Psychoeducation added to standard treatment for schizophrenia reduces relapse

The purpose of patient education/teaching (or psychoeducation) is to increase patients' knowledge and understanding of their illness and treatment. It is supposed that increased knowledge enables people with schizophrenia to cope more effectively with their illness. Psychoeducational interventions involve interaction between the information provider and the mentally ill person. This review compares the efficacy of psychoeducation added to standard care as a means of helping severely mentally ill people with that of standard care alone. The evidence shows a significant reduction of relapse or readmission rates. There seems to be some suggestion that psychoeducation may improve compliance with medication, but the extent of improvement remains unclear. The findings show a possibility that psychoeducation has a positive effect on a person's well being and promotes better social function. In the medium term, treating four people with schizophrenia with psychoeducation instead of standard care resulted in one additional person showing a clinical improvement. The scarcity of studies made the comparison between the efficacy of different formats (programmes of 10 sessions or less or 11 or more, individual or group sessions) weak.

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.

Note: the 27 new citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.

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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 strategy: 

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.

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