Brief Group Psychoeducation for Schizophrenia
Condition: Schizophrenia
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      This study evaluates the addition of psychoeducation to treatment as usual in the treatment
      of adults with schizophrenia for relapse prevention. Half of participants will receive a
      brief (5 sessions) psychoeducation intervention and treatment as usual in combination, while
      the other half will receive treatment as usual only.
    

Detailed description: 
      Schizophrenia is a chronic persistent and disabling psychiatric syndrome whose primary
      feature is the presence of delusions, hallucinations, disorganized speech or behavior,
      catatonic behavior and negative symptoms (poverty of thought, social isolation, decreased
      expression of emotions and motivation for activities). Its incidence in one year is 15.9 per
      100,000 inhabitants; its prevalence is 4.3 per 1,000 inhabitants and has been shown to be
      more common among men, migrant population, urban area, developed countries and greater
      latitude. It is associated with: 1) Increased mortality rates compared to the general
      population 2) Disability is one of the top ten causes of years lived with disability in
      people between 15 and 44 years old, which can be explained by incomplete remission of up to
      80% of affected patients and psychotic relapses (5-7). 3) High economic costs given by
      relapses, hospitalizations, decreased labor productivity and financial and emotional burden
      for families (8,9). The latter has increased in the last 50 years by changes in the mental
      health care systems throughout the world that have left families a greater responsibility in
      caring for patients so they would need more knowledge about the disorder, treatment and
      rehabilitation (10,11). All this justifies the search for strategies aimed at preventing
      psychosis crisis increase the period between crises and decrease disability (12,13,14).
      Psychoeducation is one of the strategies that have been raised so far (15).

      Psychoeducation is an intervention based on the structured and systematic knowledge
      acquisition of a mental disorder, with the aim of improving their clinical prognosis and
      reduce care costs (15,16,17). There are various designs of psychoeducative programs, they can
      be individual or group, involving only patients, family or both, or short (less than 10
      sessions) or longer. There is insufficient evidence to establish whether any of these methods
      is most effective, and with respect to the psychoeducation in general, available studies
      suggest that it may have beneficial effect on reduction in relapses, adherence, hospital
      stay, global functioning and quality of life (19). However, these studies have methodological
      limitations such as lack of clarity in the generation and concealment of randomized
      allocation sequence, non-blind assessment of outcomes and frequent losses in monitoring,
      suggesting that the effects observed for psychoeducation may not be valid and could be
      overestimated. Additionally, the cultural characteristics and health system of each country
      may limit the applicability of studies, which may be necessary to evaluate the efficacy in
      sites with particular conditions (20).

      In a private psychiatric clinic in Medellin primarily serving patients who belong to the
      contributory scheme of health care, Brief Psychoeducation Group Program was designed (five
      sessions) for Patients with Schizophrenia and their Families (PGSF). It was decided to
      include both patients and relatives because some studies suggest there may be advantages and
      generally patients with this disorder should go out accompanied. It will be group because
      some authors have argued that it could have more benefits than individual, to facilitate
      meetings with others, by facilitating the encounter with other people with similar
      conditions, which could have additional therapeutic effects and be more cost-effective (19).
      It will be five sessions because it was considered that they could cover the main issues and
      ensure the attendance at all sessions, taking into account the economic conditions and time
      restrictions most for most relatives. It is very important to evaluate the effectiveness of
      this program because that will allow making informed decisions regarding the implementation
      in this and other psychiatric care institutions in the country. In addition, there are not
      any controlled clinical trials in Colombia that evaluate the effectiveness of a
      psychoeducational intervention for this disorder.

      Therefore, the research question is: In a psychiatric clinic of Medellin (Colombia), What is
      the effectiveness of a Brief Psychoeducational Group Program for Patients with Schizophrenia
      and their Families (PGSF) added to their Outpatient Treatment as Usual (TAU) compared with
      TAU to reduce the risk of relapse?
    

Intervention name(s): Brief Group Psychoeducation; Treatment as Usual
Intervention type(s): Other; Other
Intervention description(s): First session: describe the clinical manifestations of schizophrenia, deny myths, and inform on the biological nature of the disorder. Second session: provide updated information regarding pharmacological treatment, their side effects and the importance of adherence to treatment. Third session: Achieving recognition of personal responsibility for the lifestyle, routine, physical care and the risk of addiction; awareness of the importance of self-monitoring of symptoms and the development of cognitive, behavioral and emotional strategies. Fourth Session: To recognize the role of family members in the treatment, the problem of expressed emotions and communication in times of crisis. Fifth Session: To know the rights and duties of patients and their families in the current health care system.; The patients in both arms of the intervention will receive this type of attention. The TAU is the psychiatric care that patients with schizophrenia usually receive in the clinic. This is done in consultation of 30 minutes, in which the psychiatrist evaluates the clinical condition of the patient and psychosocial factors that may be affecting, prescribes drugs according to protocols and clinical care and answers questions about the disorder. In the consultation a brochure with information is given about schizophrenia. The frequency of consultations varies depending on severity of symptoms usually split between one and six months.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Schizophrenia; Patient Education