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Psychiatric Times. Vol. 29 No. 2
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PATIENT EDUCATION: PART 2 

An Evidence-Based Practice of Psychoeducation for Schizophrenia

A Practical Intervention for Patients and Their Families

By Betty Vreeland, APRN | February 7, 2012
Ms Vreeland is an Advanced Practice Nurse and a Board-Certified Adult Nurse Practitioner with prescriptive authority at the University of Medicine and Dentistry of New Jersey (UMDNJ), University Behavioral HealthCare in Piscataway, NJ. She is also a Clinical Assistant Professor of Nursing and Psychiatry at UMDNJ. Ms Vreeland reports that she is a consultant for Eli Lilly and Co and is coauthor of Solutions for Wellness.

Summary

During my initial assessment of patients, I discuss individual recovery goals and how medication and other treatment can help the patient achieve his or her goals; this discussion continues throughout treatment. I ask if the patient would like a family session, and I include family psychoeducation as needed.

(MORE: Peer Specialists as Educators for Recovery-Based Systems Transformation)

A variety of educational pamphlets and handouts on topics such as schizophrenia, recovery, and nutrition are readily available in my office, in the waiting rooms, and on bulletin boards. A brief physical health history is included in the initial assessment. I provide education about the higher risk of medical morbidity and mortality, and the patient and I collaborate on a prevention plan. If nicotine(Drug information on nicotine) dependence and obesity are present, they are discussed and documented along with other physical health problems.

Asking patients to rate their interest and confidence in taking medication, quitting smoking, and losing weight on a scale of 1 to 10 can be enlightening. Use of pill-reminder boxes and appointment calendars is frequently recommended. These strategies can be used whether the provider is in private practice or is working in a clinic setting.

Recovery-oriented and physical health goals are included in the individual’s service plan. My organization maintains a Medical Providers Database with practitioners interested in treating patients with mental illness along with the insurance plans they accept, and referrals are made when needed.

Medication fact sheets are available to help guide medication counseling discussions. If the patient is receiving an atypical antipsychotic, information is provided about the weight gain potentials of the various agents, the possible metabolic effects, and the need to monitor for adverse effects. Baseline and ongoing weights are tracked. Brief nutritional and physical activity advice are offered, along with a variety of educational handouts that include a self-monitoring log for weight and other health measures. Handouts on topics such as stress management are also available. In addition, there are several wellness stations where patients can self-monitor their weight and other health measures and where there is easy access to a variety of patient educational materials.

In some communities, peer services may be available; practitioners can check with organizations such as the Division of Mental Health Services for a listing of peer-run services.

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Also in this Special Report

Introduction: Patient Education as Treatment Foundation

Podcast: Current Trends in Patient Education

Educating Patients About Bipolar Disorders

Chronic Disease Self-Management Programs in Psychiatry

Peer Specialists as Educators for Recovery-Based Systems Transformation

An Evidence-Based Practice of Psychoeducation for 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.


 
TOPIC INDEX

Addiction Medicine
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Health Care Reform
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