Psychoeducation and compliance in the treatment of schizophrenia: results of the Munich Psychosis Information Project Study

OBJECTIVE: The present study examined whether psychoeducational groups for patients with schizophrenic disorders and for their families can reduce rehospitalization rates and improve compliance. METHOD: 236 inpatients who met DSM-III-R criteria for schizophrenia or schizoaffective disorder and who had regular contact with at least 1 relative or other key person were randomly assigned to 1 of 2 treatment conditions. In the intervention condition, patients and their relatives were encouraged to attend psychoeducational groups over a period of 4 to 5 months. The patients' and relatives' psychoeducational programs were separate, and each consisted of 8 sessions. Patients in the other treatment condition received routine care. Outcomes were compared over 12-month and 24-month follow-up periods. The study was conducted from 1990 to 1994. RESULTS: It was possible to significantly reduce the rehospitalization rate after 12 and 24 months in patients who attended psychoeducational groups compared with those receiving routine care (p < .05). Patients who attended psychoeducational groups showed better compliance than patients under routine care without psycho-education. CONCLUSIONS: The results suggest that a relatively brief intervention of 8 psychoeducational sessions with systematic family involvement in simultaneous groups can considerably improve the treatment of schizophrenia. Psychoeducation should be routinely offered to all patients with schizophrenia and their families.     

Psychoeducational intervention for caregivers of Indian patients with schizophrenia: a randomised‐controlled trial

Objective: There are hardly any randomised‐controlled trials of structured family interventions for schizophrenia from India. This study attempted to evaluate the impact of a structured psychoeducational intervention for schizophrenia, compared with standard out‐patient treatment, on various patient‐ and caregiver‐related parameters. Method: Seventy‐six patients with DSM‐IV schizophrenia and their caregivers were randomly allocated to receive either a structured psychoeducational intervention (n = 38) consisting of monthly sessions for 9 months or ‘routine’ out‐patient care (n = 38) for the same duration. Psychopathology was assessed on monthly basis. Disability levels, caregiver‐burden, caregiver‐coping, caregiver‐support and caregiver‐satisfaction were evaluated at baseline and upon completion. Results: Structured psychoeducational intervention was significantly better than routine out‐patient care on several indices including psychopathology, disability, caregiver‐support and caregiver‐satisfaction. The psychoeducational intervention package used was simple, feasible and not costly. Conclusion: Structured psychoeducational intervention is a viable option for treatment of schizophrenia even in developing countries like India.     

Efficacy of the team solutions program for educating patients about illness management and treatment

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.     

Efficacy of a psychoeducational intervention in improving relatives' knowledge about schizophrenia and reducing rehospitalisation.

We sought to establish if a brief psychoeducational intervention for relatives is effective in improving relatives' knowledge about schizophrenia and reducing rehospitalization. We evaluated 101 relatives of 55 patients with schizophrenia before and after an 8-week psychoeducational group using a self-report method. We also conducted a matched case-control study of the effects on rehospitalisation for 28 of these patients. We calculated the number of hospital days for each index case and control in the 1 and 2 years before and after the intervention. Relatives made significant gains in their knowledge about schizophrenia, particularly about medication. Patients whose relatives attended the group had significantly fewer days in hospital and days per admission compared to controls in the year after the programme but the effect waned in the second year after the intervention. Controls were almost four times more likely to be readmitted at 2 years than cases. Median time to readmission was significantly longer in cases compared to controls. We conclude that a psychoeducational group, which is valued by carers, is effective in increasing their knowledge about schizophrenia as well as reducing and forestalling the rehospitalization of their affected relatives. Such programmes deliver what carers frequently request in a cost-effective manner.     

Effects of psychoeducation for Korean Americans with chronic mental illness

OBJECTIVE: Korean Americans' access to mental health services may be limited because of differences in their views of mental illness compared with Westerners, unfamiliarity with treatment methods, and cultural associations of social stigma with mental problems. This study used data from an urban outpatient clinic to assess the effects of a ten-week psychoeducational intervention for Korean Americans with chronic mental illness. METHODS: Forty-eight Korean-American adults with a diagnosis of schizophrenia were randomly assigned to either an experimental group that provided a culturally sensitive psychoeducational group program in addition to individual supportive therapy or a control group that offered only individual supportive therapy. The two groups were compared on pre- and posttreatment measures of psychiatric symptoms, attitudes about and understanding of mental illness, and coping skills. The experimental psychoeducational treatment group was expected to show lower symptom severity, greater understanding of mental illness leading to a decreased perception of stigma, and greater coping skills after the intervention than the control group. Comparisons were made with repeated-measures analysis of covariance with the effects of gender and education controlled for. RESULTS: Compared with the control group, the psychoeducational group showed significantly reduced symptom severity and perception of stigma and greater coping skills immediately after treatment. CONCLUSIONS: These findings suggest that a culturally sensitive psychoeducational intervention is a useful short-term treatment modality for Korean Americans with a diagnosis of schizophrenia.     

Implementing psychoeducational interventions in Italy for patients with schizophrenia and their families

OBJECTIVE: This study explored the feasibility of providing psychoeducational interventions for persons with schizophrenia and their families. METHODS: The study was carried out in 23 Italian mental health centers. Two professionals from each center attended three monthly training sessions on psychoeducational interventions. After the training, each professional provided informative sessions on schizophrenia to five families of service users with schizophrenia, which consisted of three meetings with each family on clinical aspects of schizophrenia, drug treatments, and detection of early signs of relapse. Each professional then provided the intervention to families for six months. RESULTS: Thirty-eight of the 46 participants completed the training course, and 34 provided the intervention to 71 families. Twenty-nine of the 34 provided the entire intervention to the families and five of the 34 held only informative sessions on schizophrenia. Ninety-one percent of the participants who completed the study reported difficulties in integrating the intervention with their other work responsibilities, and 96 percent acknowledged the positive effect that the intervention had on the center's relationship with patients with schizophrenia and their families. CONCLUSIONS: These results support the idea that it is possible to introduce psychoeducational interventions in mental health services after a relatively brief period of training and supervision.     

Efficacy of a psychoeducational intervention in improving relatives’ knowledge about schizophrenia and reducing rehospitalisation

We sought to establish if a brief psychoeducational intervention for relatives is effective in improving relatives’ knowledge about schizophrenia and reducing rehospitalization. We evaluated 101 relatives of 55 patients with schizophrenia before and after an 8-week psychoeducational group using a self-report method. We also conducted a matched case-control study of the effects on rehospitalisation for 28 of these patients. We calculated the number of hospital days for each index case and control in the 1 and 2 years before and after the intervention.Relatives made significant gains in their knowledge about schizophrenia, particularly about medication. Patients whose relatives attended the group had significantly fewer days in hospital and days per admission compared to controls in the year after the programme but the effect waned in the second year after the intervention. Controls were almost four times more likely to be readmitted at 2 years than cases. Median time to readmission was significantly longer in cases compared to controls. We conclude that a psychoeducational group, which is valued by carers, is effective in increasing their knowledge about schizophrenia as well as reducing and forestalling the rehospitalization of their affected relatives. Such programmes deliver what carers frequently request in a cost-effective manner.     

Group-Analytic and Psychoeducational Therapies for Binge-Eating Disorder: An Exploratory Study of Efficacy and Persistence of Effects

Research has evaluated cognitive-behavioral therapy and interpersonal psychotherapy for the treatment of binge-eating disorder (BED); other therapies, however, have received less attention. The aim of our research was to analyze the efficacy of two group therapies for BED patients: analytic psychotherapy and psychoeducation. The psychotherapeutic intervention consisted of group-analytic psychotherapy of 14 sessions over a 28-week period; the group psychoeducational intervention involved 10 sessions over a 10-week period. The Eating Disorder Inventory-2, the 16-Personality Factors questionnaire, the Hospital Anxiety and Depression Scale, and the Toronto Alexithymia Scale-20 were used for psychometric assessment. Two follow-up assessments were performed after 6 and 12 months, respectively. At the end of treatment, most patients were without eating disorders and had a lower rate of binge episodes. The psychoeducational group patients improved markedly in alexithymic traits related to the ability to describe feelings. At follow-up, most patients were still without eating disorders and had few binge episodes. Although psychoeducational group patients confirmed the amelioration on alexithymic traits, analytic psychotherapy group patients showed a trend toward an improvement in personality traits related to the ability to be at ease when communicating with others.     

