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Gender differences in patient and caregiver psychoeducation for schizophrenia
- T. Reichhart, G. Pitschel-Walz, W. Kissling, J. Bäuml, T. Schuster, C. Rummel-Kluge
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- Journal:
- European Psychiatry / Volume 25 / Issue 1 / January 2010
- Published online by Cambridge University Press:
- 16 April 2020, pp. 39-46
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Objective:
The aim of this research is to detect gender-related differences in patients and caregivers regarding knowledge about schizophrenia and attitudes towards drugs as well as gender as predictor for changes in these variables during psychoeducation.
Methods:Data sets of one randomised-controlled (study 1) and one naturalistic psychoeducation study (study 2) were reanalysed. Main outcome measures (knowledge about schizophrenia, drug attitude, confidence in medication) were assessed at baseline, post-intervention and 12 months after index discharge.
Results:The reanalysed samples consisted in total of 1002 patients and 176 caregivers. In study 2, baseline knowledge was significantly better in male patients and female caregivers. All participants improved significantly their knowledge. The amount of knowledge gain did not differ between genders in either study or either group. Gender was not a major predictor of baseline knowledge or knowledge gain. Only in study 1 did gender significantly impact the knowledge gain from baseline to follow-up. Regarding improvement of drug attitude, females seemed to benefit significantly better from psychoeducation. In both studies, however, changes in drug attitudes respectively confidence in medication were best explained by lower corresponding baseline scores, not gender. Patients’ gender did not influence outcomes of their caregivers.
Conclusion:Our findings suggest that psychoeducational programs might be better adapted to males in order to improve their drug attitude. Concerning knowledge, gender-related changes do not seem to be necessary.
S50.04 - Caregivers in the process of treatment management
- J. Bäuml, G. Pitschel-Walz
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- Journal:
- European Psychiatry / Volume 23 / Issue S2 / April 2008
- Published online by Cambridge University Press:
- 16 April 2020, pp. S72-S73
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Sixty years ago, the concept of custodial inpatient treatment began to gradually change into that of an activating outpatient concept. Through this process, the number of in-patient beds today in all psychiatric hospitals in the western part of the world has been reduced to 10-20% of those at the beginning of the 20th century. Though outpatient services had expanded to a high degree, the main burden of the psychosocial treatment still fell upon relatives. Most of these nursing families were poorly informed regarding their new duties. Thus many families were overstrained and not able to fulfill their function as "co-therapists". Because of the prevalence of overstrained families with dysfunctional behaviour, the EE-concept was developed in the sixties (Brown et al 1964). With the introduction of family therapy and the emergence of self help groups for relatives, families obtained substantial support. Through family therapeutic interventions, relatives were systematically integrated into long term rehabilitation concepts. In this way, the stigma of the "HEE"- relatives was changed (Bebbington et al 1994; Schulze-Mönking 1994; Möller-Leimkühler 2008). In the meantime, the engagement of family members can be viewed as an important resource and not merely as a stress factor which is to be reduced (Pitschel-Walz, Bäuml et al 2001). According to the therapeutic guidelines it is now part of standard therapy to integrate relatives already in the beginning of the treatment. In this context, psychoeducation is a very effective measure to inform family members of the background of the illness and the most important treatment elements. During the course of time, many concepts have been developed, particularly concerning schizophrenic psychosis, to train relatives and their patients to have better communication with less stress and more helpful interactions. Through the establishment of a worldwide network, relatives are encouraged to use their knowhow not only alone at home but also in their interaction with professionals and politicians to improve the living conditions of their patients. In this lecture, the historical background and actual findings concerning the empowerment of the relatives will be presented.
Neurocognitive prediction of illness knowledge after psychoeducation in schizophrenia: results from the Munich COGPIP study
- T. Jahn, G. Pitschel-Walz, A. Gsottschneider, T. Froböse, S. Kraemer, J. Bäuml
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- Journal:
- Psychological Medicine / Volume 41 / Issue 3 / March 2011
- Published online by Cambridge University Press:
- 19 May 2010, pp. 533-544
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Background
Many patients with schizophrenia exhibit neurocognitive impairments, namely, in attentional, mnestic and executive functions. While these deficits limit psychosocial rehabilitation, their effect on psychoeducation is unknown. Within the framework of the longitudinal Munich Cognitive Determinants of Psychoeducation and Information in Schizophrenic Psychoses (COGPIP) study, we examined: (a) whether illness knowledge after psychoeducation could be predicted more precisely from the neurocognitive than from the psychopathological status of the patients; (b) which neurocognitive domains are best predictors.
MethodA total of 116 in-patients with schizophrenic or schizoaffective disorders were randomized to a neurocognitive training or control condition (2 weeks) followed by a manualized psychoeducational group programme (4 weeks) and then observed over a 9-month follow-up. Repeated measurements included – among others – the Positive and Negative Syndrome Scale and a comprehensive neuropsychological test battery from which normative T scores were used to calculate one global and five domain-specific neurocognitive composite scores. Illness knowledge was measured by a questionnaire (WFB-52) tailored to the psychoeducational programme.
ResultsMultiple linear regression analyses showed that, apart from baseline illness knowledge, neurocognition significantly predicted knowledge outcome as well as knowledge gain (measured by reliable change indices) after psychoeducation. This was not true for psychopathology. Among the domain-specific neurocognitive composite scores, only memory acquisition was a significant predictor of knowledge outcome and gain.
ConclusionsNeurocognition, not psychopathology, is a significant predictor of illness knowledge after psychoeducation in schizophrenia. This finding should guide efforts to tailor psychoeducational interventions more closely to the patient's needs and resources.