Psychoeducational medication management training (PMT), cognitive psychotherapy (CP) and key-person counselling (KC) were carried out in various combinations in this randomized, controlled intervention study of schizophrenic out-patients (according to DSM-III-R). Special design characteristics of the study were a control group consisting of non-specifically treated patients and a 2-year follow-up after completion of treatment in order to evaluate medium-term effects. A total of 132 patients underwent a follow-up examination 2 years after completion of treatment and were evaluated with an intention-to-treat approach. In the second follow-up year, all treatment groups had lower but not significantly different relapse rates compared to the control group. The most intensive treatment (PMT+CP+KC) produces a clinically relevant reduction in rehospitalization rate (a 26% reduction compared to the control group). In comparison with the non-specifically treated control group, whose original effect decreased, at least a medium-term therapeutic effect was recorded in the treatment groups.
This study considers the question of whether relapse rates among schizophrenic patients can be reduced by means of relatives' groups. In a randomized, controlled intervention study, two therapeutic strategies (therapeutic relatives' groups, initiated relatives' self-help groups) were compared with each other and with a control group. Interventions were confined to the relatives, with the patients continuing their standard treatment. The study involved 151 relatives of 99 chronic DSMIII schizophrenics. Data were collected before and after a 1-year intervention phase and in a 2-year follow-up. No difference existed between the groups with respect to rehospitalization data. However, numerous differences recorded in the psychopathological findings and in living and working circumstances suggest that therapeutic work with relatives is of clinically significant benefit.
Within a controlled prospective intervention study, schizophrenic outpatients randomly assigned to four treatment groups and one control group were assessed with regard to collaboration with drug treatment. In total, 39.3% of 84 regular attenders of the psychoeducational training programme and 26.6% of 64 control patients reported having persuaded their psychiatrists to modify their medication prescriptions. A total of 8.3% and 7.8%, respectively, modified their medication on their own initiative, although with subsequent approval by the psychiatrist, and 20.2% and 15.6%, respectively, modified their medication after consulting their psychiatrist. With regard to medication management, the groups did not differ either at post-treatment or at follow-up. At follow-up, regular attenders showed a reduced fear of side-effects, increased confidence in their medication and stable confidence in their physician. Among the control subjects, confidence in the medication and in their physician declined, and fear of side-effects increased. Psychoeducational training therefore led to an optimization of patients' attitudes toward treatment, but not to changes in medication management.
There is increasing evidence of the efficacy and effectiveness of psychosocial interventions in schizophrenic patients. However, little research has been done on differential therapy effects. In a prospective, randomized clinical trial we carried out psychoeducational medication management training, cognitive psychotherapy, and key-person counseling. The patients of the control group participated in structured free-time activities for control of therapeutic commitment. Data from a total of 156 schizophrenic patients (DSM-III-R, no first-admissions) were available at 2-year follow-up. We analyzed in this study whether there are differential therapy effects of these interventions, depending on patient characteristics at baseline. There was a significant statistical interaction between treatment condition (specific/non-specific) and prognosis with respect to treatment outcome. Patients with a favorable prognosis and better social functioning had a better course under the specific treatment but a less favorable outcome in the non-specifically treated control group. These results suggest that more vulnerable patients are not sufficiently capable of learning and using coping strategies for relapse prevention. We need to learn more about differential indications for psychosocial treatment.
In this study we investigated whether, in conjunction with neuroleptics, a psychoeducational and cognitively oriented treatment for schizophrenic outpatients and their key-persons can improve the course of schizophrenic illness within a 2-year follow-up. This prospective randomized study covered a total of 191 schizophrenic patients (according to DSM-III-R) and comprised a psychoeducational training and cognitive psychotherapy for patients and counseling for their key persons in various combinations. Patients were examined before, immediately after and 2 years after the end of the intervention. Patients in the treatment groups reduced their overall psychopathology and their attention deficit. For patients receiving all three treatment conditions, there was a relevant preventive effect with regard to the rehospitalization rate appearing during the second year of the follow-up. We conclude that in the mid-term, a combination of psychoeducational and cognitively oriented therapy for patients and their keypersons can improve the course of schizophrenic illness.
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