Psychoeducation for schizophrenia

Abstract

Background Schizophrenia can be a severe and chronic illness characterised by lack of insight and poor compliance with treatment. Psychoeducational approaches have been developed to increase patients’ knowledge of, and insight into, their illness and its treatment. It is supposed that this increased knowledge and insight will enable people with schizophrenia to cope in a more effective way with their illness, thereby improving prognosis. Objectives To assess the effects of psychoeducational interventions compared with standard levels of knowledge provision. Search methods We searched the Cochrane Schizophrenia Group Trials Register (February 2010). We updated this search November 2012 and added 27 new trials to the awaiting assessment section. Selection criteria All relevant randomised controlled trials focusing on psychoeducation for schizophrenia and/or related serious mental illnesses involving individuals or groups. We excluded quasi-randomised trials. Data collection and analysis At least two review authors extracted data independently from included papers. We contacted authors of trials for additional and missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data. We used a fixed-effects model for heterogeneous dichotomous data. Where possible we also calculated the numbers needed to treat (NNT), as well as weighted means for continuous data. Main results This review includes a total of 5142 participants (mostly inpatients) from 44 trials conducted between 1988 and 2009 (median study duration ~ 12 weeks, risk of bias - moderate). We found that incidences of non-compliance were lower in the psychoeducation group in the short term (n = 1400, RR 0.52 CI 0.40 to 0.67, NNT 11 CI 9 to 16). This finding holds for the medium and long term. Relapse appeared to be lower in psychoeducation group (n = 1214, RR 0.70 CI 0.61 to 0.81, NNT 9 CI 7 to 14) and this also applied to readmission (n = 206, RR 0.71 CI 0.56 to 0.89, NNT 5 CI 4 to 13). Scale-derived data also suggested that psychoeducation promotes better social and global functioning. In the medium term, treating four people with schizophrenia with psychoeducation instead of standard care resulted in one additional person showing a clinical improvement. Evidence suggests that participants receiving psychoeducation are more likely to be satisfied with mental health services (n = 236, RR 0.24 CI 0.12 to 0.50, NNT 5 CI 5 to 8) and have improved quality of life. Authors’ conclusions 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. No...

Şi̇zofreni̇ Hastalarinin Ve Bakim Verenleri̇ni̇n Eği̇ti̇m Gereksi̇ni̇mleri̇ni̇n Beli̇rlenmesi̇

“…"Hasta eğitimi" kavramı bu süreç için kullanılan ve bilgiye odaklanan bir kavramdır. Hasta eğitiminin amacı, hastada davranış değişikliği yapmaktır (Xia, Merinder and Belgamwar 2011). Hastalık, hastalığın tedavisi ve hastalıkla baş etme yolları konusunda şizofreni hastasına ve ailesine bilgi sağlayan psikoeğitim müdahalelerinin, ailelerin ve hastaların işlevselliğini arttırma, hastalıkla baş etmelerine yardım etme, yaşadıkları sıkıntıları azaltma, problem çözme ve kişiler arası ilişki kurma becerisini arttırmada etkili olduğu yapılan çalışmalarda belirtilmektedir (Maldonado and Urizar 2007;Bauml, Froböse (2006) tarafından "Şizofreni hastalarının ve yakınlarının sağlık eğitimi gereksinimleri" çalışması kapsamında geliştirilmiştir.…”

Psychoeducation as an Opportunity for Patients, Psychiatrists, and Psychiatric Educators: Why Do We Ignore It?

“…Family interventions, including psychoeducation for schizophrenia, have proved to be one of the most consistently effective treatment modalities available, with relapse rate reduction at 50-60% over treatment as usual [1,2]. Besides relapse severity reduction, psychoeducation leads to less frequent relapses, better treatment adherence, lower self-stigma, better quality of life, improvement of social competencies, active engagement in rehabilitation, and lower cost of care, either alone or as a part of complex treatment regimen [3][4][5][6][7]. Thus, family psychoeducation is recommended in several schizophrenia treatment guidelines [8][9][10], for example, as an evidence-based intervention.…”

Psychoedukative Strategien bei schizophren erkrankten Patienten mit fehlender Krankheitseinsicht

“…Patienten mit mangelnder Krankheitseinsicht stehen in der Regel besonders der medikamentösen Therapie ablehnend gegenüber; dies stellt im Hinblick auf die Rückfallprophylaxe eines der größten Probleme bei der Langzeitbehandlung dieser Patienten dar (Droulout et al 2003;Xia et al 2011). Auch hier muss ein kluger Mittelweg zwischen dem Phänomen der Reaktanzbildung durch autoritäres Pochen auf Medikation und der letztendlich "untherapeutischen Komplizenschaft" mit dem von Verdrängung geprägten Wunschdenken der Erkrankten nach Absetzen der Medikamente gefunden werden.…”

“…Sie soll einen Zuwachs an sozialer Kompetenz und Zufriedenheit mit der Therapie ermöglichen. Psychoedukation kann somit einen Beitrag zur Reduktion von Liegezeiten und medizinischen Kosten leisten (Xia et al 2011). Deshalb zählt Psychoedukation laut den S3-Leitlinien der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (Gaebel et al 2006) unter Einbeziehung der Angehörigen und gemäß den Leitlinien der American Psychiatric Association (2004) ganz generell zu den allgemein empfohlenen Behandlungsmaßnahmen bei schizophren erkrankten Patienten.…”

“…Ein Unterschied zwischen dem Gefühl, körperlich oder seelisch krank zu sein, ist nicht zweckmäßig." In der Literatur wird der Anteil von schizophren erkrankten Patienten mit mangelhafter Krankheitseinsicht auf 50-80% geschätzt (Raffard et al 2008) und mangelhafte Krankheitseinsicht als geradezu charakterisierend für diese Erkrankung beschrieben (Xia et al 2011). Sie kann ein wichtiger Risikofaktor für die Entwicklung einer medikamentösen "noncompliance" Cavelti et al 2012) mit großem Einfluss auf die langfristige Behandlungsperspektive sein.…”