CPG for Psychosocial Interventions in Severe Mental ... - GuíaSalud

5.1.6. Pyschoeducational interventions
The pyschoeducational type approach is frequently used in interventions with patients affected by
schizophrenia and bipolar disorders, both in hospitals and outpatients. This intervention involves
transmitting information about the disease to patient and families; it is not always done in an
organised manner and the inclusion of family members is not normal practice. It is important to
know the effectiveness of these interventions, which are usual in practice.
Problems have been encountered to focus the search for scientific evidence due to the fact
that the majority of studies associate pyschoeducation as an essential part of family intervention,
although the surveys on clinical activity inform us that family incorporation is very scarce and not
generalised in clinical practice.
This CPG development group decided to focus the search on pyschoeducation programmes
for users that were compared with an inactive control group. They included studies that evaluated
the impact of the pyschoeducation of family members/caregivers in group format on results in
patients with bipolar disorders. Those studies that included non-specific cognitive-behavioural
interventions were excluded for the pyschoeducation of people with bipolar disorders.
An important overlapping is observed between user-orientated pyschoeducation and standard
treatment when the standard treatment includes transmission of relevant information as well
as coping and handling strategies for the disease, both if carried out individually and with the
incorporation of family members.
There is a lack of knowledge about whether the mere family involvement in the treatment
is per se the determining factor for the improvement of treatment adherence (pharmacological)
and these condition the results, or if what is important is to give adequate information, or achieve
a change in the transactional patterns 105 . It is difficult to find control groups that incorporate the
family without having carried out any specific intervention with them.
The protocolisation and standardisation of pyschoeducational intervention (for example, inclusion
of contents in a manual, with a specific timeframe) may be a reason for not accepting the
intervention for quite a large subgroup of patients, above all if the content does not adapt to the
evolutionary moment of the disorder or to the attitudinal state of the patient. Another factor to be
taken into account is that when the presentation is more interactive, it incorporates more behavioural
components and the content is understood and accepted better, the impact of the intervention
is optimised.
Studies that assess exclusively user-orientated pyschoeducational programmes do not “continue”
with the patient when they end and do not involve support and intervention to incorporate
the different issues dealt with in their daily lives. Thus, the long-term assessment of the results
may produce evidence of ineffectiveness when compared with interventions that incorporate family
members and which, therefore, get “co-therapists” in the home, outside the intervention hours.
The relapse ratios seem to be strongly related to the medication adherence, and the question of
whether the efficiency of the family pyschoeducational interventions is the consequence mainly
of the increase in adherence still cannot be answered 104 .
Providing suitable information about the disorder with a view to improving its handling, by
patients or by their family members, is an act that is carried out from the moment of the referral,
at the time when admission is decided, when the treatment is proposed and prescribed, or
when pharmacological treatment is advised, or when a periodical check-up is carried out, etc.
Therefore, a good knowledge of the effectiveness of this intervention may help improve the use
of resources and clinical practice.
66 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS