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The effectiveness of psychoeducational family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area

Published online by Cambridge University Press:  17 February 2015

M.-S. Ran ,
C. L.-W. Chan ,
S.-M. Ng ,
L.-T. Guo  and
M.-Z. Xiang
M.-S. Ran*
Affiliation:
Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Hong Kong, China
C. L.-W. Chan
Affiliation:
Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Hong Kong, China
S.-M. Ng
Affiliation:
Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Hong Kong, China
L.-T. Guo
Affiliation:
Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
M.-Z. Xiang
Affiliation:
Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
*
* Address for correspondence: M.-S. Ran, M.Med., Ph.D., Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Hong Kong, China. (Email: [email protected])
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Abstract

Background

It is unclear if the impact of psychoeducational family intervention for patients with schizophrenia can be sustained over 10 years. In this study, we explored the 14-year effect of psychoeducational family intervention for patients with schizophrenia in a Chinese rural area.

Method

The data from a cluster randomized control trial (CRCT) study of psychoeducational family intervention in a 14-year follow-up was analyzed. All patients with schizophrenia (n = 326) who participated in the CRCT drawn from six townships in Xinjin County of Chengdu in 1994, of whom 238 (73.0%) who were still alive, and their informants were followed up in 2008. The Patients Follow-up Scale, the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning were used in the follow-up study.

Results

There were no significant differences of marital status, mean scores of PANSS positive symptoms, negative symptoms, general mental health, and total scores among the psychoeducational family intervention, medication, and control groups in 2008. The psychoeducational family intervention group had a significantly higher rate of antipsychotic medication and a higher level of work ability than other two groups. The control group had a significantly higher rate of never-treated (26.0%) than psychoeducational family intervention group (6.5%).

Conclusion

Psychoeducational family intervention might be still effective in the 14-year follow-up, especially in patients’ treatment adherence/compliance and social functioning. Psychoeducational family intervention might be more effective in places where family members frequently participated in patients’ care and had a lower level of knowledge on mental illness. Family intervention should be considered when making mental health policy and planning mental health services.

Keywords

Chinaeffectivenesslong-term follow-uppsychoeducational family interventionschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 10 , July 2015 , pp. 2197 - 2204
Copyright
Copyright © Cambridge University Press 2015 