自我管理训练对社区慢性精神分裂症患者的疗效:中国上海的单盲随机对照试验(英文)

目标:评估自我管理训练对社区精神分裂症成年患者的效果。方法:总共招募了201例慢性精神分裂症患者(平均病程17.4年),并随机分为自我管理干预组(n=103)和常规治疗对照组(n=98)。自我管理训练包括每周一次小组会议,为期6个月,讨论和模拟基本的自我管理能力,然后进行24个月的每月小组助推会议,社区卫生工作人员回顾患者的自我管理清单。两名对分组单盲的精神科医生评估参与者基线和登记后6个月、30个月的症状和社会功能,采用简明精神病评定量表(BPRS),社会功能缺陷筛选量表(SDSS)和Morningside康复状态量表(MRSS)。总共有194人(干预组99人和对照组95人)完成2.5年的随访。使用末次观察结转法的意向性治疗分析进行分析。结果:相较于对照组,干预组在两个随访时间点的BPRS,SDSS和MRSS平均分较低。在入组后6个月到30个月的治疗维持阶段,干预组的评分持续改善。结论:自我管理训练是一种能改善社区慢性精神分裂症患者的症状和社会功能有效的方法。在6个月的每周自我管理技能训练后,每月的助推会议检查患者记录中与疾病相关的症状事件的日常清单,足以维持培训的有效性。将来研究应注意该方法的长期成本效益     

Group psychoeducation for long‐term offender patients with schizophrenia: An exploratory randomised controlled trial

Background Psychoeducation is now commonly provided in forensic settings, but its effectiveness among long‐term offender patients with schizophrenia has not yet been established in randomised controlled trials (RCTs). Aim To test the effects of a brief group psychoeducation programme for offenders with schizophrenia (n = 39) resident in a high‐security hospital (Niuvanniemi Hospital, Finland). Method High‐security hospital patients were randomised into either eight sessions of group psychoeducation or ‘treatment as usual’ (TAU). Outcome measures, made at baseline, immediately post‐treatment, and 3 months after that, included knowledge about illness, insight, compliance, attitudes towards medication, psychiatric symptoms and ward behaviour, self‐esteem, health‐related quality of life and perceived stigma. Results Three months after completing treatment, or an equivalent time under TAU, patients in the intervention group showed a positive treatment effect in terms of knowledge about illness, self‐esteem and insight into the illness. The only possible adverse effect was a slight increase in irritability, but this did not translate into behaviour of concern to staff. Conclusions Our sample size was small, and the findings must be regarded as preliminary, but the positive treatment effect of psychoeducation, and the absence of alarming side effects, suggests a full scale trial would be worthwhile. Most encouraging was that even the most severely ill patients were able to join the groups. Copyright © 2010 John Wiley & Sons, Ltd.     

Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy.

BACKGROUND: Few studies have examined the combined effects of psychosocial treatment and pharmacotherapy for bipolar disorder. This study used a randomized, controlled design to examine a 9-month, manual-based program of family-focused psychoeducational treatment (FFT). METHODS: Bipolar patients (N = 101) were recruited shortly after an illness episode and randomly assigned to 21 sessions of FFT (n = 31) or to a comparison treatment involving two family education sessions and follow-up crisis management (CM; n = 70). Both treatments were delivered over 9 months; patients were simultaneously maintained on mood stabilizing medications. Patients were evaluated every 3 months for 1 year as to relapse status, symptom severity, and medication compliance. RESULTS: Patients assigned to FFT had fewer relapses and longer delays before relapses during the study year than did patients in CM. Patients in FFT also showed greater improvements in depressive (but not manic) symptoms. The most dramatic improvements were among FFT patients whose families were high in expressed emotion. The efficacy of FFT could not be explained by differences among patients in medication regimes or compliance. CONCLUSIONS: Family-focused psychoeducational treatment appears to be an efficacious adjunct to pharmacotherapy for bipolar disorder. Future studies should evaluate family treatment against other forms of psychotherapy matched in amount of therapist-patient contact.     

Psychoeducational multi-family group treatment with adolescents at high risk for developing psychosis

Aim: In this study, we investigate the feasibility and acceptability of a 9‐month psychoeducational multi‐family group (PMFG) intervention for adolescents who are at ultra‐high–risk (UHR) for developing psychosis. Methods: The treatment programme was adapted from those previously shown to be effective in patients with established psychotic illness, but emphasizes content relevant to adolescence and to a pre‐onset phase of illness. Results: Participants report that psychoeducational presentations are highly useful, they attend the PMFG group sessions regularly and report feeling comfortable in meetings and benefiting from them, and adolescents demonstrate improvement in symptoms and functional outcome. Conclusions: This study was not a randomized controlled trial and multiple interventions were introduced simultaneously; thus, changes in outcome cannot be attributed to the PMFG intervention per se. Nonetheless, these results establish the acceptability of PMFG to adolescents and families, and encourage further research into the potential positive impact of PMFG with this at‐risk population.     

