Early results support the feasibility of this approach, with more than
100 cases being successfully managed in this way. A tenfold reduction in the
expected incidence of schizophrenic and major affective disorders has been
observed. Further efforts are being made to conduct a controlled evaluation
of this approach.
The increasing sophistication of intervention strategies has been accompanied
by similar advances in the assessment process. Rather than merely
counting the numbers of positive and negative responses observed during
problem-related discussions, methods of examining sequences of family interaction
have been developed. The methods developed by Hahlweg and his
colleagues (Hahlweg et al. 1984a, 1984b) allowed heated arguments to be
mapped and contrasted with constructive expressions of unpleasant feelings
that contribute to effective conflict resolution. It was established that the expression
of unpleasant feelings in a manner that assisted in the clear definition
of a specific problem, rather than through coercive nagging or hostile
comments, was a crucial first step in conflict resolution.
manner similar to the USC study. The main hypothesis being tested in this
study is that BFT, with its effectiveness in enhancing stress management,
may reduce the need for higher doses of neuroleptic medication and hence
the detrimental effects associated with these drugs. However, the large number
of cases entering the study will enable a wide range of secondary issues
to be explored. These include the association between therapist competency
and therapeutic outcome; the association between problem-solving
skills and outcome; the specific benefits of more intensive, targeted family
therapy; the cost-effectiveness of these approaches; and predictors of therapeutic
efficacy.
The Buckingham Early Intervention Project was based on the assumption
that if BFT is effective in reducing the frequency of major schizophrenic
and depressive episodes in established cases of schizophrenia, a similar approach
might reduce the morbidity associated with initial episodes of schizophrenic
and major affective disorders. An attempt was made to detect cases
during the prodromal phases of these disorders, when major episodes appeared
imminent. The current absence of clear biological measures of vulnerability
limited early detection strategies to recognition of the clinical
features through screening by primary care physicians, who worked in close
collaboration with highly trained mental health professionals. The detection
of a suspected prodromal state led to immediate intervention with BFT and
targeted low-dose neuroleptics or antidepressants when appropriate. BFT
focused on stress management and educating the index patient and caregivers
to recognize the main symptoms of these mental disorders. The drugs
were discontinued as soon as the prodromal features remitted.