Psychoeducation in Psychiatric Disorder

Government of India
CENTRAL INSTITUTE OF PSYCHIATRY, RANCHI
SEMINAR
PSYCHOEDUCATION IN PSYCHIATRIC DISORDER

Chairperson – Mr. Deepanjan Bhattacharjee
Presenter – Mr. Akulandaisamy
Discussant – Mr. Shajan M.A.
Venue – R.B. Davis Hall
Dated – 30th September, 2010
Contents:
Presenter: Discussant:
 Introduction  Brief Introduction
 Definition of Psychoeducation  Psychoeducation: Why it is so important & recent trends
 Etymology of Psychoeducation as a method of psychotherapeutic  Psychoeducation: limited to psychiatry or applicable to
treatment physical disorders too
 Therapeutic Factors of Psychoeducation  Transcultural aspects of psychoeducation
 Models of Psychoeducation  Status of Psychoeducation in India
 Application of Psychoeducation in different mental disorders:  Limitations of psychoeducation
 Schizophrenia  Psychoeducation to special sections:
 Affective disorders  Parents of children & Adolescent with Psychiatric
 Anxiety disorders Disorders
 Personality disorders  Caregivers of females with psychiatric disorders
 Substance addiction  Summary, conclusion & future direction
 Organic disorder
 Conclusion
INTRODUCTION:
Psychoeducation is an educative method based on clinical findings for providing information and training
to families with psychiatrically ill persons to work together with mental health professionals as part of an
overall clinical treatment plan for their ill family members. Psychoeducation has been shown to improve
patient outcomes for persons with schizophrenia and other major mental illnesses and behavioural
disorders. Imminent goals of psychoeducation are to prevent patients with severe mental illnesses from
having frequent relapsing episodes of illness, ensuring medicine as well as treatment adherence, and to
promote their re-entry into their home communities, with particular regard for their social and
occupational functioning. To achieve these goals, psychoeducation programmes seek to provide families
with the information they need about mental illness and the coping skills that will help them to deal with
their loved one's psychiatric disorder. In a nutshell Psychoeducation’s goal is to offer education and
therapeutic strategies to improve the quality of life for the family while decreasing the possibility of
relapse for the patient (Solomon, 1996). It also has been described as a “systematic didactic-
psychotherapeutic intervention, designed to inform patients and their relatives about the disorder and to
promote coping” (Lincoln et al., 2007). By strengthening the coping skills, communication and problem
solving abilities of the family, the well-being and adaptability of the individual and family members are
expected to improve.
Definition of Psychoeducation:
A. Psychoeducation can be defined as ‘systematic, structured, didactic information on the illness
and its treatment, and includes integrating emotional aspects in order to enable patients – as well
as family members – to cope with the illness’ (Bäuml & Pitschel-Walz, 2008).
B. The working group of ‘‘Psychoeducation of patients with schizophrenia’’ gave the following
definition of psychoeducation: “The term psychoeducation comprises systemic, didactic
psychotherapeutic interventions, which are adequate for informing patients and their relatives
about the illness and its treatment, facilitating both an understanding and personally responsible
handling of the illness and supporting those afflicted in coping with the disorder” (Bäuml &
Pitschel-Walz, 2003).
C. Psychoeducation is the “process of teaching clients with mental illness and their family members
about the nature of the illness, including its aetiology, progression, consequences, prognosis,
treatment and alternatives” (Barker, 2003).
Etymology of Psychoeducation as a method of psychotherapeutic treatment:

Educative method in health sector was used in as early as 18 th Century and early part of 19th
Century where philanthropists like Johann Heinrich Pestalozzi (1746-1827) and Dr. Samual Gridley
Howe (1801-1876) used educative methods for providing therapeutic service and care to the physically
and psychologically compromised people. But before the onset of “Mental Hygiene Movement” of early
20th Century and “Deinstitutionalization Movement of 1950-60” there was no example of structured and
organized psychoeducation. Psychoeducation came into the field of psychiatry strongly after the
appearance of “Expressed Emotion” and “Family Burden Concept” in connection to severe and chronic
psychiatric disorder like schizophrenia.
The known earliest evidence of the writings of psychoeducative intervention could be traced in
the Journal of Abnormal Psychology: In that journal John E. Donley wrote about psychoeducation in an
article namely "Psychotherapy and re-education", published in 1911. Subsequently Brian E. Tomlinson
wrote a book entitled as: “The psychoeducational clinic” which was published by MacMillan Co in 1941.
The popularization and development of the term psychoeducation into its current form can be attributed to
the American researcher C.M. Anderson. She established this intervention as an adjunctive but effective
treatment of schizophrenia in 1980. She made some commendable endeavours to scientifically establish
psychoeducation as a medium of therapeutic intervention for the persons with chronic mental disorder
like schizophrenia. She concentrated on educating relatives concerning the symptoms and the process of
the schizophrenia. Also, her research focused on the stabilization of social authority and on the
improvement in handling of the family members among themselves. Finally, C.M. Anderson's research
included more effective stress management techniques. Psychoeducation in behavior therapy has its
origin in the patient's relearning of emotional and social skills. In the last few years increasingly
systematic group programs have been developed, in order to make the knowledge more understandable to
patients and their families (Hogarty et al., 1991; Bäuml et al., 2006). In a single sentence
psychoeducation could be explained as systematically used and structured forms of patient information,
which are meant for informing the patient and/or the family members about the following things:
 Aetiology, factors (precipitating, predisposing and perpetuating) associated with the course and
outcome of various mental disorders
 Signs and symptoms of mental disorders
 Explaining early signs of warning/triggering factors of relapses
 Guidance for the introspection and appropriate perception of typical symptoms of the problem
 How to act as a responsible person/how cope with the situation?
 When and whom to seek treatment?
 Dos and don’ts to family members while handling patient at home
Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 1

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 Dispelling off stigma, prejudices, misconception and negative attitudes to mental illness and patients
Therapeutic Factors of Psychoeducation:

In psychoeducative intervention following therapeutic factors could be identified. Due to those factors
psychoeducation becomes an effective tool to cater necessary information to patients and their key
relatives as well as dispel negative attitudinal factors like expressed emotions and sense of burden ( Bäuml
et al., 2006). Those are:
a) Development of a good therapeutic relationship between patient and therapist
b) Unconditional appreciation towards patients
c) Empathic response to participants
d) Respectful attention to subjectively deviant opinions
e) Need- and resource-orientated procedures
f) Stimulation of hope and reassurance to patients
g) Encouragement of personal exchange of experiences
h) Facilitation of ‘‘shared fate’’ idea among the members (if group psychoeducation is initiated)
Models of psychoeducation:
There are several different models of psychoeducation. These models include strategic elements while
applying interventions like: development of single- and multiple-family groups; mixed groups that
include family members and patients; groups of varying duration ranging from nine months to more than
five years; and groups that focus on patients and families at different phases in the illness. The various
psychoeducational models can be categorised into four approaches (Zipple & Spanial, 1997). Most
models used the component from more than one approach but usually they have specific focus.
 Information model: the emphasis of this model is to provide families the knowledge about
psychiatric illness and its management. The aim of this approach is to improve the families’
awareness about the illness and contribution to the management of the patient.
 The skill training model: this model is directed at systematically developing specific behaviours
so that family members can enhance their capability to assist the ill relatives and manage the
illness more effectively.
 The supportive model: it is an approach which generally utilizes support groups designed to
engage the families of patient in sharing their feelings and experiences. Here the main goal is to
enhance and improve the emotional capacities of the families to cope with the burden of caring
for their ill relatives.
 Comprehensive model: it is also called combination approach because it consists of information,
skill training and supportive model. In the initial phase of this approach members are given
lectures about the illness. They are to take part in multi-family support group. In the final phase
they have to participate particularly as a member of individual sessions with a mental health
professional. (Left et al., 1992)
Family psychoeducation programs have been studied extensively and refined by a number of
researchers, including Ian R.H. Falloon, Gerald Hogarty, William McFarlane, and Lisa Dixon. William
McFarlane proposed a model of psychoeducation namely ‘Multiple Family Group Therapy’ (MFGT) with
the aims of engaging families in the rehabilitation and after care programmes of severe psychiatric illness
like schizophrenia. This model acknowledges the essentially chronic nature of this disease and seeks to
engage families in the rehabilitation process by creating a long-term working partnership with them and
providing them with the information needed to understand schizophrenia. This model seeks to assist the
patient and family in accommodating the disease while developing social support systems for the
reduction of confusing, anxiety, and exhaustion in the patient's family, while they learn adaptive
strategies. William McFarlane delivered following assumptions of this model:
a) Schizophrenia and schizo-affective disorders have strong biological correlates which point to the
brain in the illness. This involvement can best be understood as a deficit in the attention-arousal
mechanisms of the brain, yielding a condition whereby stimuli are idiosyncratically handled.
b) Ordinary life events, and certainly extraordinary ones, can produce stress which overwhelms the
patient's ability to respond in a directed and adaptive manner to a wide variety of stimuli,
precipitating a psychotic episode.
c) Schizophrenia is a chronic disease which is characterized by recurring episodes which each may
last up to two years (including both positive and negative symptom phases).
d) Families do not cause schizophrenia although they may inadvertently exacerbate the condition in
their efforts to respond to it.
e) The preferred response to the presence of schizophrenia is usually not deductible from "common
sense" and may be in opposition to standard treatments for other mental disorders.
f) Anti-psychotic and other psychotropic medications are generally of use in controlling symptoms
although they are usually not sufficient in themselves to bring about complete rehabilitation.
g) The use of street drugs or alcohol tends to exacerbate symptoms of schizophrenia.
h) Clinicians who are warm, collegial, and non-blaming of families have the best chance of helping
them learn new ways of responding to this illness.