Service use among patients with schizophrenia in psychoeducational multiple-family group treatment

OBJECTIVES: Outpatient and inpatient mental health service outcomes for outpatients with schizophrenia or schizoaffective disorder who received psychoeducational multiple-family group treatment were compared with outcomes for similar patients who received standard care. METHODS: A total of 106 outpatients with schizophrenia or schizoaffective disorder who were receiving services from a large community mental health center were randomly assigned to receive standard care or standard care plus multiple-family group treatment. The two-year multiple-family intervention consisted of weekly group sessions designed to educate patients and their family members about the biological basis of mental illness and treatment, to improve illness management and coping skills, and to provide social support. The group sessions were conducted by two clinicians using a standardized protocol. Each multiple-family group included five to eight families and consumers. Service records for the year before and after random assignment to the study groups were examined in an intent-to-treat analysis. RESULTS: During the year after random assignment to study groups, multiple-family group treatment was associated with a lower rate of psychiatric hospitalization than standard care. It was only marginally associated with lower use of crisis services, and it was not associated with the amount of outpatient service time. CONCLUSIONS: The findings suggest that implementation of multiple-family group treatment in a capitated community mental health setting improves hospitalization outcomes without increasing the overall volume of outpatient mental health services.     

Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial

OBJECTIVE: Psychosocial interventions are effective adjuncts to pharmacotherapy in delaying recurrences of bipolar disorder; however, to date their effects on life functioning have been given little attention. In a randomized trial, the authors examined the impact of intensive psychosocial treatment plus pharmacotherapy on the functional outcomes of patients with bipolar disorder over the 9 months following a depressive episode. METHOD: Participants were 152 depressed outpatients with bipolar I or bipolar II disorder in the multisite Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. All patients received pharmacotherapy. Eighty-four patients were randomly assigned to intensive psychosocial intervention (30 sessions over 9 months of interpersonal and social rhythm therapy, cognitive behavior therapy [CBT], or family-focused therapy), and 68 patients were randomly assigned to collaborative care (a 3-session psychoeducational treatment). Independent evaluators rated the four subscales of the Longitudinal Interval Follow-Up Evaluation-Range of Impaired Functioning Tool (LIFE-RIFT) (relationships, satisfaction with activities, work/role functioning, and recreational activities) through structured interviews given at baseline and every 3 months over a 9-month period. RESULTS: Patients in intensive psychotherapy had better total functioning, relationship functioning, and life satisfaction scores over 9 months than patients in collaborative care, even after pretreatment functioning and concurrent depression scores were covaried. No effects of psychosocial intervention were observed on work/role functioning or recreation scores during this 9-month period. CONCLUSIONS: Intensive psychosocial treatment enhances relationship functioning and life satisfaction among patients with bipolar disorder. Alternate interventions focused on the specific cognitive deficits of individuals with bipolar disorder may be necessary to enhance vocational functioning after a depressive episode.     

Effects of a 10-week weight control program on obese patients with schizophrenia or schizoaffective disorder: A 12-month follow up

Aims:  Weight gain secondary to antipsychotic medication is associated with many serious conditions, including type II diabetes mellitus, hypertension, and coronary heart disease, and also with poor medication compliance. Weight control programs may be of benefit to outpatients with schizophrenia, but also raise an issue of cost-effectiveness. We aimed to evaluate the effectiveness of a 10-week weight control program for outpatients taking atypical antipsychotics for treatment of schizophrenia, and to follow up the effects of this weight control program in controlling weight gain after termination of the program.
Methods:  A total of 33 patients with schizophrenia and antipsychotic-related obesity were enrolled in a 10-week multimodal weight control program. The patients' weights were recorded at baseline, week 4, week 8, week 10 (end of the intervention), week 12, week 24, and week 48. Secondary measures included blood sugar levels, cholesterol levels, triglyceride levels, quality of life and mental health.
Results:  For those who completed the weight control program, there was a mean weight loss of 2.1 kg by the end of the intervention, 3.7 kg over 6 months, and 2.7 kg over 12 months. The mean body mass index decreased by 0.8, 1.5 and 1.1 at week 10, week 24 and week 48, respectively, all with statistical significance.
Conclusions:  The 10-week weight control program was effective in terms of weight reduction among obese patients with schizophrenia or schizoaffective disorder, and the weight reduction effect lasted for up to 6 months, and up to 12 months in some cases.     

