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Psychoeducation for schizophrenia

  • Review
  • Intervention

Authors


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.

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

摘要

精神分裂症的心理教育

背景

精神分裂症可以是嚴重且慢性的疾病,其特徵是缺乏病識感及無法配合治療。心理教育方法的發展,用以增加病患對其疾病及治療的知識與病識感。一般認為此增加的知識及病識感,將讓精神分裂症患者能更有效地適應他們的疾病,因此改善預後。

目的

評估比較心理教育介入與提供標準知識之效果。

搜尋策略

我們搜尋了Cochrane Schizophrenia Group Trials Register(2010年2月)。

我們於2012年11月更新此搜尋並增加27個新試驗到等候評估部分。

選擇標準

所有相關的隨機對照試驗都針對心理教育運用在精神分裂症及/或相關嚴重心理疾病之個人或群組。 我們排除了準隨機試驗。

資料收集與分析

至少有兩位回顧文獻作者獨立地由所包含的論文中摘錄數據。我們聯絡試驗的作者以取得額外及缺漏的數據。我們計算同質性二分法數據的風險比(RR)及95%信賴區間(CI)。我們使用固定效果模式(fixed-effects model)於異質性二分法數據。在可能的時候,我們也計算益一需治數(NNT),還有連續性數據的加權平均值。

主要結果

本回顧文獻總計包含5142名參與者(大多數是住院病人),來自44個在1988年到2009年期間進行的試驗(研究期間的中位數為12週,偏差風險-中度)。我們發現在短期內,心理教育群組中【不配合遵守治療】的事件較低(n =1400,RR 0.52 CI 0.40到0.67,NNT 11 CI 9到16)。此發現在中到長期也一樣。心理教育群組復發較低(n =1214,RR 0.70 CI 0.61到0.81,NNT 9 CI 7到14),同樣地【再住院】也較低(n =206,RR 0.71 CI 0.56到0.89,NNT 5 CI 4到13)。量表衍生的數據也顯示出心理教育能促進更佳的社會及整體機能。在中期治療,每4個精神分裂症患者接受心理教育治療取代標準照護,會增加一位病患得到臨床上改善。證據顯示,接受心理教育的參與者比較有可能對心理健康服務感到滿意(n =236,RR 0.24 CI 0.12到0.50,NNT 5 CI 5到8)並得到生活品質的改善。

作者結論

在這些以醫院為基礎且品質受限的研究中,心理教育似乎可以降低復發、再住院、強化藥物治療順從性以及住院長度。真正療效的大小可能較本回顧文獻所顯示的少,但是,雖然如此,有些心理教育可能在臨床上是有效的且具有潛在的成本效益。針對這個有前景的方法【心理教育】之效果做完整調查,要驗證此領域更好、更可施行的研究並不困難。

注意事項:27個新引用試驗,正等候審閱分類中,有可能改變目前回顧文獻的評估結果。

Plain language summary

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.

淺顯易懂的口語結論

精神分裂症標準治療中加入心理教育可降低復發。

病患教育/教導(或心理教育)的目的在於增加病患對本身疾病及治療的知識與理解。 一般認為增加知識能讓精神分裂症患者更有效率的適應自身的疾病。心理教育介入涉及資訊提供者與精神患者間的互動。 此回顧文獻比較將心理教育加入標準照護中與僅有標準照護,用於協助嚴重精神疾病患者的療效。 證據顯示在復發或是再住院率上有顯著的降低。似乎暗示心理教育或許可以提昇病患對於藥物的遵從性,但改善的程度仍不明確。 研究結果顯示出心理教育對病患健康福祉有正面影響,且能促進更好的社會機能。在中期治療,每4個精神分裂症患者接受心理教育治療取代標準照護,會增加一位病患得到臨床上改善。 研究量不足導致不同課程安排(10堂課程或以下、或是11堂或更多、個別或團體課程) 間之療效比較顯得薄弱。

譯註

翻譯: East Asian Cochrane Alliance
翻譯補助: 台灣衛生福利部/台北醫學大學實證醫學研究中心

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