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i) Clinicians need active support and supervision by more senior clinicians in their efforts to put this
model into practice.
Peer-to-Peer Psychoeducation Approach:

This approach was developed by Rummel et al (2005). According to them persons who underwent same
kind of experience earlier can understand the problem of the people who have that problem now. Those
people who had the problem earlier could empathize the problem of people who have recently develop
that problem in much better manner than those people who never had that. In peer-to-peer
psychoeducation programme mentally ill persons are given the access to mix with the people who had the
same problem earlier but they recuperated from that problem. These people can motivate the patients up
to considerable extent and provide them a new ray of hope. Rummel et al (2005) proposed a 5 step
psychoeducation programme which can be delivered through peer educators who happen to the ex-
patients. These ex-patients are called as ‘peer moderators’. In step-1 peer future peer-moderators are to
take part in the meetings being conducted by the trained mental health professionals to know the subtle
aspects of mental illness. Those peer-moderators have to provide education to the recently affected
persons and their key caregivers. In step-2, 4 half day training workshops under the guidance of
physicians and psychologists are conducted within a time span of 2 months. These future moderators at
this stage gain the knowledge about conducting and managing group activities and also gained the
thorough knowledge about psychiatric disorder (mainly schizophrenia as this method of psychoeducation
is developed for schizophrenic patients). Training at this stage is done by video operated role playing and
specific manuals which are specially developed for these peer-educators or motivators. In step-3, 2 peer
moderators are told to conduct group programmes for patients. A physician may be present at this stage
but he has to take part in the group programme only when his intervention is required and he has to play a
passive role at this stage. At step-4 peer moderators are to conduct psychoeducational group programmes
independently under the passive supervision of mental health professionals. Group members, i.e., new
patients are provided with information through workshops and group sessions. In step-5 recruitment of
new peer moderators are done. At this step recovered patients who have the interest in providing proper
information and knowledge about psychiatric disorder to recently ill people and their family members are
included in this programme.
Short term goal directed psychoeducational programme is also developed in recent years. Researcher s
had shown that this short term psychoeducational programme can be as beneficial as long term
programmes. Baüml et al. (2006) showed that this brief, eight-session psychoeducation program may
also have long-term effects like long term programme. They found statistically significant and clinically
important differences between the persons who had received it and who hadn’t. Their research was the
part of the 7-year follow-up of the Psychosis Information Project Study (PIP-study). In this study separate
groups for patients and their families were exmined. In Japan Yamaguchi et al (2006) postulated a short
time goal directed psychoeducative intervention for the families with severely ill schizophrenia affected
patients. Their therapy could be given in a period of 2 months and at the time of intervention the key
relatives are to participate in three or four sessions of psychoeducation. Each session should last for 2
hours and consist of two to six participants. The sessions are to be led by two or three doctors, a nurse and
a social worker. These sessions of this approach should include interactive lectures on information about
schizophrenia, rehabilitation, social support programs, and management of patient behaviors which
should be followed by an intensive discussion, taking advantage of the small size of the groups. Authors
claimed that after the intervention, both state and trait anxieties, subjective burden, sense of distress and
depression of the relatives should come down at the significant level.
Pollio et al (2006) developed a format of composed but time limited single day psycho-education
programme for relatives of patients with severe mental illnesses like schizophrenia, bipolar disorder,
major depression, and other affective disorders. They had tested this approach of psychoeducation on few
relatives of those patients. For that reason they organized a workshop for these people and saw the results.
This 1-day psychoeducation workshop contains three lectures (descriptive and diagnostic information on
schizophrenia and mood disorders, biological basis of mental illness, including neurochemistry and
genetics, and medication and other treatment options). Informal discussion between the therapist and
participants was organized during the lunch break of the work shop. After that two breakout sessions with
a brief didactic presentation on following areas like ‘area resources’, ‘success stories’, ‘ask the doc’,
‘religion’, and ‘legal rights’ took place. They evaluated that short-term goals of the workshops were
achieved satisfactorily. Expected positive goals of the workshop were ‘control of daily life’,
‘effectiveness in crisis situation’, ‘knowledge on obtaining community resources’, and ‘knowledge about
mental illness and treatment’ and those things were significantly increased, whereas ‘feelings of guilt’
decreased. Authors opined that families with such patients would reap the fruits of this intervention in
satisfactory manner.
Passive & Active Psychoeducation Models:

Passive psychoeducational intervention is an educative as well as therapeutic intervention which provides
information, education materials or feedback/advice. Examples of passive psychoeducation are
programmes served to targeted individuals through means like leaflets, pamphlets, brochures, posters,
audio-visual aids, lectures, internet material or software. This approach aims to educate the recipient

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about the nature and treatment of psychological distress. The intervention can be delivered in primary or
secondary care settings, or within universities, community centres or other public venues. Passive
psychoeducation programme does not require the recipient to undertake explicit homework or relaxation
exercises and it does not deliver active treatment. Psychoeducation is often tagged with other active
psychotherapies like CBT or IPT as an important part. This is not done with passive psychoeducative
programme. Active psychoeducational intervention is the specific type of psychoeducation which is
deemed as an important part of other psychotherapies like CBT, IPT, Family Therapy, Group Therapy or
any other kinds of individual or group psychotherapies (Donker et al., 2009).
Therapeutic Role of Psycho-education in schizophrenia:

