[Psychoeducational-psychotherapeutic treatment of schizophrenic patients and their caregivers. Results of a 1-year catamnestic study]. Clinical significance of inpatient family intervention: conclusions from a clinical trial. Efficacy of the team solutions program for educating patients about illness management and treatment. A family psychoeducation group program for chinese people with schizophrenia in Hong Kong. A program for relapse prevention in schizophrenia: a controlled study. [Effect of patient education on neuroleptic treatment of young psychotic patients]. Compliance with treatment in schizophrenia: a drug intervention program in a developing country. The impact of education groups for people with schizophrenia on social functioning and quality of life. A controlled study of education about drug treatment in schizophrenia. The community management of schizophrenia. A controlled trial of a behavioural intervention with families to reduce relapse. Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. TRIP: a psycho-educational programme in Hong Kong for people with schizophrenia.
In this study we look into the question of whether, in addition to neuroleptic treatment, relapse rates among schizophrenic patients can be reduced by means of a combined psychoeducational and psychotherapeutic intervention strategy for patients and their relatives. In a randomized controlled intervention study in an outpatient routine treatment setting, psychoeducational training for medication management, cognitive therapy and work with relatives' groups were compared with each other and with a control group. The patients continued their standard treatment, including neuroleptic relapse prevention. The study comprised 191 chronic DSM-III-R schizophrenics. Data were collected before and after an 8-month intervention phase and at the 1-year follow-up. The group receiving all three treatments had the lowest relapse rates. Moreover, numerous gains recorded in subjective findings suggest that therapeutic work with schizophrenic patients and their relatives is of clinically significant benefit. To test whether the statistically significant results of a randomized clinical trial of an inpatient family intervention were clinically significant for hospital practice, the authors reanalyzed outcome data using a measure of clinical significance based on the extent to which patients had recovered during the course of the intervention.
                A total of 169 hospitalized subjects and their families were randomly assigned to a psychoeducational inpatient family intervention or to a comparison group. Patient and family outcome measures were assessed at admission, discharge, and six and 18 months after admission. Analyses of statistically significant differences in outcome suggested that inpatient family intervention was effective for certain patient subgroups identified by gender and diagnosis. Global Assessment Scale scores two or more standard deviations above the pretreatment (admission) mean were used as indicators for clinically significant improvement.
                The reanalysis confirmed that inpatient family intervention was associated with clinically significant improvement at discharge, especially for female patients and patients with chronic schizophrenia and bipolar disorder. These effects were maintained six months after admission before attenuating at 18 months.
                Inpatient family intervention results in clinically meaningful outcomes for certain subgroups of patients and their families. Despite the demonstrated efficacy of psychosocial approaches to schizophrenia treatment that include a psychoeducational component, such as illness management, the implementation of these approaches into routine mental health treatment has been slow. The authors sought to examine the efficacy of a comprehensive, modularized, psychoeducational program called Team Solutions, which was designed to educate patients with major mental illnesses about their illness and how to manage it. Team Solutions was chosen for study because it is available over the Internet and other venues at no cost and is used by mental health agencies across the United States and Canada.
                Seventy-one persons with schizophrenia or schizoaffective disorder from three day treatment settings participated in this randomized, single-blind study. Participants were randomly assigned to attend one of two interventions: the Team Solutions intervention, which consisted of participating in a 24-week psychoeducational group focused on illness management, or treatment as usual.
                For participants who attended the experimental group, significant improvement was observed in knowledge about schizophrenia. In addition, client satisfaction was high. However, no changes were observed in symptoms or functioning.
                Results indicated that participation in the Team Solutions psychoeducational group improved participants' knowledge. However, participation in the program did not demonstrate superiority over treatment as usual with respect to secondary and tertiary outcomes, such as symptom severity, treatment adherence, and global functioning. This study tested the effectiveness of a family psychoeducation group program over a 12-month period for families of Chinese patients in Hong Kong with schizophrenia. The psychoeducation program is a needs-based group intervention that addresses the perceptions, knowledge, and skills of families in caring for relatives with schizophrenia.
                A controlled trial was conducted with 84 family members. Patient and family variables were measured at recruitment and at one week and 12 months after completion of the intervention.
                Multivariate analyses of variance showed that participants in the psychoeducation group reported greater improvements in families' and patients' functioning, families' burden of care, and the number and length of patients' rehospitalizations over the 12-month follow-up period, compared with the standard care group.
