

The treatment of individuals with schizophrenia requires a co-ordinated multidisciplinary approach.

A Care Plan should be drawn up which specifies all aspects of the care to be provided.

Care should be taken to avoid overly stressful interventions which may result in worsening of psychotic symptoms.

ACUTE PHASE

Families and carers should be involved from the outset (with the patients' consent).

Once a diagnosis has been established, information should be provided to families and carers on the illness, its aetiology, course, treatment and the services available, including information regarding local and national support groups.

Information should be provided by an experienced health professional who is familiar with the concerns and circumstances of the carers/relatives.

Information may not be assimilated in one session and repetition may be required.

STABILISATION PHASE

Families and carers will continue to receive education and support in this phase, which may be integrated into a Family Intervention Programme.

An Education Programme for patients should be undertaken in this phase, giving information on the illness and on the benefits and side effects of medication which should allow optimal prescribing and hence improved compliance.

Information should be skilfully delivered in a way that meets individual needs.

Family Intervention Programmes should be implemented in appropriate cases following assessment.

The Family Intervention Programme should include:

an education programme
analysis of family relationships and functioning
family sessions to address the problems identified in the analysis
relatives' support group.

Family Intervention programmes should be integrated with other aspects of care.

Family relationships should be assessed to identify the need for family sessions to address relationship difficulties.

A relationship of trust and an explanation of the aims of the programme are essential.

The aims of family sessions should include:

construction of an alliance with the family
improvement of adverse family atmosphere
enhancement of the capacity of the relatives to anticipate and solve problems
reduction of feelings and expressions of anger and guilt by the family
maintenance of reasonable expectations for patient performance
attainment of desirable change in relatives' behaviour and belief system.

The Intervention Programme should continue for at least nine months with family sessions at least monthly.

Intervention Programmes should be carried out by a trained health professional.

STABLE PHASE

Family Intervention Programmes will continue into this phase.

Cognitive Behaviour Therapy should be considered for symptoms of psychosis which are distressing and resistant to conventional treatment.