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Transcript of Eliane Duvekot © Eliane Duvekot. Family Motivational Intervention Training motivational...
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