Gender differences in patient and caregiver psychoeducation for schizophrenia

Initial attitudes toward a drug predict medication adherence in first-episode patients with schizophrenia: a 1-year prospective study in China

BACKGROUND

Patients' attitudes toward medication have been shown to be a predictor of nonadherence to antipsychotic treatment. However, most previous studies that explored this relationship used a cross-sectional design. It is important to explore the association of attitudes toward drugs with discontinuation at different time points during antipsychotic treatment. In this study, we investigated the association of attitudes toward drugs (measured by the Drug Attitude Inventory (DAI-10)) with adherence at seven time points (baseline, 4 weeks, 8 weeks, 12 weeks, 26 weeks, 39 weeks, and 52 weeks) during 1 year of treatment. Factors that were potentially associated with attitudes toward drugs at the time point of interest were also studied.

METHODS

Demographic characteristics, psychopathology, social functioning, and attitudes toward drugs (measured by the DAI-10) were collected at baseline, 4 weeks, 8 weeks, 12 weeks, 26 weeks, 39 weeks and 52 weeks. The association of attitudes toward drugs (measured by DAI-10) with adherence at the seven time points was calculated using the Mann‒Whitney U test. The optimal cutoff point for the DAI-10 was then determined using receiver operating characteristic (ROC) analysis. Cox regression analysis was conducted to further investigate the association of DAI-10 scores with discontinuation, controlling for potential confounding variables. We used multiple regression analysis to identify the factors associated with DAI-10 scores.

RESULTS

Among the six time points, only baseline DAI-10 total scores were significantly different between the completed and discontinued groups (p = 0.004). Female sex and a baseline DAI-10 total score greater than - 1 were found to be independent protective factors against discontinuation of antipsychotic drug treatments during the 1-year follow-up. At baseline, the severity of the disease (CGI-s) and insight regarding the disease were shown to be associated with DAI-10 total scores.

CONCLUSION

Attitudes toward antipsychotic drugs at baseline were shown to play a crucial role in predicting treatment discontinuation.

TRIAL REGISTRATION

The data were collected from a clinical trial and the clinical trials.gov ID of the study is NCT01057849.

Psychoeducational groups for close relatives of patients with borderline personality disorder

Psychoeducational groups for family members of patients with schizophrenia have proven to be effective. Borderline personality disorder (BPD) implies serious impairment in interpersonal relationships. Close relatives of individuals with BPD also show high levels of burden and need support. Psychoeducational groups could help to cope with the interactional problems in a relationship with a person with BPD. A manualised psychoeducational programme of 10 group sessions for close relatives of patients with BPD was tested. Measures administered at pretest and after 10 sessions were: perceived burden (IEQ-EU), knowledge about the disorder (WFB_BPS-A) and quality of life (WHOQOL-BREF). For formative evaluation, a "Group Therapy Session Questionnaire" (participant and therapist version; GTS-A, GTS-T) was used. A total of 33 persons in three groups took part. Pre-post evaluations revealed a significantly lower level of burden and a significantly better knowledge about the disorder after participating in the psychoeducational group. Reduction of burden correlated significantly with the assessment of patients' symptom severity and carers' level of burden at study entry. There was no change in the quality of life. The participants and therapists generally rated the psychoeducational sessions very positively. The highest ratings were found in the sessions about communication skills and coping with crises. Findings indicate that the psychoeducational programme is well accepted and supportive for persons with close relationships to patients with BPD.

Patients' Knowledge about Prescribed Antipsychotics and Medication Adherence in Schizophrenia: A Cross-Sectional Survey

Introduction Data on the knowledge about antipsychotic medications prescribed in patients with schizophrenia are very limited. Moreover, it remains unclear how patients' knowledge about prescribed antipsychotics affects medication adherence. Methods ighty-one Japanese outpatients with schizophrenia according to the International Classification of Diseases, 10th edition, were included. Patients' knowledge of the primary antipsychotics prescribed to them in terms of therapeutic effects, type, and implicated neurotransmitters was assessed with a multiple-choice questionnaire developed for this study. Medication possession ratios (MPRs) were compared between patients who answered correctly and those who did not in each category. Results The percentages of subjects who answered correctly regarding antipsychotic effects, type, and implicated neurotransmitters were low at 30.9%, 30.9%, and 7.4%, respectively. No differences were found in MPRs between subjects who answered correctly and those who did not. Discussion Our preliminary results indicate that patients lack knowledge about their antipsychotic medications. More concerning, they suggest that knowledge about prescribed antipsychotics may not directly translate into actual medication adherence in patients with schizophrenia.

Gender differences in attitudes towards antipsychotic medications in patients with schizophrenia

Non-adherence was more frequent in male than in female psychiatric patients. This multi-center study in China examined the gender difference with regard to attitude towards antipsychotic medications and its associations with socio-demographic variables, insight, and psychopathology. Patients' basic socio-demographic and clinical data were collected. Psychopathology and insight were measured with the Symptom Checklist-90 (SCL-90) and the Insight and Treatment Attitudes Questionnaire (ITAQ), respectively. Their attitudes towards antipsychotic medications were assessed by two standardized questions. Nearly 39.6% (109/275) males and 31.1% (70/225) females reported negative attitudes towards antipsychotic medications. Binary logistic regression revealed that in males single marital status (OR=2.9, 95% CI=1.3-6.4), rural residence (OR=0.4, 95% CI=0.2-0.7), longer duration of schizophrenia (OR=1.0, 95% CI=1.0-1.1), knowledge of medication (OR=1.5, 95% CI=1.3-1.6) and the SCL-90 hostility subscale (OR=0.9, 95% CI=0.9-1.0) were contributors to negative attitudes. In female patients, knowledge about medications (OR=1.4, 95% CI=1.3-1.6), the SCL-90 somatization (OR=0.8, 95% CI=0.8-0.9) and anxiety (OR=1.1, 95% CI=1.0-1.2) subscales were contributors to negative attitudes. The study suggested that different psychosocial and clinical factors accounted for the negative attitude towards antipsychotic treatment in male and female patients.

