Cochrane Database of Systematic Reviews

Psychoeducation for schizophrenia (Review)

Xia J, Merinder LB, Belgamwar MR

Xia J, Merinder LB, Belgamwar MR.

Psychoeducation for schizophrenia.
Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD002831.
DOI: 10.1002/14651858.CD002831.pub2.

www.cochranelibrary.com

Psychoeducation for schizophrenia (Review)

Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Review]

Psychoeducation for schizophrenia

Jun Xia1 , Lars Bertil Merinder2 , Madhvi R Belgamwar3

1 Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK. 2 Dept of Psychiatric Demography, Institute of
Basic Psychiatric Research, University Hospital of Aarhus, Risskov, Denmark. 3 Radbourne Unit, Royal Derby Hospital, Derby, UK

Contact address: Jun Xia, Cochrane Schizophrenia Group, The University of Nottingham, Institute of Mental Health, Sir Colin Camp-
bell Building„ University of Nottingham Innovation Park, Triumph Road„ Nottingham, NG7 2TU, UK. Jun.Xia@nottingham.ac.uk.

Editorial group: Cochrane Schizophrenia Group.

Publication status and date: Edited (no change to conclusions), published in Issue 1, 2013.
Review content assessed as up-to-date: 19 April 2010.

Citation: Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database of Systematic Reviews 2011,
Issue 6. Art. No.: CD002831. DOI: 10.1002/14651858.CD002831.pub2.

Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT
Background
Schizophrenia can be a severe and chronic illness characterised by lack of insight and poor compliance with treatment. Psychoeducational
approaches have been developed to increase patients’ knowledge of, and insight into, their illness and its treatment. It is supposed that
this increased knowledge and insight will enable people with schizophrenia to cope in a more effective way with their illness, thereby
improving prognosis.
Objectives
To assess the effects of psychoeducational interventions compared with standard levels of knowledge provision.
Search methods
We searched the Cochrane Schizophrenia Group Trials Register (February 2010).
We updated this search November 2012 and added 27 new trials to the awaiting assessment section.
Selection criteria
All relevant randomised controlled trials focusing on psychoeducation for schizophrenia and/or related serious mental illnesses involving
individuals or groups. We excluded quasi-randomised trials.
Data collection and analysis
At least two review authors extracted data independently from included papers. We contacted authors of trials for additional and
missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data. We used a fixed-
effects model for heterogeneous dichotomous data. Where possible we also calculated the numbers needed to treat (NNT), as well as
weighted means for continuous data.
Main results
This review includes a total of 5142 participants (mostly inpatients) from 44 trials conducted between 1988 and 2009 (median study
duration ~ 12 weeks, risk of bias - moderate). We found that incidences of non-compliance were lower in the psychoeducation group
in the short term (n = 1400, RR 0.52 CI 0.40 to 0.67, NNT 11 CI 9 to 16). This finding holds for the medium and long term.
Relapse appeared to be lower in psychoeducation group (n = 1214, RR 0.70 CI 0.61 to 0.81, NNT 9 CI 7 to 14) and this also
Psychoeducation for schizophrenia (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
applied to readmission (n = 206, RR 0.71 CI 0.56 to 0.89, NNT 5 CI 4 to 13). Scale-derived data also suggested that psychoeducation
promotes better social and global functioning. In the medium term, treating four people with schizophrenia with psychoeducation
instead of standard care resulted in one additional person showing a clinical improvement. Evidence suggests that participants receiving
psychoeducation are more likely to be satisfied with mental health services (n = 236, RR 0.24 CI 0.12 to 0.50, NNT 5 CI 5 to 8) and
have improved quality of life.
Authors’ conclusions
Psychoeducation does seem to reduce relapse, readmission and encourage medication compliance, as well as reduce the length of hospital
stay in these hospital-based studies of limited quality. The true size of effect is likely to be less than demonstrated in this review - but,
nevertheless, some sort of psychoeducation could be clinically effective and potentially cost beneficial. It is not difficult to justify better,
more applicable, research in this area aimed at fully investigating the effects of this promising approach.
Note: the 27 new citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.

PLAIN LANGUAGE SUMMARY

Psychoeducation added to standard treatment for schizophrenia reduces relapse
The purpose of patient education/teaching (or psychoeducation) is to increase patients’ knowledge and understanding of their illness
and treatment. It is supposed that increased knowledge enables people with schizophrenia to cope more effectively with their illness.
Psychoeducational interventions involve interaction between the information provider and the mentally ill person. This review compares
the efficacy of psychoeducation added to standard care as a means of helping severely mentally ill people with that of standard care alone.
The evidence shows a significant reduction of relapse or readmission rates. There seems to be some suggestion that psychoeducation
may improve compliance with medication, but the extent of improvement remains unclear. The findings show a possibility that
psychoeducation has a positive effect on a person’s well being and promotes better social function. In the medium term, treating
four people with schizophrenia with psychoeducation instead of standard care resulted in one additional person showing a clinical
improvement. The scarcity of studies made the comparison between the efficacy of different formats (programmes of 10 sessions or
less or 11 or more, individual or group sessions) weak.

Psychoeducation for schizophrenia (Review)

Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.