Efficacy of a Psychoeducational Programme for the Social Adjustment of Psychiatric Patients

TLDR: These observations reinforce the hypothesis that a cognitive-behavioural programme changes family dynamics in favour of patients with severe psychiatric disturbances, especially for their adjustment in the family and community.

Abstract: Objectives: To study the effectiveness of a family psychoeducational programme for social adjustment of individuals with schizophrenia and mood disorders and to determine whether the intervention had an impact on the family dynamics and caregivers' knowledge and experiences. Patients and Methods: Using Solomon's experimental design, 170 patients with schizophrenia and 174 patients with the diagnosis of mood disorders were assigned to 2 experimental and 2 control groups. Family members from the experimental groups participated in a weekly educational programme for 6 months. Tests were used to determine and compare family characteristics and social adjustment of patients at baseline and after 6 and 18 months. Results: More attitudinal, cognitive, and behavioural changes among families and enhanced performance abilities were observed among patients from the experimental groups. Conclusions: These observations reinforce the hypothesis that a cognitive-behavioural programme changes family dynamics in favour of patients with severe psychiatric disturbances, especially for their adjustment in the family and community. Key words: Family, Mood disorders, Schizophrenia, Social adjustment Introduction The presence of a mentally ill patient in the home imposes several limitations on the family such as social burden, financial strain, and psychological stress. (1-5) The family dynamics may be affected, and tolerance of the patient may be reduced. Several studies have focused on families' responses to mental illness and living with a mentally ill family member, resulting in several promising clinical approaches. (6-16) Liberman and Corrigan introduced techniques for interpersonal problem solving therapy for the better social adjustment of people with schizophrenia. (17) It has been observed that relapse rates of mentally ill patients after discharge are significantly lower for those patients whose families were exposed to behavioural interventions than for those who received routine treatment. (18) Similarly, family therapy and group therapy techniques have reduced the levels of overinvolvement, hostility, and criticism in the family, reducing relapse rates. (19) Some authors have claimed that family intervention can help to reduce patients' negative and positive symptoms. (20) In addition, improvement of family communication has been associated with desirable changes in patients' interpersonal functioning. (21) Family education and family therapy have a promising role in minimising the relapse rates of mentally ill patients. (22,23) An evaluation of a family psychoeducation programme by de Groot et al has determined the positive role of family intervention in increasing people's knowledge and understanding of mental health services in the community. (24) Family intervention for dual disorders not only improved the course of the illness for patients with psychiatric disorders and substance abuse but also promoted collaboration between their families and professionals. (25) Montero et al compared the impact of 2 family intervention strategies on families of patients with schizophrenia in a Mediterranean environment, which yielded equally significant results for the outcome of the illness. (26) An attempt has been made by Pollio et al to bring together mentally ill people and their family members with the intention of sharing their experiences and ameliorating their problems. (27) Participants in this programme expressed satisfaction with learning different coping strategies and problem-solving skills. Cassidy et al predicted fewer days of hospitalisation for patients with schizophrenia whose relatives attended a family psychoeducation programme, as well as significant attitudinal and cognitive changes in their families and improved knowledge about their medication. (28) Hospital staff who underwent a training course on cognitive behavioural family intervention knew more about family dynamics and demonstrated more regular inclusion of family members in their routine clinical practice after training. …