Impact of Psychoeducation on Knowledge of and Attitude Toward Medications in Clients With Schizophrenia and Schizoaffective Disorders

PURPOSE

To examine a psychoeducational intervention's effects on knowledge and attitudes toward antipsychotic medication in clients with schizophrenia and schizoaffective disorders.

DESIGNS AND METHODS

A one-group pretest-posttest design was employed. A convenience sample (61 psychiatric clients aged 20 or above) was recruited from a Korean mental health center.

FINDINGS

At baseline, participants had limited knowledge (M = 50.89, range: 27-77, SD = 12.05) of and negative feelings toward antipsychotic medications (M = -.89, range: -8 to 8, SD = 4.27). Both measures significantly improved post-intervention.

PRACTICE IMPLICATIONS

A psychoeducational intervention improved clients' knowledge of and attitudes toward antipsychotic medications.

Carer psychoeducation in first-episode psychosis: evaluation outcomes from a structured group programme

BACKGROUND

Carers play an important role in supporting client adjustment and relapse prevention following a first psychotic episode. The caring experience however is a stressful and demanding one, and carers require support to develop coping strategies and sustain themselves in their role.

AIMS

To evaluate a psychoeducation programme provided within a public adult mental health service, designed for the families of clients experiencing first-episode psychosis.

METHODS

A pre- and post-test questionnaire was administered to quantitatively measure the participants' changes in perceptions of their knowledge and understanding regarding mental illness and its treatment through attending the group. Qualitative items were included to ascertain other knowledge gained or benefits perceived and any critical feedback.

RESULTS

The programme significantly improved carers' perceptions of their understanding of psychosis, recovery and relapse prevention. Additional feedback replicated previous findings that participants value support and feel less isolated through group attendance, gaining a sense of collective experience and the opportunity to share experiences and feel heard by peers.

CONCLUSIONS

The evaluation demonstrates the efficacy of such a group and the importance of public mental health services in providing family interventions in first-episode psychosis care.

Caregiver burden in chronic mental illness: the role of patient and caregiver characteristics

The aim of the present study is to identify the relative contribution of patient and caregiver characteristics in a sample of primary carers of patients with chronic mental disorders living in the community. As carers were recruited from caregiver organizations, mainly mothers of an adult child suffering from schizophrenia participated in the study (n = 102). Within a comprehensive transactional stress model, burden was assessed with respect to objective and subjective burden, cognitive-emotional well-being, psychological distress and subjective quality of life. Primary stressors include illness-related characteristics of the patient, and a number of personal dispositions and resources of the caregivers were included as potential moderating variables. Multiple regression analyses were separately calculated for each dimension of burden. Interaction of carers' expressed emotion and external locus of control with the patient's problem with family communication as well as perceived social support was most predictive for objective and subjective burden, whereas carers' neuroticism appeared as the most relevant predictor of their well-being, psychological distress and subjective quality of life. Among the patients' variables, regular employment contributed significantly to reduce carers' distress and enhance their well-being. As the sample was recruited from caregiver organizations, a selection bias has to be taken into account. To reduce caregiver burden, especially mothers' burden, the patients' occupational abilities should be strongly enhanced at an early stage. Family interventions should improve dysfunctional interactions, enhance the carers' social activities and focus more intensely on the carers' own dispositions.

Psychoeducation for patients with a psychotic disorder: effects on knowledge and coping

OBJECTIVE

Psychoeducation is an essential and promising element in the nonpharmacologic treatment of patients with a psychotic disorder. This study examined the effects of patient-directed psychoeducation on knowledge and coping.

METHOD

This study included 99 primary care patients with a psychotic disorder according to DSM-IV-TR criteria who completed a knowledge questionnaire before and a knowledge and coping questionnaire halfway through, immediately after, and 6 months after a 20-session group psychoeducation program. The first time the program was given was between April and October 2007, and the final time the program was given was between October 2009 and April 2010. Results were analyzed with multilevel analysis.

RESULTS

Knowledge increased significantly from the beginning of the program to halfway through the program (P < .001), even after correction for baseline scores, but not any further thereafter. Coping improved from halfway through the program to the end of the program (P = .02), also after correction for baseline scores, but not thereafter. Only at 6 months after the program was knowledge related to coping (P = .01). There were no differences in knowledge and coping between male and female patients. Halfway through (P = .001) and at the end of the program (P = .02), the increase in knowledge was significantly lower for patients taking atypical antipsychotic medication than for patients taking typical antipsychotic medication.

CONCLUSIONS

In patients with a psychotic disorder, psychoeducation results in more knowledge immediately and several months after the program and contributes to better coping only immediately after the program. Patients with more knowledge several months after psychoeducation may also be patients who then cope better with the disorder.