                These findings support the effectiveness of the family psychoeducation group program in improving the psychosocial health and functioning of Chinese patients with schizophrenia and their families. This study examined whether a program for relapse prevention (PRP) is more effective than treatment as usual (TAU) in reducing relapse and rehospitalization rates among outpatients with schizophrenia.
                Eighty-two outpatients with DSM-III-R schizophrenia or schizoaffective disorder were randomly assigned to receive either PRP (experimental group, n = 41) or TAU (control group, n = 41) and were followed up for an 18-month prospective controlled study. Patients in both groups were prescribed standard doses of maintenance antipsychotic medication. Treatment with PRP consisted of a combination of psychoeducation, active monitoring for prodromal symptoms with clinical intervention when such symptoms occurred, weekly group therapy for patients, and multifamily groups. The TAU consisted of biweekly individual supportive therapy and medication management.
                Outcome rates over 18 months were 17% for relapse (7 patients) and 22% for rehospitalization (9 patients) in the PRP group, compared with 34% for relapse (14 patients) and 39% for rehospitalization (16 patients) in the TAU group (P = .01 and P = .03, respectively). Addition of age, sex, baseline Global Assessment Scale score, Positive and Negative Syndrome Scale scores (3 measures), and substance abuse to the proportional hazards regression models all yielded nonsignificant effects. The PRP teams were much more likely than the TAU psychiatrists to identify prodromal episodes before patients met objective relapse criteria or needed hospitalization.
                The PRP was effective in detecting prodromal symptoms of relapse early in an episode. Crisis intervention including increased antipsychotic medication use during the prodromal phase reduced relapse and rehospitalization rates. This study verifies the effect of the neuroleptic treatment teaching module, the French translation of the Medication Management Module produced by the social skills training programs. Twenty patients from an outpatient clinic (with schizophreniform or schizoaffective schizophrenia) were assigned at random to a test group (n = 10) or a control group (n = 10). The pre-test evaluation found that the two groups were the same with regard to 13 significant parameters. The experimenters used French translations of well-known instruments, and the double-blind method was applied to their respective observations throughout the study. Results were obtained by applying the neuroleptic treatment teaching module three hours per week for two to three months. The post-test evaluation revealed that patients who had been exposed to the education module had an improved understanding of schizophrenia and the medication required to treat it than patients who had not been exposed. The dose of medication prescribed between pre- and post-test evaluations were able to more effectively stabilize patients who had received education than patients who had not. Nevertheless, the education module continues to have no significant effect on the symptomatology (according to the Brief Psychiatric Rating Scale) and final SAS-II social scores of schizophrenics. The compliance with drug regimens and follow-up visits of 225 known cases of relapsed schizophrenia was assessed. About 27% of the patients met the criteria for good compliance. The compliance was found to be significantly related to the patients' view of usefulness of the medication, treatment duration of less than 5 years, dosage schedule of once or twice per day and the supervision of medication at home. Patients with poor compliance who were prescribed drug dosage of not more than twice per day throughout follow-up and underwent counseling to enhance treatment compliance had a significantly lower relapse rate than the controlled group at the end of 1 year of follow-up. The importance of family support and understanding patients' cultural background in ensuring good compliance was highlighted. Education groups for people with schizophrenia have tended to concentrate on compliance with medication. This study examines impact on social behaviour and quality of life.
                A catchment-wide service was set up for community-based patients. Patients who indicated an interest in education groups were randomly allocated to either an education group or a waiting list control group. Those who attended groups were compared with the control group.
                About one-quarter of community-based patients showed interest in attending education groups. Those who attended showed no change in mental state or compliance with medication (already high) but significant gains in quality of life, social functioning and social networks.
                For patients who choose to attend education groups significant gains in social functioning and quality of life are possible without specific skills training. Various problems are associated with schizophrenia which may theoretically lead to impaired educability about treatment.
                The Understanding of Medication Questionnaire, designed to measure knowledge about treatment in schizophrenia, is described and presented. An educational programme based on a specially designed information booklet was developed. Sixty-four patients with DSM-III-R diagnosis schizophrenia were randomly allocated to groups receiving none (control), one session or three sessions of education.