Family attributions and coping in the prediction of emotional adjustment in family members of patients with first-episode schizophrenia

OBJECTIVE: This study used a stress and coping framework to examine family members' emotional adjustment to caring for a patient with a first episode of schizophrenia. METHOD: One family member providing primary assistance to each of 63 patients with a first episode of schizophrenia or schizoaffective disorder was interviewed shortly after patient hospitalization. RESULTS: Overall, family members showed evidence of reasonably good emotional adjustment. Select indices of poorer emotional adjustment by family members were linked to (i) attributions in which the patient's psychiatric problems were viewed as a result of the patient's moral failings or psychological problems from earlier life, (ii) coping that was avoidant and (iii) patient management strategies that involved conflict avoidance and authoritarianism/reasoning. CONCLUSION: These findings are consistent with psychoeducational interventions that educate family members about psychiatric illness and assist them in their efforts to cope with and manage patient problems at home.     

Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia

Background: The aim of this study was to explore the characteristics and efficacy of psychoeducational family intervention for persons with schizophrenia in rural China. Methods: A cluster randomised controlled trial of psychoeducational family intervention for families experiencing schizophrenia (three groups, 326 cases) was conducted in Xinjin County, Chengdu. Treatment groups consisted of family intervention and medication, medication alone, and a control. Results: The results showed a gain in knowledge, a change in the relatives' caring attitudes towards the patients, and an increase in treatment compliance in the psychoeducational family intervention group (p < 0.05, 0.001). Most importantly, the relapse rate over 9 months in this group (16.3 %) was half that of the drug-only group (37.8 %), and just over one-quarter of that of the control group (61.5 %) (p < 0.05). Antipsychotic drug treatment and families' attitudes towards patients after the 9-month follow-up were significantly associated with clinical outcome (p < 0.05). Conclusions: In rural China, family intervention should focus on improving the relatives' recognition of illness, the caring attitude towards the patients, treatment compliance, relapse prevention, and the training of the patients' social functioning. This trial, one of the largest in the literature, has shown that psychoeducational family intervention is effective and suitable for psychiatric rehabilitation in Chinese rural communities. Received: 16 April 2002 / Accepted: 29 August 2002 Correspondence to Mao-Sheng Ran, M. D., Ph. D.     

Booster sessions and long-term effects of behavioral family therapy on adolescent substance use and school performance.

This study investigated the long-term impact on adolescent substance use and academic failure of 6 months of booster sessions following the termination of behavioral family therapy. Subjects were four 14-16-year-old white and Hispanic males and females whose parents or teachers had referred them for 5-12 months of behavioral family therapy. The first subject received no booster sessions; after the typical decrease in substance use and academic problems at the end of treatment, his problems recurred and subsequently worsened during follow-up. The other three subjects responded similarly to behavioral family therapy, but this was followed by 6 months of booster sessions, leading to a second decrease in substance use and academic problems. Improvement was maintained throughout follow-up. These results suggest that booster sessions can prevent the recurrences of adolescent problem behavior that often follow treatment termination.     

Direct effects of short-term psychoeducational intervention for relatives of patients with schizophrenia in Japan

This study examined the direct effects of short-term psychoeducation on relatives of inpatients with schizophrenia, with the goal of introducing this type of support program into standard care. The subjects were 46 relatives of inpatients with schizophrenia who attended three or four sessions of psychoeducation. Levels of anxiety and subjective burden and distress were measured before and after sessions using self-administered rating scales. In addition, levels of expressed emotion were also measured. Results showed that both state and trait anxiety on the State-Trait Anxiety Inventory were significantly lower after psychoeducational intervention than before intervention. In addition, subjective burden and distress reported by the family significantly decreased on the subscales for family confusion resulting from a lack of knowledge of the illness and anxiety about the future, subjective burden and depression resulting from the patient's illness, and difficulties in the relatives' relationships with the patient. Comparison of high and low expressed emotion families showed that the intervention was almost equally effective for the two groups. However, its effectiveness with regard to the subjective burden and depression experienced by the families was significantly greater among high expressed emotion families. The present study confirmed that family psychoeducation during hospitalization, even for a short period, is effective for all families, whether high or low expressed emotion. Moreover, the results suggested that the intervention may have a greater effect on emotional factors in high expressed emotion families than in low expressed emotion families.