Schizophrenia is a severe and chronic psychiatric illness characterised by lack of insight, slipping into an
enduring state of withdrawal from environment, turning and living in inner world, compromised socio-
occupational functioning, perceptual abnormality, inappropriate thinking and poor compliance with
treatment. Approximately 50 to 80% of persons with schizophrenia and related psychotic disorders live
with or are in touch with family caregiver (Gibbons et al., 1984; Lehman & Steinwaches, 1998). Very
often these caregivers have subjective feeling being overwhelmingly burdened by proving care to their ill
relatives (Gibbons et al., 1984). Demands of caregiving include paying for psychiatric treatment,
supervision of a mentally ill family member, dealing with societal stigma associated with mental illness,
and emotional distress that may result from symptoms of a family member’s illness. The level of burden
of the relatives of the persons with schizophrenia is as equal as the burden of caregivers of persons with
other chronic disorders like Alzheimer’s disease, mental retardation and Diabetes and cancer (Biegel et
al., 1991; Pariante & Carpiniello, 1996). There are many family based interventions were developed in
past to aid families with schizophrenic patients. Such as family therapy in a single family setting (Falloon
et al., 1982; Tarrier et al., 1988; Hogarty et al., 1991) or in a group of multiple families with same kind of
patients (multi-family group therapy) (McFarlane et al., 1995a, 1995b), psycho-educational relatives’
groups (Leff et al., 1982, 1990), arrangements of educational lectures for key caregivers and relatives
(Smith and Birchwood 1987; Tarrier et al., 1988, 1989, 1991), counselling groups for key caregivers and
relatives (Vaughan et al., 1992), and group therapy for key caregivers and for relatives (Köttgen et al.,
1984). Most of these interventions for relatives can be put under the broader label of “psycho-education”
as in all those interventions psycho-education happens to be an essential component.
Family psycho-education interventions have demonstrated effectiveness in reducing problems like
prevention illness relapse, alleviation of negative symptoms, and better inpatient service utilization (Leff
et al., 1989; McFarlane et al., 1995). Psycho-educational 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. Psycho-education in schizophrenia aims to bolster and strengthen
the treatment and rehabilitation process by making the patient and his family members aware about the
necessary aspects of the illness. Terms like ‘patient education’, ’patient teaching’, and ‘patient
instruction’ have also been used interchangeably to describe psycho-education in schizophrenia. All
imply that there is a focus on knowledge. Providing education to this group is a gradual process by which
they gain knowledge and understanding through learning. Learning, in this case, however, involves more
than knowledge and, learning involves cognitive, affective and psychomotor processes. Learning implies
changes in behaviour, skill or attitude. Patient education can take a variety of forms depending upon the
abilities and interest of the patient and family. Psychoeducation in schizophrenia aims to enable the
patient to engage in positive behaviour change. Basic emphasis is to prevent hospitalisation or to manage
the illness or condition to help the patient attain her/his maximum degree of health. In schizophrenia
compliance with treatment is of great concern and is often appeared as the major challenge for the
therapist in the long run. Many people with severe mental illness like schizophrenia are frequently and
repeatedly hospitalised due to poor compliance with treatment. Many patients as well as their caregivers
do often feel stigmatised by illness and may deny its existence, which ultimately increases non-
compliance. This thing becomes more problematic when people are living in the community and is often
related to adverse effects of medication as well as a lack of adequate knowledge about medication
(Goldman & Quinn, 1986; Hogarty & Anderson, 1986; Zhang et al., 1994). Majority of the patients with
schizophrenia rely heavily on their key caregivers and relatives for emotional support, instrumental and
financial assistance, housing, and advocacy. Factor like, their relationship pattern and quality with their
key caregivers and relatives greatly influences the family and client well-being and the outcome of
illness. Psycho-education interventions for family members of people with schizophrenia have been
emerged as a major adjunctive psychotherapy over the past two and half decades (Dixon et al., 2000).
The construct of "expressed emotion" (EE) has played a significant role in the development of family
psycho-education interventions. Previous studies on schizophrenia suggests that people with
schizophrenia living with family members who exhibit high levels of negative EE (critical comments,
hostility, and emotional over-involvement) are more likely to relapse (Koenigsberg & Handley, 1986;
Scazufca & Kuipers, 1998). This association may be linked to the difficulty persons with schizophrenia
have in processing complex emotions and in sustaining attention in emotionally charged environments.
The Schizophrenia Patient Outcomes Research Team (PORT) once came up with some retreatment
recommendations which strongly support the family psychoeducational service for the schizophrenia

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patients’ families for its proven therapeutic value. The Schizophrenia Patients Outcomes Research Team
(PORT) categorically gave following recommendations:
1. Patients who have been staying with their families should be given a comprehensive family
psychosocial intervention that lasts for at least 9 months and includes things like education about
illness, raising family support, crisis intervention, and problem-solving skills training. Such
interventions should also be given to important nonfamily caregivers of schizophrenia patients’.
(Lehman et al., 1998).
2. Family interventions should not be limited only to patients whose families are identified as having
high levels of "expressed emotion" (criticism, hostility, over-involvement) (Lehman et al., 1998) but
should be given to all families with such patients to avert the development of negative expressed
emotions in families.
3. Family therapies based on the hypothesis that family dysfunction is the aetiology of the patient's
schizophrenic disorder should not be used. (Lehman et al., 1998)

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Table-1: Few Studies on Family Psycho-education:
Authors &
Sample & Place of the Study Intervention Result’s
Year
Goldstein  104 schizophrenia patients  Six crisis-oriented, brief weekly  Significantly lower relapses in
et al (mostly first admission) sessions of psychoeducation given. family treatment groups at 6
(1978)  This programme contains months.
education about illness, building
acceptance, planning for the future
Falloon &  36 schizophrenia patients  Behavioral family therapy:  Significantly fewer relapses in
Pederson living with high-EE relatives problem-solving & communication family treatment group at 9
(1985) or judged to be at high risk skills training in family home. 3 months (p < 0.01) & 2 years (p
Falloon et for relapse. months of intensive therapy with 6 <0.001). Increased patient
al (1982) months of follow-up sessions. functioning, reduced family
burden, & reduced cost in
treatment group.
Leff et al.  24 schizophrenia subjects  Education of relatives, relatives'  Significantly reduced relapses
(1982, with high-EE relatives. group, family therapy in home for family treatment group at 9
1985) months (p < 0.05); non-
significant reduction at 2 years.
Hogarty et  103 schizophrenia subjects  Education, discussion,  Family treatment significantly
al. living in high EE households. communication, and problem- reduced relapse at 1- and 2-year
(1986, solving training for 2 years. follow-up (p < 0.01) for
1991) treatment takers; little effect on
patient functioning.
Vaughan et  36 schizophrenia patients  10-week program for relative  No difference in relapse rates or
al. (1992) living with both parents, at oriented to building alliance & symptoms between groups.
least one rated as high EE. problem solving.
Mingyun  3,092 schizophrenia patients  Group psychoeducation comprised  Significant improvement in
et al. & their key relatives. of 10 lectures & 3 group functional status of the patients.
(1993)  China discussions over 1 year period  Better treatment adherence &
along with other modes of low rate of relapse.
treatment  Significant decrease of illness
symptoms.
Xiong et  63 schizophrenia patients &  Education to patients & their  Fewer & shorter relapses.
al. (1994) their key relatives. families.  Improvement in vocational
 China  Multifamily group treatment functioning.
(MGFT) given.  Feeling of less subjective burden
 Home visits to patients’ place. by family members.
 Duration of intervention 1 year  Less expensive & easy to grasp
for family members.
Xiong et  69 schizophrenia patients &  Workshops for patients & families.  Improvement in vocational
al. (1994) their key relatives.  Home visits to patients’ place. functioning.
 8 affective disorder patients  Group discussions & providing  Improved mental status of
& their key relatives. information about mental illness to patients.
 China associated neighbourhood.  Better treatment adherence.
 Medication monitoring.  Reduction of disruptive
 Duration of intervention 4 months behaviour of patients.
 Reduction in negative attitude &
behaviour (neglect & abuse) to
patients by family members.
Zhang et  78 schizophrenia patients &  Monthly individual & family  Better treatment adherence &
al. (1994) their key relatives. counselling over 1½ year. low rate of relapse.
 China  Multifamily group format used
McFarlane  A total of 172 acutely  Patients were randomly assigned to  Psychoeducational multiple-
et al. psychotic patients, aged 18 to single- or multiple-family family groups were more
(1995b) 45 years were selected. psychoeducational treatment effective than single-family
 USA  Six public hospitals in the state of treatment in extending
New York were selected for this remission, especially in patients
study. at higher risk for relapse.
Tellas et al  42 Spanish speaking  1 year IRH Falloon’s Behavioural  Patients with acculturation
(1995) schizophrenia affected Family Management (BFM) which problems had higher relapse
immigrants came to Los includes structured education, rates but through this
Angeles. communication skills training, intervention it can be minimized
 People belonged to low problem-solving programme + case significantly.
income group. management  Improvement in vocational
 USA functioning.
 Improved mental status of
patients.
 Better treatment adherence.
Magliano  Thirty-four mental health  The intervention consists of four  Psychoeducational family
et al professionals from 17 public components: assessment of intervention may have a
(2006) mental health centers in Italy individual and family needs; significant impact on functional

