Health care decisions can have life-altering consequences, so consumers must be as informed as possible. This is particularly true when it comes to developing treatment programs for schizophrenia. Schizophrenia is often characterized by lack of insight, treatment nonadherence, and poor prognosis. However, research suggests that patients with schizophrenia benefit immensely from learning about their illness. The Cochrane analyses on psychoeducation for schizophrenia found that psychoeducational interventions significantly reduced relapse and readmission rates, enabled fewer hospital days, increased medication adherence, increased satisfaction with mental health services, and improved quality of life.1
According to the American Psychiatric Association (APA) treatment guidelines, psychoeducational interventions should be part of the standard therapy for patients with schizophrenia.2 The Substance Abuse and Mental Health Services Administration has identified family psychoeducation as an evidenced-based practice that should be implemented in psychiatric settings.3 And, the Schizophrenia Patient Outcomes Research Team recommends education for patients with schizophrenia and their families as well as psychosocial interventions that include psychoeducation for weight loss in overweight individuals with schizophrenia.4
Over the past decade, providers have increasingly focused less on the long-term disability associated with schizophrenia and more on recovery. In a recovery-oriented paradigm, there is an emphasis on patient involvement and a focus on facilitating a collaborative relationship by providing psychoeducation. Psychoeducation cultivates a shared decision-making approach that brings together the clinician’s expertise and the patient’s treatment preferences. Shared decision making fosters autonomy, which results in decisions that better serve the individual’s choices, values, and interests. “Shared decision making provides an approach through which providers and consumers of health care come together as collaborators in determining the course of care. Research has shown that shared decision making . . . increases consumers’ knowledge about and comfort with the health care decisions they make.”5
What is psychoeducation?
Patient and family education, ie, psychoeducation, is an evidence-based psychotherapeutic intervention for patients with mental illness and their families. It teaches patients and their families about the nature of the illness, its treatment, coping and management strategies, and skills needed to avoid relapse (Table). Psychoeducation has been defined as “the education of a person with a psychiatric disorder in subject areas that serve the goals of treatment and rehabilitation.”1
Psychoeducation includes cognitive, behavioral, and supportive therapeutic elements. Education is a gradual process, and intended outcomes of psychoeducation fall on a continuum and build on one another.
Psychoeducational approaches are intended to increase knowledge of and insight into illness and treatment. The goal of psychoeducation is behavioral change, which will lead to better treatment adherence. A psychoeducational program designed for patients with schizophrenia generally teaches participants that schizophrenia is a brain disor-der that is partially helped by medication and that other factors, including family involvement, stress, substance abuse, and coping skills, affect recovery.
Psychoeducation can be offered to patients, family members, or both. Study results from more than 30 randomized clinical trials have shown reduced relapse rates, enhanced recovery, and improved family well-being.6 Effective family psychoeducation includes empathic engagement, problem-solving and communication skills, social networking, education on clinical resources, and ongoing support.
Patients with serious mental illness, such as schizophrenia, are vulnerable to alcohol and drug abuse and may have co-occurring substance use problems. Substance use will worsen the mental health problem, and when the mental health problem goes untreated, or worsens, it makes patients more prone to addictive behaviors. Substance use may also be a risk factor for medication nonadherence. Therefore, it is important to educate patients with schizophrenia about the adverse effects of substance use.
What is already known about the role of psychoeducation on treatment adherence for patients with schizophrenia?
? Patients with schizophrenia can benefit from learning about their illness. Guidelines recommend psychoeducational interventions as part of standard treatment for patients with schizophrenia.
What new information does this article provide?
? Recovery-oriented psychoeducation can cultivate a shared decision-making approach that brings together the clinician’s expertise and the patient’s treatment preferences. Tips and strategies that can help foster recovery, wellness, and shared decision making are provided as well as a list of wellness- and recovery-oriented psychoeducational materials and resources.
What are the implications for psychiatric practice?
? Implementing recovery- and wellness-oriented psychoeducational programs and materials as part of standard treatment may improve mental and physical health outcomes in patients with schizophrenia.
References
1. Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database Syst Rev. 2011;(6):CD002831.
2. American Psychiatric Association. Practice Guideline for the Treatment of Patients With Schizophrenia. 2nd ed. Arlington, VA: American Psychiatric Association; 2004.
3. The Substance Abuse and Mental Health Services Administration (SAMHSA). How to Use the Evidence-Based Practices Kits: Family Psychoeducation. http://store.samhsa.gov/shin/content//SMA09-4423/HowtoUseEBPKITS-FP.pdf. Accessed November 29, 2011.
4. Kreyenbuhl J, Buchanan RW, Dickerson FB, Dixon LB; Schizophrenia Patient Outcomes Research Team (PORT). The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009. Schizophr Bull. 2010;36:94-103.
5. The Substance Abuse and Mental Health Services Administration (SAMHSA). Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions. 2011. http://store.samhsa.gov/shin/content//SMA09-4371/SMA09-4371.pdf. Accessed November 29, 2011.
6. McFarlane WR, Dixon L, Lukens E, Lucksted A. Family psychoeducation and schizophrenia: a review of the literature. J Marital Fam Ther. 2003;29:223-245.
7. National Council for Patient Information and Education (NCPIE). Enhancing Prescription Medication Adherence: A National Action Plan. August 2007. http://www.talkaboutrx.org/documents/enhancing_prescription_medicine_adherence.pdf. Accessed November 29, 2011.
8. Zygmunt A, Olfson M, Boyer C, Mechanic D. Interventions to improve medication adherence in schizophrenia. Am J Psychiatry. 2002;159:1653-1664.
9. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and cause of death among public mental health clients in eight states. 2006. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1563985/pdf/PCD32A42.pdf. Accessed November 29, 2011.
10. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. Parks J, Svendsen D, Singer P, Foti ME, eds. Morbidity and Mortality in People With Serious Mental Illness. 2006. http://nasmhpd.org/general_files/publications/med_directors_pubs/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf. Accessed November 29, 2011.
11. Vreeland B, Toto AM, Verna M, Williams JM. Cultivating physical health and wellness utilizing a person-centered approach. In: Rudnick A, Roe D, eds. Serious Mental Illness: Person-Centered Approaches. New York: Radcliff Publishing; 2011:284-300.
12. Williams JM, Ziedonis DM, Vreeland B, et al. A wellness approach to addressing tobacco in mental health settings: learning about healthy living. Am J Psychiatr Rehabil. 2009;12:352-369.
13. Roe D, Yanos PT. Psychoeducation for people with psychotic symptoms: moving beyond information and towards inspiration. Behav Therapist. 2006;29:53-56.