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References

Alem, A, Kebede, D, Fekadu, A, Shibre, T, Fakadu, D, Beyero, T, Medhin, G, Negash, A, Kullgren, G (2009). Clinical course and outcome of schizophrenia in a predominantly treatment–naive cohort in rural Ethiopia. Schizophrenia Bulletin 35, 646–654.CrossRefGoogle Scholar
APA (2000). Diagnostic Criteria from DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
APA (2004). Guidelines for Treatment of Schizophrenia. American Psychiatric Association: Washington, DC.Google Scholar
Barkhof, E, Meijer, CJ, de Sonneville, LMJ, Linszen, DH, de Haan, L (2012). Interventions to improve adherence to antipsychotic medication in patients with schizophrenia – a review of the past decade. European Psychiatry 27, 9–18.Google Scholar
Bäuml, J, Pitschel-Walz, G, Volz, A, Engel, RR, Kissling, W (2007). Psychoeducation in schizophrenia: rehospitalisation and hospital days: 7-year follow-up of the Munich Psychosis Information Project Study. Journal of Clinical Psychiatry 68, 854–861.CrossRefGoogle Scholar
Buchkremer, G, Klingerberg, S, Holle, R, Moenking, HS, Hornung, WP (1997). Psychoeducational psychotherapy for schizophrenic patients and their key relatives or care givers: results of a 2-year follow-up. Acta Psychiatrica Scandinavica 96, 483–491.Google Scholar
Dixon, L, Adams, C, Lucksted, A (2000). Update on family psychoeducation for schizophrenia. Schizophrenia Bulletin 26, 5–20.Google Scholar
Dossenbach, M, Arango-Davila, C, Silva Ibarra, H, Landa, E, Aguilar, J, Caro, O, Leadbetter, J, Assuncao, S (2005). Response and relapse in patients with schizophrenia treated with olanzapine, risperidone, quetiapine, or haloperidol: 12-month follow-up of the Intercontinental Schizophrenia Outpatient Health Outcomes (ICSOHO) study. Journal of Clinical Psychiatry 66, 1021–1030.Google Scholar
Falloon, IR, Boyd, JL, McGill, CW, Williamson, M, Razani, J, Moss, HB, Gilderman, AM (1982). Family management in the prevention of exacerbations of schizophrenia: a controlled study. New England Journal of Medicine 306, 1437–1440.CrossRefGoogle ScholarPubMed
Falloon, IR, Boyd, JL, McGill, CW, Williamson, M, Razani, J, Moss, HB, Gilderman, AM, Simpson, GM (1985). Family management in the prevention of morbidity of schizophrenia. Clinical outcome of a two-year longitudinal study. Archives of General Psychiatry 42, 887–896.Google Scholar
Fiorillo, A, Bassi, M, de Girolamo, G, Catapano, F, Romeo, F (2010). The impact of a psychoeducational intervention on family members’ views about schizophrenia: results from the OASIS Italian multi-centre study. International Journal of Social Psychiatry 57, 596–603.Google Scholar
Hogarty, GE, Anderson, CM, Reiss, DJ, Kornblith, SJ, Greenwald, DP, Ulrich, RF, Carter, M (1991). Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. II. Two-year effects of a controlled study on relapse and adjustment. Archives of General Psychiatry 48, 340–347.Google Scholar
Hornung, WP, Feldmann, R, Klingberg, S, Buchkremer, G, Reker, T (1999). Long-term effects of a psychoeducational psychotherapeutic intervention for schizophrenic outpatients and their key-persons-results of a five-year follow-up. European Archives of Psychiatry and Clinical Neuroscience 249, 162–167.Google Scholar
Kuipers, E, Yesufu-Udechuku, A, Taylor, C, Kendall, T (2014). Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. British Medical Journal 348, g1173.Google Scholar
Law, SF, Liu, P, Hodges, BD, Shera, W, Huang, X, Zaheer, J, Links, PS (2011). Introducing psychiatry to rural physicians in China: an innovative education project. American Journal of Psychiatry 168, 1249–1254.CrossRefGoogle Scholar
Li, Z, Arthur, D (2005). Family education for people with schizophrenia in Beijing, China: randomized controlled trial. British Journal of Psychiatry 187, 339–345.Google Scholar
Lincoln, TM, Wilhelm, K, Nestoriuc, Y (2007). Effectiveness of psychoeducation for relapse, symptoms, knowledge, adherence and functioning in psychotic disorders: a meta analysis. Schizophrenia Research 96, 232–245.Google Scholar
Mari, JJ, Streiner, DL (1994). An overview of family interventions and relapse on schizophrenia: meta-analysis of research findings. Psychological Medicine 24, 565–578.Google Scholar
McFarlane, WR, Link, B, Dushay, R, Marchal, J, Crilly, J (1995). Psychoeducational multiple family groups: four-year relapse outcome in schizophrenia. Family Process 34, 127–144.Google Scholar
McWilliams, S, Hill, S, Mannion, N, Fetherston, A, Kinsella, A, O'Callaghan, E (2012). Schizophrenia: a five-year follow-up of patient outcome following psycho-education for caregivers. European Psychiatry 27, 56–61.CrossRefGoogle ScholarPubMed
Montero, I, Asencio, A, Hernandez, I, Masanet, MJ, Lacruz, M, Bellver, F, Iborra, M, Ruiz, I (2001). Two strategies for family intervention in schizophrenia: a randomized trial in a Mediterranean environment. Schizophrenia Bulletin 27, 661–670.Google Scholar