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selected 71 families with information sessions with outcomes of schizophrenia when
schizophrenia affected consumers & their relatives about provided to patients and
persons. clinical aspects of schizophrenia, its caregivers in real-world settings.
 Forty-two families were treatments & early signs of relapse;
randomly assigned to a group communication skills training; &
that received the intervention problem- solving skills training.
for six months, & 29 families  The training program included
were assigned to a waiting three monthly modules of two and a
list for six months. half days each.
 Assessment was done at
baseline & six months later.
 Italy
Pitschel-  Aimed for examining the  Two separate psychoeducational  Psychoeducational sessions
Walz et al efficacy of groups were formed for patients & clubbed with systematic family
(2006) psychoeducational groups in their relatives. involvement can considerably
schizophrenia to reduce  Each group were given 8 sessions improve the treatment of
rehospitalization rates & of psychoeducation. schizophrenia.
improve compliance.  Duration of psychoeducational  Psychoeducation should be
 236 inpatients who met groups was 4 to 5 months. routinely offered to all patients
DSM-III-R criteria for  Outcomes were compared over 12- with schizophrenia and their
schizophrenia or month & 24-month follow-up families.
schizoaffective disorder & periods.
who were in constant touch  The study was conducted from
with at least 1 relative or 1990 to 1994.
other key person were
selected for this study.
Pitschel-  116 inpatients with  A manualized, interactive  Individuals with both
Walz et al schizophrenic or psychoeducational programme of schizophrenia & borderline
(2009) schizoaffective disorders & eight sessions (4 weeks) was given. intellectual disability could be
borderline intellectual  Measures of knowledge, adherence successfully integrated into
disability. & the concept of illness were general conventional
 Conducted at 3 inpatient completed before & after the psychoeducational groups.
wards of Psychiatric groups.  Borderline intellectual disability
Hospital, Technische  The short-term outcome of 22 should not be deemed as an
Universität München, participants with schizophrenia & exclusion criterion for
Germany. borderline intellectual disability (IQ participation in such groups.
70–85) was compared with the
outcome of 75 participants with
schizophrenia & IQ > 85.
Efficacy of Psychoeducation in BPAD:

Bipolar illness is a severe, chronic and recurrent condition that appears as a major health problem which
has high degree of economic burden to the society and also has high mortality rates. Bipolar disorders are
common, severe mental disorders with similar lifetime prevalence (1%) to schizophrenia. The mean
relapse rate is 50% at one year and over 70% at four years. Few years back a prospective twelve year
follow-up study showed that individuals with bipolar disorder were symptomatic for 47% of the time
(Gitlin et al., 1995). Recently some psychological treatments are developed in preventing relapses which
have shown some promises. These psychotherapies often used adjunctively with other psychiatric
treatments, e.g., pharmacotherapy and psychotherapy. Recently many studies on the effectiveness of
psychotherapy on BPAD showed the efficacy of these psychotherapies in reducing the chances of
relapses and increasing treatment adherence among BPAD patients. Factors like presence of high
expressed emotion, poor family atmosphere, and sense of burden among relatives owing to patient care,
poor medication and treatment compliance are associated with increased risk of relapse and poor
outcomes in bipolar disorder. Miklowitz et al (1983; 1984) developed a specific form of family
intervention which includes family psychoeducation as an important element e.g., family-focused therapy.
Psycho-education is aimed at providing bipolar patients in understanding and coping with the
consequences of illness in the context of a medical model, and attempting to make them understand the
complex relationship amongst symptoms, personality, interpersonal environment, medication side-effects,
and becoming responsible (but never guilty) when faced with the illness. This allows them to actively
collaborate with the physician in some aspects of the treatment. Psychoeducational approach like group
psychoeducation is effective in preventing recurrence in patients with bipolar I or II disorder receiving
standard medical therapy. According to Colom et al (2003) group psychoeducation approach has got the
potential to reduce the number of relapses and recurrences in depressive, manic, hypomanic, and mixed
episodes. These authors also mentioned that the number and length of hospitalizations per patient were
also lower in patients who received this type psychoeducation.
Therapeutic Role of Psycho-education in anxiety & other neurotic disorders:

Globally anxiety disorders are the most frequent as well as commonest forms of mental disorders in and
collectively anxiety disorder contribute significantly to health care costs (Kessler et al., 2005). Once in

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Western World (European Countries) it was measured that at least one third of all disabilities and sick
leave days due to a mental disorder are caused by anxiety disorders (Andlin-Sobocki & Wittchen, 2005).
The negative effects related to anxiety disorders are not restricted only to high treatment costs as well as
monetary loss because of low involvement in job but also marked suffering of patients, which often ends
to induce maladaptive behaviours to them in the form of self-medication with alcohol and drugs
(Robinson et al., 2009). In chronic anxiety disorder like Generalized Anxiety Disorder (GAD) specific
model of psycho-education along with other forms of psychiatric treatments are used. One such example
is integrative approach. This approach includes the principles and strategies of cognitive –behaviour
therapy and mindfulness training. Through CBT these patients are taught to know the maladaptive angle
of their behaviour which are used for reducing anxiety, e.g., avoiding tendency, generalization, seeking
reassurance every time etc. The mindfulness training helps them to have better control over their worries,
gain perspectives of their basis of anxiety and control their feeling that provides the direction for taking
negatively oriented evasive action. This way the vicious cycle of anxiety is broken by this
psychotherapeutic approach. Psycho-education has also got some positive role in the treatment of panic
disorder. In panic disorder psycho-education which includes contents like giving explanation to the
patients concerning the nature of their illness and a description of management methods available for their
disorder can be given. This may emerge as an effective mode of treatment in panic disorder, because
patients with panic disorders tend to use cognitive coping mechanisms in a faulty manner and would
always anticipate panic attacks and reckon any son-specific psycho physiological symptom as dreadful
thing. In obsessive compulsive disorder (OCD) role of psycho-education is also as important as other
psychiatric disorders (Freeman et al., 2009). Donker et al (2009) commented in a meta-analysis of studies
on psychoeducation on anxiety and depressive disorders that psychoeducative approach like brief passive
psychoeducational can reduce symptoms. Because this form of psychoeducation, i.e., brief passive
psychoeducation interventions are easy to implement, can be applied immediately and are not expensive.
They may offer a first-step intervention for those experiencing psychological distress and might serve as
an initial intervention in primary care or community models. In Post Traumatic Stress Disorder (PTSD)
psychoeducation has also got some role in the treatment process. It may be use as adjunctive therapy in
PTSD. According to Harkness & Zador (2001), ideal family interventions for PTSD patients should have
three components, e.g., psychoeducation, disclosure and dialectical dilemma. Psychoeducation involves
educating family members on the illness. Disclosure includes acknowledging the traumatic event. While
the disclosure can be specific or generalized, the significance is to share the experience with the family.
Dialectic dilemma involves how the family manages the challenge of acknowledgement of the trauma
while finding a way to reframe and channel the emotions and energy of the situation. The combination of
the three components allows the family to “hear, appreciate and validate” the experience of the patient.
Other important psychoeducation oriented family interventions in PTSD are: a) trauma workshop- this is
didactic and educational in nature, and conclude with a discussion period. b) Support and Family
Education (SAFE) Program- this model was used for the treatment of war veterans in USA. This model
entails a supportive learning environment for family members with the goal of providing a more nurturing
and supportive home and family environment for the patient.
Therapeutic Role of Psycho-education in personality disorders:

Colom et al (2004) initiated a study to examine the efficacy of group psychoeducation over the patients
with bipolar disorder and comorbid personality disorders. They came up with the rationale that as group
psychoeducation has shown its efficacy in improving the clinical outcome of bipolar illness by preventing
recurrence of any polarity whether it is also equally effective to the patients with both bipolar and
personality disorders. Their study aimed to see the efficacy of group psychoeducation in the prevention of
recurrences in remitted bipolar patients with axis II comorbidity. They came up with the conclusion that
psychoeducation may be a useful intervention for bipolar patients with comorbid personality disorders.
Huband et al (2007) used a combined approach to devise a psycho-educative treatment for the persons
with personality disorders. They augmented brief psycho-education with social problem-solving group
therapy for the treatment of the adults with personality disorders. The problem-solving therapy includes
techniques like counteracting impulsivity, defining problems, generating solutions, encouraging
consequential thinking and developing means–end action planning. Whereas brief individual psycho-
education includes programmes like informing patients about their diagnoses, let them to prioritize
problems identified by the personality assessment, to clarify links between diagnosis and social problem-
solving difficulties, and to highlight the importance of the treatment to follow and encourage their
engagement in the treatment process. Authors commented at the end of the study as problem-solving plus
psycho-education has potential as an intervention for adults with personality disorder. Family psycho-
education programmes have also some role in the long term treatment of the persons with borderline
personality disorder. Hoffman et al (2005) measured the change among family members of the persons
with borderline personality disorder who took part in Family Connection. This was a specially designed
12-week manualized education program for relatives of persons with borderline personality disorder
(BPD). Family Connections, led by trained family members, is based on the strategies of standard
Dialectical Behavior Therapy (DBT) and DBT for families. The program provides (a) current information
and research on BPD, (b) coping skills, (c) family skills, and (d) opportunities to build a support network