                Pre-intervention low levels of knowledge about illness and treatment increased significantly immediately after a standard education session. Three education sessions led to significantly greater knowledge gain than one session. There was no significant change in the control group. Only the PANSS negative syndrome score independently and consistently explained a significant proportion of the education effect. The influence on educability of attitudes to education, impaired insight, cognitive impairment and other variables were considered. Three sessions of education led to significantly increased insight, but no change in compliance.
                Techniques appropriate for educating schizophrenic patients were discussed, and the value of involving patients in education emphasised. A series of patient education sessions is needed to consolidate learning, rather than a single informing process. The strong association between impaired learning and more severe negative schizophrenic syndrome emphasises the need for responsible prescribing of antipsychotic treatment in schizophrenia. Schizophrenic patients were recruited into a trial of a prophylactic behavioural intervention with families. Families with at least one high Expressed Emotion (EE) relative were randomly allocated to one of four intervention groups: Behavioural Intervention Enactive; Behavioural Intervention Symbolic; Education Only; Routine Treatment. Patients from low-EE families were randomly allocated to two groups: Education Only or Routine Treatment. Relapse rates over nine months after discharge were significantly lower for patients in the two Behavioural Intervention, compared with Education Only and Routine Treatment groups. There was little difference between the two low-EE groups. Patients returning to high-EE relatives showed significantly higher relapse rates than those returning to low-EE relatives, in groups not receiving active intervention. Changes from high to low EE occurred in the Behavioural Intervention groups, and similar although less extensive changes occurred in the Education Only and Routine Treatment groups. Changes in criticism and marked emotional over-involvement (EOI) occurred generally in high-EE groups but were larger in magnitude in the Enactive and Symbolic groups. Reduction of hostility only occurred in the Behavioural Intervention groups. These results give partial support for the causal role of EE in relapse. There were no significant differences between the groups with respect to contact with the psychiatric services or medication. To evaluate the effectiveness of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers.
                A randomized controlled trial was conducted. Seventy-three clients with a diagnosis of schizophrenia and their caregivers (n=73) were recruited and randomized into a study (n=36) and control group (n=37). Ten psychoeducation sessions were provided to the study group. The outcomes were measured at the baseline, immediately after (post-1), six months (post-2), and 12 months after the intervention (post-3).
                There were significant treatment effects across time for all client outcomes: adherence to medication (p<0.01), mental status (p<0.01), and insight into illness (p<0.01). However, no significant differences were found between groups at the post-3 measures for all client outcomes. For the caregivers, significant group differences were only detected in self-efficacy at the post-1 (p=0.007) and post-2 (p<0.001) measures, the level of satisfaction at the post-1 (p=0.033) and post-2 (p<0.021) measures, and the perception of family burden at the post-2 measures (p=0.043).
                A psychoeducation intervention had positive effects on Chinese clients and their caregivers. However, these effects might not be sustained 12 months after the intervention.
                To substantiate its effects, psychoeducation should be an ongoing intervention, with its outcomes constantly evaluated. 'TRIP' (Transforming Relapse and Instilling Prosperity) is a ward-based illness management programme that aims to decrease treatment non-compliance and relapse rate by improving the insight and health of acute psychiatric patients with schizophrenia. Eighty-one stable male acute psychiatric patients with schizophrenia were randomized to receive the TRIP programme (n = 44) or the comparison group of traditional ward occupational therapy (WOT) programme (n = 37). Participants' insights and health were assessed by the Unawareness of Mental Disorder Scale and the Hong Kong version of the Short Form-36 (SF-36) health survey, respectively. Each group was then followed up for a 12-month period. One-way analysis of covariance (ANCOVA) showed that participants in the TRIP programme had significantly better insight and health than a comparison group during post-study measurement. Participants in the TRIP programme had significantly fewer re-admissions in the 12-month follow-up period than those who attended the WOT programme. In summary the TRIP programme, as led by an occupational therapist, was effective in improving insight, awareness of health and in having a lower re-admission rate than a traditional occupational therapy programme.
Psychoeducation does seem to reduce relapse, readmission and encourage medication compliance, as well as reduce the length of hospital stay in these hospital-based studies of limited quality. The true size of effect is likely to be less than demonstrated in this review - but, nevertheless, some sort of psychoeducation could be clinically effective and potentially cost beneficial. It is not difficult to justify better, more applicable, research in this area aimed at fully investigating the effects of this promising approach.
Note: the 27 new citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.