Montero, I, Masanet, MJ, Bellver, F, Lacruz, M (2006). The long-term outcome of 2 family intervention strategies in schizophrenia. Comprehensive Psychiatry 47, 362–367.Google Scholar
Patterson, TL, Leeuwenkamp, OR (2008). Adjunctive psychosocial therapies for the treatment of schizophrenia. Schizophrenia Research 100, 108–119.Google Scholar
Pekkala, ET, Merinder, LB (2002). Psychoeducation for Schizophrenia (Cochrane Review). The Cochrane Library, Art. no. CD002831. Issue 2. doi:10.1002/14651858. John Wiley and Sons, Ltd.Google Scholar
Penn, DL, Mueser, KT (1996). Research update on the psychosocial treatment of schizophrenia. American Journal of Psychiatry 153, 607–617.Google Scholar
Pfammatter, M, Junghan, UM, Brenner, HD (2006). Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophrenia Bulletin 32, S64–S80.Google Scholar
Pitschel-Walz, G, Bäuml, J, Bender, W, Engel, RR, Wagner, M, Kissling, W (2006). Psychoeducation and compliance in the treatment of schizophrenia: results of the Munich Psychosis Information Project Study. Journal of Clinical Psychiatry 67, 443–452.CrossRefGoogle ScholarPubMed
Ran, MS, Chan, CLW, Chen, EYH, Mao, WJ, Hu, SH, Tang, CP, Lin, FR, Conwell, Y (2009). Differences in mortality and suicidal behaviour between treated and never-treated persons with schizophrenia in rural China. British Journal of Psychiatry 195, 126–131.Google Scholar
Ran, MS, Chen, SY, Chen, EY, Ran, BY, Tang, CP, Lin, FR, Li, L, Li, SG, Mao, WJ, Hu, SH (2011). Risk factors for poor work functioning of persons with schizophrenia in rural China. Social Psychiatry and Psychiatric Epidemiology 46, 1087–1093.CrossRefGoogle ScholarPubMed
Ran, MS, Xiang, MZ (1995). A study of schizophrenia patients’ treatment compliance in a rural community. Journal of Mental Health 1, 85–89.Google Scholar
Ran, MS, Xiang, MZ, Chan, CLW, Leff, J, Simpson, P, Huang, MS, Shan, YH, Li, SG (2003 a). Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia: a randomised controlled trial. Social Psychiatry and Psychiatric Epidemiology 38, 69–75.Google Scholar
Ran, MS, Xiang, MZ, Huang, MS, Shan, YH (2001). Natural course of schizophrenia: two-year follow-up study in a rural Chinese community. British Journal of Psychiatry 178, 154–158.Google Scholar
Ran, MS, Xiang, MZ, Li, SX, Shan, YH, Huang, MS, Li, SG, Liu, ZR, Chen, EYH, Chan, CLW (2003 b). Prevalence and outcome of schizophrenia in a Chinese rural area: an epidemiological study. Australian and New Zealand Journal of Psychiatry 37, 452–457.Google Scholar
Ran, MS, Xiang, MZ, Simpson, P, Chan, CLW (2005). Family-Based Mental Health Care in Rural China. Hong Kong University Press: Hong Kong.Google Scholar
Robinson, D, Woerner, MG, Alvir, JM, Bilder, R, Goldman, R, Geisler, S, Koreen, A, Sheitman, B, Chakos, M, Mayerhoff, D, Lieberman, JA (1999). Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Archives of General Psychiatry 56, 241–247.Google Scholar
Rummer-Kluge, C, Pitschel-Walz, G, Bäuml, J, Kissling, W (2006). Psychoeducation in schizophrenia–results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland. Schizophrenia Bulletin 32, 765–775.Google Scholar
Si, TM, Yang, JZ, Shu, L, Wang, XL, Kong, QM, Zhou, M, Li, XN, Liu, C (2004). The reliability, validity of PANSS and its implication. Chinese Mental Health Journal 18, 45–47.Google Scholar
Swartz, MS, Perkins, DO, Stroup, TS, Davis, SM, Capuano, G, Rosenheck, RA, Reimherr, F, McGee, MF, Keefe, RS, McEvoy, JP, Hsiao, JK, Lieberman, JA (2007). Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study. American Journal of Psychiatry 164, 428–436.Google Scholar
Tarrier, N, Barrowclough, C, Porceddu, K, Fitzpatrick, E (1994). The Salford Family Intervention Project: relapse rates of schizophrenia at five and eight years. British Journal of Psychiatry 165, 829–832.Google Scholar
Tarrier, N, Barrowclough, C, Vaughn, C, Bamrah, JS, Porceddu, K, Watts, S, Freeman, H (1989). Community management of schizophrenia: a two-year follow-up of a behavioural intervention with families. British Journal of Psychiatry 154, 625–628.Google Scholar
Wing, JK, Cooper, JE, Sartorius, N (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: New York.Google Scholar
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO: Geneva.Google Scholar
WHO (2001). Impact of disorders (http://www.who.int/whr/2001/chapter2/en/index3.html).Google Scholar
WHO (2013). Mental health: schizophrenia (www.who.int/mental_health/management/schizophrenia/en/).Google Scholar
Xiang, MZ, Ran, MS, Li, SG (1994). A controlled evaluation of psychoeducational family intervention in a rural Chinese community. British Journal of Psychiatry 165, 544–548.CrossRefGoogle Scholar
Zhang, M, Wang, M, Li, J, Phillips, MR (1994). Randomised-control trial of family intervention for 78 first-episode male schizophrenic patients: an 18-month study in Suzhou, Jiangsu. British Journal of Psychiatry 24 (Suppl.), 96–102.Google Scholar