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for family members. Authors observed the positive changes in those families as significant reduction in
grief and burden, and a significant increase in mastery and coping skills.
Therapeutic Role of Psycho-education in substance addiction:

Persons with an addiction disorder often do have an ego deficit in the area of self-care. This deficiency
often emerges as an inability deal with day-to-day problem solving and life tasks. Psychotherapies like
individual psychotherapy and psychodynamic group therapy aim to teach basic life skills to patients in
order to deal with day-to-day living. To address both issues of ego and life skills deficits, approach like
psychoeducational group therapy can be used. This group setting can be task-oriented and didactic in
nature. A psychoeducational group in the treatment of addictions can serve as a synthesis for problem-
solving skills training used in mental health and the psychodynamic theory of addictive behavior (La
Salvia, 1993). Plasse (2000) examined the efficacy of psychoeducational parenting skills group. The
author included seven women who were the mothers of addicted adolescents. The components of the
treatment were contracting, requisite attendance and writing requirements, participation in structured
group activities and interpersonal peer and staff relationships. Result of this psychoeducational approach
was very positive in terms of helping these mothers about the various facets of addiction, how to interact
with their addicted children, problem solving skills, getting into the main frame of addiction treatment so
on. Psychoeducation can also be very much effective in ensuring good prognosis among the persons who
have been receiving specialized detoxification therapy e.g., ‘methadone maintenance therapy’.
Methadone maintenance has become the treatment of choice for opioid addiction because of its beneficial
effects on illicit opiate use and criminality. Despite that methadone maintenance has some pitfalls in the
forms of: ‘methadone clients continue to use drugs’, ‘experience high rates of psychopathology and
alcoholism’, and ‘fail to become employed’ and ‘integrated into the community’. Through
psychoeducation training of educational, recreational, and personal skills can be done in these people
(Stark, 1989).
Integrated Approach for the People with Dual Diagnosis (Psychosis & Substance Addiction):
In case of persons with severe mental disorders such as schizophrenia and co-occurring substance
use disorders treatment, aftercare and rehabilitation would become much more difficult to the clinicians
and these people usually receive treatments for their two disorders from two different sets of clinicians in
parallel treatment systems. But separate treatment from two different sets of professional stream could not
provide the desired result in these people. So integrated treatment models in which the same clinicians or
teams of clinicians provide substance abuse treatment and mental health treatment can be initiated for the
treatment and rehabilitation of these people. This integrated model includes approaches like
pharmacotherapy, appropriate group and individual psychotherapy, family psychoeducation programme,
case management and assertive community treatment. This form of treatment i.e., integrated treatments
simultaneously address two or more chronic disorders. Conceptually, interventions for patients with
severe mental disorders such as schizophrenia and interventions for patients with substance use disorders
share common ground: both hold the philosophy that treatment of chronic illness requires a long-term
approach in which stabilization, education, and self-management are central. In integrated treatments for
patients with dual disorders, mental health treatments and substance abuse treatments are clubbed
together and served by the same clinician, or team of clinicians, in the same program in order to providing
the patient consistent explanation of illness and a coherent prescription for treatment rather than a
contradictory set of messages from different providers. Integrated treatment aims to reduce conflicts
between providers, to eliminate the patient's burden of attending two programs and hearing potentially
conflicting messages, and to remove financial and other barriers to access and retention (Drake et al.,
1998).
Therapeutic Role of Psycho-education in dementia & Alzheimer’s disease:

There are an estimated 7.4 million people living with dementia worldwide and at least 3.7 million with
Alzheimer's disease (AD). Dementia and Alzheimer's disease (AD) is a terminal condition with disastrous
consequences for the afflicted person and those who care for the person. These patients develop multiple
troublesome as well as disabling symptoms, e.g., sleep disturbances; incontinence of urine and feces;
difficulty in keeping balance; decreased mobility; inability to recognize family and friends; changes in
sexual behaviour; disorientation; paranoia; demanding, critical behaviors; night awakenings; wandering
tendency; irritability, agitation and being hostile to others; and catastrophic reactions. Previously done
studies have shown that caregiving for family members with dementia are extremely stressful and
burdensome, with negative consequences for the physical and emotional health of caregivers or key
relatives. Caregiving in dementia is extremely burdensome because of few reasons, i.e., “physical,
psychological or emotional, social, and financial problems experienced by family caregivers representing
both subjective and objective aspects of the impact of care” (George & Gwyther, 1986). Burden has also
been described in terms of the impact of the cognitive and behavioural changes of the care receiver, or the
“negative phenomena” linked with caring for the person. The burden of caregiving is important because
the course of AD may last from 1 to 20 years and averages 8 years of symptoms; thus, caregiving duties
may continue for a prolonged time. Family caregiving process holds a key position in the treatment and
aftercare of organic disorder. Success of the treatment and rehabilitation process largely depends on the

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fact that how qualitatively good the caregiving is. Caregiving extracts a significant toll from family
caregivers. The caregiver role is marred by few certain and perpetually disturbing problems, e.g.,
appearance of family stress and burden owing to borrowing the cost of treatment and rehabilitation, social
isolation of the family as a whole, development of stigma, disturbance in normal family functioning and
unfulfillment or underfulfillment of the needs of other members of family, so on. Multiple causes are
associated with negative outcomes of caregivers’ experience. Persistent behavioural problems, coupled
with caregivers’ perceived or actual incapapcity to deal with those problems, would appear as the most
important source of their stress and burden (Ostwald et al., 1999). Ostwald et al. (1999) did a 3 year
randomized clinical trial for seeing the effectiveness of an interdisciplinary psychoeducational family
group intervention in reducing the caregivers’ perceptions of the frequency and magnitude of behavioural
problems in persons with cognitive disorder like dementia and their reactions to those problems and in
reducing caregiver burden and psychological problem like depression. Their intervention comprised of
seven weekly, 2 hour multimedia training sessions which incorporated education, family support and
skills training for 94 primary caregivers and their families. This intervention was very much successful in
decreasing caregivers’ negative reactions to disruptive behaviours being shown by their ailing relatives
and also reducing their burden. Acton & Kang (2001) conducted a comprehensive meta-analysis of the
researches which have been carried out on these people. These authors have found that interventions like
‘family support group’, ‘family psychoeducation and counselling’ have some beneficial effects on this
area. Support-group interventions entail intensive unstructured, non-specific and informal interactions and
exchanges among individuals with dementia and Alzheimer’s disease affected people to share their
experiences, normalize experiences, give mutual support, and increase connections among the group
members. Support-group interventions were usually monitored and maneuvered by laypersons with
experience in caregiving or group facilitation. Whereas psychoeducation interventions are designed to
provide standardized information about the disease process, disruptive behaviors, and caregiving in order
to enhance the ability of the caregiver to manage the problematic behaviors of the care receiver. This kind
of intervention often includes time for the caregiver to practice the new skills learned. Education
interventions were delivered by trained professionals. The psychoeducation also works as educational and
supportive interventions. Participants in the treatment groups received both education and support
interventions.
Table-2: Some Studies examining the efficacy of psychoeducation in Dementia & Alzheimer’s
Diseases:
Authors &
Study Method & Samples Result
Year
Coon et al Examined the short-term impact 169 Female caregivers aged ≥50 years The primary outcomes examined were anger
(2003) psychoeducational small group who were caring dementia patients or hostile mood, depressed mood, frequency
interventions with distressed female were selected. of use of positive & negative coping
caregivers, & it also examines the role They were randomly assigned to one strategies, & perceived caregiving self-
of specific moderator & mediator of three treatment interventions: anger efficacy.
variables on caregiver outcomes. management, depression management, Participants in both anger management &
or a wait-list control group. Duration depression management groups had
of interventions was 3- to 4-months. significant reductions in their levels of anger
or hostility & depression in comparison to
participants in the wait-list control group.
Self-efficacy also increased in both anger
management & depression management
groups.
Judge et al This research aims to give an in-depth Authors used a strength-based Content & process of the intervention were
(2010) description of a dyadic intervention approach, caregiving dyads received viewed as highly acceptable & feasible by
for individuals with dementia and skills training across 5 key areas: (a) both participants & intervention specialists.
their family caregivers. education regarding dementia &
memory loss, (b) effective
communication, (c) managing
memory loss, (d) staying active, (e)
recognizing emotions & behaviours.
Caregiving dyads were randomly
assigned to participate in the
intervention.
Depp et al To provide the rationale of advantages Systematic review of studies on According to authors’ two major strengths of
(2003) of psychoeducational programs versus support groups & psychoeducation psychoeducational interventions are their
support groups for caregivers of programmes for the caregivers of emphasis on training caregivers in a variety of
people with dementia. dementia patients. cognitive & behavioural skills for coping with
caregiving, & their adaptability to caregivers
from diverse backgrounds.
Hepburn et Development & field testing of a Program development started with a All selected caregivers reported increased
al (2003) specially designed psychoeducational prototype of a 12-hr course with the skill, knowledge, & confidence.
programme namely “Savvy Caregiver targets of helping family caregivers to
Program”. know what the caregiving role is &
what knowledge, skills, & attitudes
needed to carry out that role, &
alerting them to self-care issues.
Akkerman To see the effectiveness of Brief To assess CBT's effectiveness, 38 Short term CBT has got immense potential to
& Ostwald Group Cognitive Behavioural anxious Alzheimer’s Disease affected act as an aid to raise awareness level as well

