Psychoeducational family interventions for schizophrenia in the last decade: from explanatory to pragmatic trials

A number of explanatory RCT studies published since the 1980s have demonstrated the clinical efficacy of Psychoeducational Family Interventions (PFI) for schizophrenia when provided in combination with drug therapy. In recent years, there has been a shift from efficacy to effectiveness studies and great attention by the researchers in developing training programmes in these interventions for ordinary staff. In this paper, we will provide an overview of the studies on PFI for schizophrenia which have been carried out in the last decade in routine clinical settings or with at least a partial involvement of ordinary staff. These studies have been grouped into: a) studies comparing PFI with standard care; b) studies comparing PFI with individual integrated interventions; c) studies comparing different PFI strategies; d) implementation studies. The results of these studies reveal that, when provided in clinical settings, PFI have positive middle-term effects on patients' clinical status and disability, and limited impact on family burden. From a methodological viewpoint, these studies had several similarities, such as homogeneity of PFI models and mid-term follow-up assessments, and several differences, mainly in the intensity and duration of the family exposure to the intervention. Future studies are needed to identify the "best dose" at which PFI can be provided in routine conditions at the most convenient cost-benefit ratio.