Knowledge Gain by Psychoeducation for Patients with Schizophrenia: Associations with Sociodemographic Data, Psychopathology, Insight and Global Neurocognitive Performance
DOI:
https://doi.org/10.12970/2310-8231.2014.02.02.4Keywords:
Psychoeducation, schizophrenia, knowledge gain, neurocognition, insight.Abstract
Purpose: In the psychiatric hospital of the Technische Universität München a prospective intervention study (PIP II) was conducted from the year 2004 to 2006 with schizophrenic patients to investigate the knowledge gain of patients after psychoeducation.
Methods: Psychoeducation was performed standardized by APES manual with eight meetings for a period of four weeks. A psychiatric and a neuropsychological assessement were carried out before and after psychoeducation. In addition, two questionnaires (Knowledge of Illness Questionnaire, Illness Concept Scale) were used. They were analysed to see to what extent the soziodemographic data, the psychopathology, the participation rate of the patients in psychoeducation, the neurocognition and the insight of the patients influence the knowledge gain.
Results: Comparison of pre and post data of 62 patients showed CGI declined from 5.0 to 3.2 (p<0.000), PANSS decline from 81.8 to 54.7 (p<0.000). The knowledge increased (0–107 points possible) from 82.6 to 88.5 points (p<0.000). Severely cognitively impaired patients had a knowledge increase from 77.4 to 86.3 points and mildly cognitively impaired patients from 86.8 to 92.8 points (p=0,106). Regression analysis showed that the knowledge score before psychoeducation (p<0,000) is the strongest predictor for knowledge gain.
Conclusion: Psychopathology does not limit knowledge gain. Insight into illness is not absolutely necessary for the participation in a psychoeducational group. In this study even cognitively impaired patients have been able to benefit from psychoeducation.
References
Anderson CM, Hogarty GE, Reiss DJ. Family treatment of adult schizophrenic patients: a psycho-educational approach. Schizophr Bull 1980; 6(3): 490-505. http://dx.doi.org/10.1093/schbul/6.3.490
Bäuml J, Bechdolf A, Behrendt B, et al. Konsensuspapier zu psychoedukativen Interventionen bei schizophrenen Erkrankungen. In: “Psychoedukation bei schizophrenen Erkrankungen”, Bäuml J., Pitschel-Walz P. (Hrsg.), Schattauer GmbH, Stuttgart, 2008; 2. Auflage, 1-34.
Bäuml J, Froböse T, Kraemer S, et al. Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families. Schizophr Bull 2006 Oct; 32 Suppl 1: S1-9. Epub 2006 Aug 18. http://dx.doi.org/10.1093/schbul/sbl017
Bäuml J. Psychoeducation from a psychiatric-psychotherapeutic point of view. Psychiatr Prax 2006 Nov; 33(8): 379-82.
Hamann J, Langer B, Winkler V, et al. Shared decision making for in-patients with schizophrenia. Acta Psychiatr Scand 2006; 114(4): 265-73. http://dx.doi.org/10.1111/j.1600-0447.2006.00798.x
Pitschel-Walz G, Gunia H, Berger H, et al. Übersicht über aktuelle psychoedukative Programme bei schizophrenen Erkrankungen im deutschsprachigen Raum. In: „Arbeitsbuch Psychoeduktion bei Schizophrenie (APES)“, Bäuml J., Pitschel-Walz G., Berger H., Gunia H., Heinz A., Juckel G. (Hrsg.), Schattauer GmbH, Stuttgart, 2005; 155-161.
Pitschel-Walz G, Bäuml J, Bender W, et al. Psychoeducation and compliance in the treatment of schizophrenia: results of the Munich Psychosis Information Project Study. J Clin Psychiatry 2006; 67(3): 443-52. http://dx.doi.org/10.4088/JCP.v67n0316
Bäuml J, Pitschel-Walz G, Berger H, et al. Arbeitsbuch Psychoedukation bei Schizophrenie (APES). Schattauer GmbH, Stuttgart, 2. Auflage 2010.
Lincoln TM, Wilhelm K, Nestoriuc Y. Effectiveness of psychoeducation for relapse, symptoms, knowledge, adherence and functioning in psychotic disorders: A meta-analysis. Schizophr Res 2007; 96(1-3): 232-45. http://dx.doi.org/10.1016/j.schres.2007.07.022
Kulhara P, Chakrabarti S, Avasthi A, et al. Psychoeducational intervention for caregivers of Indian patients with schizophrenia: a randomised-controlled trial. Acta Psychiatr Scand 2009; 119(6): 472-83. http://dx.doi.org/10.1111/j.1600-0447.2008.01304.x
Rummel-Kluge C, Kissling W. Psychoeducation in schizophrenia: new developments and approaches in the field. Curr Opin Psychiatry 2008; 21(2): 168-72. http://dx.doi.org/10.1097/YCO.0b013e3282f4e574
Degmecić D, Pozgain I, Filaković P. Psychoeducation and compliance in the treatment of patients with schizophrenia. Coll Antropol. 2007 Dec; 31(4): 1111-5.
Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database Syst Rev 2011; (6): CD002831.