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(2004) Therapy among the caregivers of AD individuals’ family caregivers were as coping & problem-solving skills of the
in dispelling misconceptions, recruited & randomly assigned to a caregivers of AD patients.
enhancing their problem-solving nine-week group CBT intervention or
abilities & functionality. to a waitlist control.
Rabinowitz To promote caregiver well-being and Authors examined relationships Higher levels of self-efficacy for Obtaining
et al (2007) to help caregivers persevere in their between self-efficacy beliefs in three Respite & self-efficacy for having control
invaluable roles, personal resources distinct domains of caregiving & over disturbing thoughts were found to have
that predict increased self-care and cumulative health risk associated with relationship with reduced health risk to
reduced health risk behaviors need to health behaviour patterns. caregivers.
be identified.
Thompson To examine whether information & A systematic review examining Forty-four studies were included in this
et al (2007) support interventions improve the evidence from randomized controlled review. Controlling for the quality of the
quality of life of people caring for trials in which technology, evidence, authors found statistically
someone with dementia. individualized or group-based significant evidence that group-based
interventions built around the supportive interventions impact positively on
provision of support and/or psychological morbidity of the caregivers.
information were evaluated.

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Conclusion:
The psychoeducation has been appeared as a major therapeutic approach to enable patients and
their caregivers more skilful in dealing with the manifold stress being caused by psychiatric disorders.
Psycho education has very important place in treatment and rehabilitation of patients with psychiatric
disorders Over time, when individuals with serious mental illness and their families learn more about the
illness and ways to reduce its effects, there can be many positive changes, such as:
a) Fewer relapses
b) Less time spending in the psychiatric hospital
c) Decreased sense of stigma
d) A feeling of better control over life
e) Better medication adherence
f) Having better social living and problem solving skills among patients
g) Better global family functioning
h) Less occurrences of depression and anxiety among caregivers
DISCUSSION
Brief Introduction:
Psychoeducation is an adjunctive approach which has the immense potentialities to reduce the relapse as
well as rehospitalization rates and mental health costs in relapsing psychiatric disorders. Psychoeducation
is understood as systematic, structured, didactic information on the illness and its treatment options and
psychoeducation aims to enable patients as well as family members—to cope with the illness. Modern
treatment protocols cite psychoeducation as an indispensible part of psychiatric treatment.
Psychoeducation for patients with severe and relapsing mental disorder improves the understanding of
mental illness, increases the quality of life, and can reduce relapse rates. Family psychoeducation as well
has become a strongly supported evidence-based practice in the treatment of chronic and relapsing mental
disorders. Psychoeducation in families of patients with such disorders can reduce the relapse rates of
these patients, positively influence the course of the patient’s illness, and help the families and patients to
better cope with the mental illness (Rummel-Kluge et al., 2006).
Psychoeducation: Why it is so important & Recent trends:

Psychoeducation has been emerged as an indispensible mode of treatment in modern day psychiatric
treatment. Most mental health clinicians and researchers are in favour of adding psychoeducation as the
adjunct to strengthen the other forms of psychiatric treatment because psychoeducation has the
potentialities to help the patients and family members know about their creative and positive role in the
treatment and enhance their ability to deal with daily stress, i.e., dealing with psychopathology, societal
animosity and development of incapacity owing to mental illness. Moreover through psychoeducation all
forces around mental patients can be channelized into a positive direction. Modern psychiatric treatment
approach upholds the essentiality of multimodal approach or combination of therapies which include
pharmacotherapy and psychotherapy to address all corners of psychiatric illness. Multiple studies have
proven the value of psychoeducation in psychiatric disorders ranging from mild mental illness to most
severe and debilitating mental illness.
The importance of psychoeducation in the management of the mentally ill has been reinforced in recent
times by multiple prospective clinical trials which have compared a medications only approach with
techniques that blended psychoeducation with medications (Colom et al., 2003; Perry et al., 1999). The
outcomes from most of these studies have validated the utilization of psychoeducation as an approach that
improves the efficacy of pharmacological approaches. In most instances, the blended approach remains
superior to a medications only approach. Bipolar illness and schizophrenia are two of the most
debilitating mental illness among many mental health conditions where the combined approach has been
found to be very effective. Colom et al (2003, 2004) asserted that in the treatment of bipolar patients,
psychoeducation has a role beyond the enhancement of patient compliance to drug treatment rather it
helps them to be more focussed and skilful in addressing and interpreting daily life tasks. These authors
mentioned that psychoeducation holds a special role for patients who tend to have poor prognosis because
of their comorbid personality disorders. Recent studies have proven the associations between multiple
socio-environmental stressors and remission-relapse successions of BPAD. Factors like escalation in the
levels of negative expressed emotion, lack of warmth from parent or key caregivers, presence of
disruptive life events and disturbances in biological functioning can become the precursors of the acute
exacerbations in bipolar disorders. Other psychosocial variables like marital status, social support (and
more importantly the lack of it), education, socioeconomic status and lack of accurate knowledge about
one’s condition all influence a patients’ compliance to drug treatment (Miklowitz et al., 2003). Through
individualized forms of psychoeducation harmful impact of those factors could be eliminated up to a
significant extent. Ways in which adjunctive psychoeducation may help the mentally ill are by improving
treatment adherence (which remains one of the most crucial factors that governs the outcome of a
disease), helping in a greater stabilization of symptoms, preventing relapses and reducing inter-episode
symptoms through enhancing patients stress management abilities and finally helping in the rehabilitation
of patients to the maximum level of functioning possible (Miklowitz et al., 2003). Psychoeducation helps
in improving the compliance to the long term drug treatment often prescribed in mental illnesses. Hogarty

