Family education improves outcomes for schizophrenia patients

A study conducted in China highlights the importance of educating families about schizophrenia and its treatment in order to improve functioning and symptoms among affected family members.

"The pressure on families to care for their ill relatives is high in China, and these results offer encouraging clinical tools for development in rural communities as well as institutions," say Zheng Li (Peking Union Medical College, Beijing) and David Arthur (Hong Kong Polytechnic University, Kowloon).

Noting that many of the existing services for schizophrenia in China focus on hospitals, the researchers explored the benefit of an education program offered by nurses, which teaches patients and their families about schizophrenia and its treatment along with the skills needed to help them cope effectively with the condition.

They tested the benefit of such a program in 101 patients with schizophrenia and their families, of whom 55 received standard treatment and care, while 46 received standard care and family education.

Data were collected at admission, discharge, and again 3 and 9 months after the patients had left hospital.

The education program proved effective at improving the knowledge of the patients and their families.

Moreover, 3 months after discharge, average scores on the Brief Psychiatric Rating Scale were significantly lower among the patients assigned to the education program than among controls, at 22.8 versus 23.8 points.

These improvements were sustained at 9 months, at which time thinking disturbance, hostile-suspicious symptoms, and overall symptoms in the intervention group were significantly lower than for those in the control group.

Psychosocial functioning improved in both groups of patients, but for those in the intervention group, overall functioning continued to improve, and at 9 months after discharge there was a significant difference in Global Assessment Scale scores between the two groups.

In all, 16% of patients in the intervention group relapsed 9 months after discharge, compared with 37% of controls, but this difference was not statistically significant.

"Family education on schizophrenia by nurses in China was effective in... promoting improvement in patients' symptoms," Li and Arthur write in the British Journal of Psychiatry.

"As nursing expands in quantity and with expanded roles, this intervention offers a culturally valid treatment and offers challenges for future implementation across the country."

Br J Psychiatry 2005; 187: 339-345