Aguglia E, Pascolo-Fabrici E, Pertossi F, et al. Psychoeducational intervention and prevention of relapse among schizophrenic disorders in the Italian community psychiatric network. Clin Pract Epidemol Ment Health 2007; 3: 7. http://dx.doi.org/10.1186/1745-0179-3-7
Bäuml J, Pitschel-Walz G, Volz A, et al. Psychoeducation in schizophrenia: 7-year follow-up concerning rehospitalization and days in hospital in the Munich Psychosis Information Project Study. J Clin Psychiatry 2007; 68(6): 854-61. http://dx.doi.org/10.4088/JCP.v68n0605
Merinder LB. Patient education in schizophrenia: a review. Acta Psychiatr Scand 2000; 102: 98-106. http://dx.doi.org/10.1034/j.1600-0447.2000.102002098.x
Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie AMDP (Hrsg.). Das AMDP-System. Manual zur Dokumentation psychiatrischer Befunde. Hogrefe Verlag GmbH, 8.Auflage, 2007.
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13(2): 261-76. http://dx.doi.org/10.1093/schbul/13.2.261
Addington D, Addington J, Schissel B. A Depression rating scale for schizophrenics. Schizophr Res 1990; 3(4): 247-51. http://dx.doi.org/10.1016/0920-9964(90)90005-R
Guy W: ECDEU Assessment Manual for Psycho-pharmacology —Revised. Rockville, MD, U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs, 1976; 218–222.
Pitschel-Walz G. (Hrsg.). Die Einbeziehung der Angehörigen in die Behandlung schizophrener Patienten und ihr Einfluss auf den Krankheitsverlauf. Peter Lang GmbH, Frankfurt am Main, 1997; 99-118.
Linden M, Nather J, Wilms HU. Definition, significance ans measurement of disease concepts of patients. The Disease Concept Scale for schizophrenic patients. Fortschr Neurol Psychiatr 1988; 56(2): 35-43. http://dx.doi.org/10.1055/s-2007-1001215
Amador XF, Strauss DH, Yale SA, et al. Awareness of illness in schizophrenia. Schizophr Bull 1991; 17(1): 113-32. http://dx.doi.org/10.1093/schbul/17.1.113
Niemann H, Sturm W, Thöne-Otto A, et al. CVLT California Verbal Learning Test – Deutsche Adaption. Pearson Assessment and Information, Frankfurt, 2008.
Brickenkamp R, Zillmer E. D2 test of attention. Hogrefe und Huber, 1998.
Zimmermann P, Fimm B. Testbatterie zur Aufmerksam-keitsprüfung (TAP). Handbuch. Herzogenrath: Psycholo-gische Testsysteme Vera Fimm, 2002.
Heaton RK, Miller SW, Taylor MJ, et al. Comprehensive norms for an expanded Halstead-Reitan Battery: Demographically adjusted neuropsyhological norms for African, American and Caucasion adults. Professional Manual. Psychological Assessment Resources, 2004.
Rummel-Kluge C, Pitschel-Walz G, Bäuml J, et al. Psychoeducation in schizophrenia - results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland. Schizophr Bull 2006; 32(4): 765-75. http://dx.doi.org/10.1093/schbul/sbl006
Rabovsky K., Stoppe G. The role of psychoeducation in the treatment of psychiatric inpatients. Nervenarzt 2006; 77(5): 538-48. http://dx.doi.org/10.1007/s00115-005-2036-0
Reichhart T, Pitschel-Walz G, Kissling W, et al. Gender differences in patient and caregiver psychoeducation for schizophrenia. Eur Psychiattry 2010; 25(1): 39-46. http://dx.doi.org/10.1016/j.eurpsy.2009.08.001
McWilliams S, Hill S, Mannion N, et al. Caregiver psychoeducation for schizophrenia: is gender important? Eur Psychiatry 2007 Jul; 22(5): 323-7. http://dx.doi.org/10.1016/j.eurpsy.2006.10.009
Pitschel-Walz G, Bäuml J, Froböse T, et al. Do individuals with schizophrenia and a borderline intellectual disability benefit from psychoeducational groups? J Intellect Disabil 2009; 13(4): 305-20. http://dx.doi.org/10.1177/1744629509353237
Jahn T, Pitschel-Walz G, Gsottschneider A, et al. Neurocognitive prediction if illness knowledge after psychoeducation in schizophrenia: results from the Munich COGPIP study. Psychol Med 2011; 41(3): 533-44. http://dx.doi.org/10.1017/S0033291710001029
Pitschel-Walz G, Gsottschneider A, Froböse T, et al. Neuropsychology of psychoeducation in schizophrenia: Results of the Munich COGPIP study. Nervenarzt 2013 Jan; 84(1): 79-90. http://dx.doi.org/10.1007/s00115-011-3383-7
Misdrahi D, Denard S, Swendsen J, Jaussent I, Courtet P. Depression in schizophrenia: the influence of the different dimensions of insight. Psychiatry Res. 2014; 216(1): 12-6. http://dx.doi.org/10.1016/j.psychres.2014.01.039
Sibitz I, Amering M, Gössler R, et al. Patients` perspectives on what works in psychoeducational groups for schizophrenia: A quality study. Soc Psychiatry Psychiatr Epidemiol 2007; 42(11): 909-15. http://dx.doi.org/10.1007/s00127-007-0245-5