Eliane Duvekot

© Eliane Duvekot

Family Motivational Intervention

Training motivational interviewing for family members of patients with schizophrenia and cannabis use

Contents presentation

BackgroundInterventionResearch design

Linszen 2006

Why aiming an intervention at cannabis use and compliance?

Early independent predictors of a poor outcome:

1. Cannabis

2. Poor compliance

3. Lack of insight

Eliane Duvekot

© Eliane Duvekot

Kemp BMJ 1996, BJP 1998

Randomised controlled trials Motivational Interviewing in schizophrenia: compliance

Compliance therapy4-6 sessions, n=74Control intervention: supportive

counseling23% more improvement with MI4 other RCT’s, 2/4 MI significantly

better

Barrowclough AJP 2001;158:1706-13

RCT MI in schizophrenia: drug use

MI+CBT+family-intervention, n=36 Intensive treatment: 5x MI, 24x CBT,

10-16 x family-interventionSignificantly more abstinence, better

level of functioning, symptom reduction and less relapse

7 other RCT’s, 6/7 MI effective

Eliane Duvekot

© Eliane Duvekot

Mueser, Guilford Press 2003

Family interventions in dual diagnosis patients

25-50% dual diagnosis patients live with their parents, even more have frequent contact

Family stress unfavorable course schizophrenia and increase of drug use

Need of information in family members

Contents presentation

BackgroundInterventionResearch design

Basic considerations FMI

Need of information Improvement of contactPromote desired changeParents are neither care workers nor do

they need a therapy, therefore we provide a training

Family motivational intervention

Psychoeducation– Schizophrenia: 2 sessions– Schizophrenia and cannabis: 1 session

Interaction skills: 6 sessions Motivational Interviewing: 6 sessions Workshop MI care workers Individual supervision care workers

volhouden teru

gval

voorstadium

overwegen

besl

isse

n en

voor

bere

iden

uitvoeren start

definitieve uitgang

Stadia van verandering bij gewoonteproblemen

Interaction skills

Interaction problems Own needs Communication: transmitting and listening Ownership of problems Constructive confrontation Conflicts: unwilling or unable Collaboration

Maintenanc

e

Rel

apse

Precontemplation

Contem-

platio

n

Preparation

Action

start

Permanent exit

Prochaska, DiClemente, & Norcross, 1992

Stages of change

Stages and actions

Precontemplation Contemplation Preparation Action Maintenance Relapse

Raising doubt Influence balance Choose moment, plan Advise, support Relapse prevention Reassure, renew plans

Motivational Interviewing

Wheel of change Listening, summarizing, open ended

questions Change talk, selective reflection Resistance

Contents presentation

BackgroundInterventionResearch design

Study design

Randomisation: Intervention or psychoeducation only, n=80

Outcome: cannabis use patient, wellbeing parents, communication skills parents

Individual supervision care worker of patients in the Intervention arm

Workshop MI for care workers

Inclusion criteria

Schizophrenia – schizophreniform/schizoaffective disorder

Cannabis use– At least 2 days/week per week.

Age < 41 years Contact with parents/ family members At least 10 hours per week

Flow chart patients

baseline 6 months 12 months

TLFB x x x

Insight x x x

RTCQ x x x

OCDUS x x x

LEE x x x

Compliance x x x

Flow chart parents

baseline 6 months 12 months

FQ x x x

GHQ x x x

ECI x x x

COSIT x x x

IPQ-R x x x

Contacttime

x x x

FMI team: who is who

Maarten Smeerdijk, psycholoog Marijke Krikke, trainer Anouschka de Jager, trainer Bas van Raay, interactievaardigheden Lieuwe de Haan, lid werkgroep Don Linszen, principal investigator Gerard Schippers, AIAR René Keet, projectleider

Eliane Duvekot

© Eliane Duvekot