Psychoeducaton For Psychotic Disorders Found To Have No Effect On Medication Adherence
Effectiveness of psychoeducation for relapse, symptoms, knowledge, adherence and functioning in psychotic disorders: A meta-analysis
T.M. Lincoln, K. Wilhelma and Y. Nestoriuca. Schizophrenia Research (Article in Press, Corrected Proof) Available online 7 September 2007. doi:10.1016/j.schres.2007.07.022
Testing Assumptions
As the introduction to this article notes, psychoeducation is widely credited as an effective means of improving outcomes for patients with schizophrenia and other psychotic disorders, and, in fact, meta-analytic data has demonstrated efficacy for PE when interventions include family members. This study, however, focuses on the effectiveness of psychoeducation directed solely at patients. Specifically, “this meta-analysis evaluates short- and long-term efficacy of psychoeducation with and without inclusion of families with regard to relapse, symptom-reduction, knowledge, medication adherence, and functioning.”
A literature search found 18 studies, reporting on 19 comparisons, that met the inclusion criteria. Results of the meta-analysis follow:
Commentary
The value of this study originates in its motivation. Key to medical science is the unwillingness to accept “common sense,” random recall of ones own experience, or “clinical wisdom” in place of evidence. The weakness of the scientific method in the realm of treatment adherence, however, is the conceptualzation of patient compliance as a task. Consequently, the questions and issues are divided, subdivided, and further split into ever tinier data points. In this case, the data point is that current studies indicate that psychoeducation directed only at a psychotic patient does not improve medication compliance, which is an important finding that should be considered in planning treatment for such patients.
The problem lies in the arbitrary nature of the parameters. Implicit in the study’s terms is that these findings are valid for schizophrenic and psychotic patients. Why are those findings not pertinent to patients diagnosed with borderline personality disorger? Are they valid for schizophrenic patients with concomitant substance abuse? Is there any reason other than historical diagnostic divisions to think that psychoeducation for psychotic patients has a different effect than it would on nonpsychotic patients?
Perhaps it’s time to consider compliance a trait rather than a task.
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