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et al (1986, 1991) accomplished a series of well-controlled research studies to examine the effectiveness
of psychoeducation over a 2-year time period. They randomly selected 103 patients with schizophrenia
and schizoaffective disorder and depute them to one of four conditions: family psychoeducation;
individual social-skills training (SST); family psychoeducation and social skills training; or supportive
treatment. All patients received equal and standard medication management, and were followed for two
years to assess the impact of intervention on relapse rates, psychiatric symptoms, and adjustment. During
the first year of the intervention, the relapse rate was significantly lower in both SST (20%) and FPE
(19%) conditions, compared with a 38% relapse among patients in the control support condition. An
additive effect emerged when individual and family treatment was combined, as no patients that were
provided both treatments relapsed during this time. After 2 years, the effects on relapse rates generally
favoured the family treatment and combined condition, as the significant relapse-protective effect of SST
alone was lost during the second year. Also, results indicated that patients provided some form of family
intervention fared significantly better in terms of employment status. For the 30 patients provided some
form of intervention, the full time employment rate was 50%, compared with 27% for patients who were
not provided any family-based treatment. Conclusively, these studies indicate that the family
psychoeducation model is effective in reducing patient relapse and enhancing the outcomes of vocational
rehabilitation for patients with schizophrenia.
Recently newer versions of psychoeducative interventions have been pouring into the field of mental
health in a steady manner. Few years ago Bäuml et al. (2007) discovered a brief, eight-session
psychoeducation programme for the families with psychotic patients. Whereas Pollio et al. (2006) had
even experimented 1 day format of psychoeducation. It is on a new, compact format ofpsychoeducation
for relatives of patients with severe mental illness, including schizophrenia, bipolar disorder, major
depression, and other affective disorders. During the workshop activities like lecture sessions (descriptive
and diagnostic information on schizophrenia and mood disorders, biological basis of mental illness,
including neurochemistry and genetics, and medication and other treatment options), informal discussions
among participants (family members and therapists), and finally brief didactic presentation on issues like
‘identification of family resources’, ‘sharing of success stories’, ‘ask the doctors’, ‘religion’, and ‘legal
rights of the mentally ill persons’. Another example of newer psychoeducation approach is offering
psychoeducational intervention for patients with different diagnoses. Generally in group psychoeducation
is given to the individuals with same diagnosis but in smaller psychiatric set ups diagnosis-specific
psychoeducational groups are difficult to assemble due to the fact that there are not enough patients with
the same diagnosis, combining patients with different diagnoses into one group and providing them with
some basic information regarding illness, daily life skills and problem-solving and coping skills can be
done by this psychoeducational approach (Rummel-Kluge & Kissling, 2008). Another example of
recently developed form of psychoeducation is ‘peer-to-peer psychoeducation’. In this psychoeducation
model few carefully selected patients and relatives of patients work as group moderators after having
participated in special training. This approach is found to be more acceptable because of few things like
‘presence of more informal atmosphere’, ‘receiving feedbacks from the people of same hierarchy’, ‘more
cohesiveness in group’, ‘altruism’. Short-term outcomes of the peer-led groups were comparable to or
even better than those in similar groups with professional moderators (Rummel-Kluge & Kissling, 2008).
McWilliams et al. (2007) thought of a new angle of psychoeducation by looking at specific sex aspects in
psychoeducation for caregivers in schizophrenia: male caregivers gained more knowledge about ‘risk
factors’, whereas female caregivers gained more overall knowledge especially in the areas ‘signs and
symptoms’, ‘recovery’, and ‘caregiver support’. He tried to distribute the therapeutic tasks as per the
gender of the key caregivers.
Transcultural aspects of psychoeducation:

Culture has got very significant role in psychoeducation process. While giving psychoeducative services
to the targeted people the therapist should have the optimum understanding over the socio-cultural
background of them and set the plan of psychoeducation in accordance with cultural norms. Many
specifically designed psychoeducation based family intervention models were developed in past and some
of them had shown lot of promises to help those families who have culturally different from the dominant
culture of the concerned society. Psychotherapeutic interventions which use educational methods to
disseminate information increase one’s ability to recognize symptoms and signs of illness have to
recognize the socio-cultural milieu of their recipients. If those interventions are to be growth-oriented,
then the specific quality like cultural-specificity must be there. A culturally specific psychoeducational
approach uses as well as implements an educational modality with a culture-specific content to orient
minority populations to professional counseling as a viable coping resource. In a multiracial and
multiethnic modern society heterogeneity among citizens is an expected phenomena so distinct cultural
diversity and sub-groupism within a large society should be recognized and respected by the therapists,
especially mental health professional. Cultural specificity in the intervention process would ensure the
appropriate dissemination of information to the people as well as appropriate interpretation of the culture-
bound vulnerabilities that place specific populations at risk for various emotional distresses; this full
knowledge of culture specific risk factors is a necessary prerequisite for primary and secondary
interventions. Thus, without a clear acknowledgment of such risk factors, it is unlikely that one would

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seek professional counseling services, let alone benefit from primary and secondary interventions
(Kleinman & Good, 1985; Helzer et al., 1990).
One such example was Bae & Kung’s (2000) family intervention model, where these authors had tried a
distinctively designed family intervention model for providing help to Chinese-American people. Their
model designed to meet the unique sociocultural needs of Asian-American schizophrenia patients and
their families. This was a five-stage model which consists of: preparation, engagement,
psychoeducational (i.e., survivor skills) workshop, family sessions, and an ending stage. Guidelines and
specific suggestions for implementing each of these stages are planned and offered as a means of dealing
appropriately with Asian Americans' differential value orientations and cultural characteristics. Later Shin
& Lukens (2002) saw the effect of psychoeducation for Korean Americans with chronic mental illness.
These authors planned this study to see how Korean-American people get into the mental health service
delivery system of USA and also how they view, interpret and cope with mental health problems.
Because Korean Americans' access to mental health services may be limited due to differences in their
views of mental illness compared with Western community, unfamiliarity with treatment methods, and
cultural associations of social stigma with mental problems. Shin & Lukens (2002) collected the data
from an urban outpatient clinic to assess the effects of a ten-week psychoeducational intervention for
Korean Americans with chronic mental illness. They came up with the view that a culturally sensitive
psychoeducational intervention is a useful short-term treatment modality for Ethnic Minority people like
Korean people settled in USA with a diagnosis of schizophrenia.
Limitation of psychoeducation: Critical Analysis:

Since its first application psychoeducation seems to be an inseparable part of psychiatric treatment. Since
its inception many authors recommend the clinical use of psychoeducational interventions (PEI), but the
nature of such interventions varies widely and evidence for their effectiveness far from conclusive (Chan,
2006). While exploring the caveats of psychoeducation Dixon et al (1999) have identified some barrier on
the part of policy and implementing organization in the forms of high workload to staffs, higher cost
involvement, skepticism, philosophical differences and lack of leadership. Another major limitation of
psychoeducation is does act appropriately alone; it needs to be attached with other modes of psychiatric
treatment. Another limitation of psychoeducation is meddling effect of cultural disposition and belief
system of the targeted group. Psychoeducation nowadays has become a clinical jargon and fashion to a
section of mental health professionals; those people tend to use it indiscriminately and improperly without
considering the factors like psychological mindedness of the patient, motivation level, family’s basic
value and belief system, coping mechanism, literacy level etc. In developing world if the Western forms
of psychoeducation are applied blindly then it would not be emerged as an acceptable mode of treatment,
so psychoeducation has to be culture specific and need-based.
Psychoeducation: limited to psychiatry or applicable to physical disorders too:

There are many researches which have mentioned that family has a powerful influence on physical health,
the evidence for the effectiveness of family interventions in physical illness is less conclusive. Family
therapy and other forms of family interventions like family psychoeducation, support groups and parental
psychoeducational group might as well have effectiveness in chronic physical illnesses such as asthma
and diabetes. Family interventions have also been shown to be effective in the management of some
cardiovascular and neurologic disorders and for the treatment of obesity. Family therapy appears to be
more effective than individual therapy for some groups of patients with anorexia nervosa (Campbell &
Patterson, 2007). Some authors examined the role of psychoeducation in the treatment and aftercare of the
individuals with chronic physical illnesses. For that purpose specific psychoeducation based approach like
multiple-family discussion group (MFDG) can be of use. This is relatively a novel psychosocial
intervention for families and patients experiencing the chronic phase of a disabling medical illness. The
intervention, a short-term, highly structured, psychoeducationally oriented was developed within the
context of a clinical research program and has been successfully applied to a heterogeneous range of
disabling medical illnesses (Gonzalez et al., 1989). Beale (2006) did a comprehensive review of the
empirical studies of the efficacy of psychological interventions as adjuvant therapies for children with
pediatric diabetes, cancer, cystic fibrosis, and sickle cell disease. The author stated that adjuvant
psychological interventions for paediatric chronic illnesses appear in general to be efficacious associated
with a large mean Effect Size across a range of outcome variables. Albeit author pointed that more studies
are required in future in this area to have definitive conclusions. In case of chronic physical ailment like
Rheumatoid Arthritis (RA) psychological factors do play important role in the course and outcome of
illness. Many researchers had earlier mentioned that psychological stress has some bearing on the course
and outcome of Rheumatoid Arthritis (RA). Psychological factors like co-morbid depression, anxiety,
personality characteristics and cognitions related to Rheumatoid Arthritis (RA) have got some influential
role in Rheumatoid Arthritis (RA). Presence of depression and anxiety would add more problems to the
persons with Rheumatoid Arthritis (RA), so psychological interventions like individual psychotherapy
and psychoeducation could be augmented with physical methods of treatment (Creed, 1990). In case of
sexually transmitted disease like Genital herpes psycho-educative approach can be a very good option to
ensure good prognosis of illness. Genital herpes has serious long-term psychological and physical
consequences for individuals who contract the disease. Because of the chronic, reoccurring nature of

