Question: In adolescents (aged 12+) with first-episode psychosis, how effective is family therapy, compared to standard treatment, in improving patient outcomes?

Answer:

Plain language summary

There is limited evidence comparing family therapy to standard treatment. Two randomised controlled trials were found which compared different types of family therapy in adolescents. The results showed a benefit of family therapy in improving family communication and reducing some patient symptoms. Both trials were small and had some weaknesses but overall there is evidence that this could be a true effect.

Clinical and research implications

No evidence was found comparing the efficacy of family therapy to standard treatment. Research into this clinical question is needed, and is highlighted as a recommendation for research in the form of RCTs in the NICE guidance for the treatment of psychosis in children and adolescents. Evidence from RCTs however, provided some evidence on the effectiveness of family therapy in improving patient outcomes, such as the negative symptoms of psychosis, decreasing relapse rates and enhancing family communication. This evidence can be used clinically to support the encouragement of patients and families in undertaking family therapy if they are experiencing difficulties in these areas. But there is no evidence to recommend the use of family therapy as single treatment for first episode psychosis in adolescents.

Overall it is evident that specific training in communication and problem solving techniques incorporated into family therapy are associated with improved patient outcomes. And there is a general consensus that an increased number of family therapy sessions is most beneficial. These findings could be used as criteria for standardising family therapy offered to adolescents with first episode psychosis.

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