Deepanjan, Page
genital herpes, these people need education about the transmission of the herpes virus and about safer
sexual practices in addition to emotional support. Intervention like Psychoeducational groups may be
added as an adjunctive intervention for these people to let them know about the grey areas of illness and
give them a platform to develop their self-esteem and efficacy (Madrid & Swanson, 1995). Olmstead et al
(2002) conducted a study to evaluate the effect of a six-session psychoeducation (PE) program on young
women with type 1 diabetes mellitus (DM) and disordered eating attitudes and behaviour. For the purpose
of their study authors contacted 212 young women with simultaneous eating disturbances and diabetes
mellitus (DM) and who have been attending a paediatric diabetes clinic for some times. Of these women,
130 passed the screening and were invited to participate in the intervention phase of the study. Eighty-five
subjects were randomized to the PE or treatment-as-usual group. Assessments were conducted before and
after treatment and at 6-month follow-up. The psychoeducation (PE) group had shown significant
improvement in their eating behaviour and styles.
In chronic physical illness family caregivers always have be at their toes deal with daunting and complex
tasks of patient care at home. They would also deal with extensive coordination of care, including
symptom management, disability, mobility, and dressings. Due to these issues caregivers often feel to be
sapped and exhausted, isolated, and overwhelmed, because they lack support, training, information and a
sympathetic listening by the experienced clinicians and professionals. Furthermore, some family
caregivers who are employed report missing work, taking personal days, and quitting or retiring early to
provide care. This way, chronic physical illness affects not only the lives of those suffering from disease
but also those of family members who care for them. Attending to the impacts of chronic illness on family
members is important because the physical and emotional health of family caregivers has the potential to
influence the health, welfare and successful rehabilitation of persons with such chronic illness. One
theoretical construct namely ‘Family Stress Theory’ provides a way of viewing the family's relentless
endeavours over time to adapt to multiple stressors through using family resources and perceptual factors
as a coping mechanism. Families need to overpower the stress in to maintain the family’s homeostasis. In
many occasions a family has to address multiple changes and demands simultaneously, not single
stressors or the primary stressor. Secondary stressors, such as role change, responsibility, and care-giving
demands, emerge from the primary stressors and these strains often may be difficult to resolve. They
become instead a source of chronic strain. Chronic strain causes a build-up of unresolved stressors and
contributes to undesirable characteristics in the family environment. An Ideal family intervention plan for
helping the family to be more knowledgeable about the illness and more efficient to deal with the stresses
should includes the following strategies: (a) commitment of all family members to work on the problems;
(b) inclusion of all past successful coping strategies; (c) brainstorming of all possible strategies; (d) use of
strategies that are flexible, reality-oriented, and open to expression of emotions; and (e) discussion of
possible outcomes of all strategies (Goode et al., 1998; Lim & Zebrack, 2004).
Status of Psychoeducation in India:

A large body of research has unequivocally demonstrated the efficacy of structured psychoeducation in
the long term treatment and rehabilitation of psychiatric disorders, especially those disorders which are
generally chronic and have varied course. Progress achieved in the field of formal psychoeducation based
family interventions in the West has not generally been paralleled by similar advances in developing
countries, including India. In these countries, families have traditionally been deemed as the natural
partners in the care of persons with severe mental disorders. Yet, these families do not have the access to
enjoy the benefits of evidence-based psychoeducation oriented family interventions, chiefly because of
lack of infrastructure and other logistic reasons. The bulk of such evidence from developing nations
seems to consist of a handful of randomized-controlled trials (RCTs), majority of them were from China.
These trials categorically demonstrate that a relatively simple psychoeducational approach can be
implemented in routine clinical settings and can have very rewarding results. Structured
psychoeducational intervention has emerged as superior to standard ⁄ routine outpatient care in almost all
these trials. Benefits appear to be much more than similar trials conducted in the Western World. In those
limited numbers of clinical trials conducted in Developing countries results were very satisfactory as
introduction of psychoeducation along with other therapies led to improvement in several areas like
relapse ⁄ re-hospitalization rates, psychotic symptoms, medication adherence, social functioning, relatives
knowledge and attitudes, family burden, caregivers’ perception of support and their sense of self-efficacy.
In India so called structured form of psychoeducative family or patient oriented intervention has never
been adjudged as very much important by mental health professionals because of few inherent reasons,
e.g., Indian families have never been excluded from the treatment process, are more tolerant and
supportive towards their ailing members, more accommodative towards them and believe in plurality and
inclusiveness not individualism like West. Additionally structured psychoeducation based family
interventions are costly, time-consuming and labour-intensive, which makes them unsuitable for countries
like India where trained personnel and mental-health services are scarce. According to Shankar & Rao
(2005) not only do an overwhelming majority of Indian patients live with their natural caregivers, but the
primary kinship network of these people has a pre-eminent role in the decision making process related to
treatment. This high level of involvement of Indian families in the patient’s care is partly because of their
choice, and partly because of the scantiness and inadequacy of the mental-health infrastructure of the
country. Shankar & Rao (2005) proposed that one remedy for the situation would be to provide support to

Deepanjan, Page
families by implementing formal family interventions that are culturally congruent, socially appropriate,
economical and widely applicable. In India there are very few studies available which examined the
efficacy of formal psychoeducation over Indian population. One study examined the group-based
educational interventions with caregivers, which showed that application of such mode of intervention
could improve attitudes and reduce burden in families. However, such interventions are generally of short
duration, and most studies are not controlled. There have been only two RCTs; one of them was home-
care treatment (Thara et al., 2005) and a more recent one that examined the effect of a relatively brief
structured educational intervention on explanatory models of relatives of patients with schizophrenia (Pai
et al., 1985; Das et al., 2006). The lack of further RCTs is particularly disappointing given the fact that
both these controlled trials reported significant benefits for structured interventions. More recently
Kulhara et al (2009) conducted a randomized-controlled trial of structured family interventions over 76
patients with schizophrenia and their key caregivers. This study aimed to evaluate the impact of a
structured psychoeducational intervention for schizophrenia, compared with standard out-patient
treatment, on various patient- and caregiver-related parameters. For the purpose of study authors
randomly allocated the selected patients and their key caregivers into either a structured
psychoeducational intervention (n = 38) consisting of monthly sessions for 9 months or routine out-
patient care (n = 38) for the same duration. Psychopathology was assessed on monthly basis. Disability
levels, caregiver-burden, caregiver-coping, caregiver-support and caregiver-satisfaction were evaluated at
baseline level and at the end of the study. At the end these authors commented that structured
psychoeducational intervention can be a better option than routine out-patient care for the long term
treatment of the persons with severe mental disorders. It can work positively on psychopathology,
disability, caregiver-support and caregiver satisfaction. In India such kind of structured psychoeducational
intervention package is ideal because of its feasibility and cost-effectiveness. In Central Institute of
Psychiatry some studies related to psychoeducation were carried out by various researchers time to time.
Examples of some of them are:
a) Pillai, R.R., Sahu, K.K., Matthew, V., Hazra, S., Chandran, P., Ram, D. (2010).Rehabilitation
Needs of Persons with Major Mental Illness in India. International Journal of Psychosocial
Rehabilitation, 14(2), 95-104.
b) Ameen, S. & Nizamie, S.H. (2004). The internet revolution: implications for mental health
professionals. Indian Journal of Social Psychiatry. 20 (1-4), 16–26.
Psychoeducation to special population:

A. Children & Adolescents-
Children and Adolescents with psychiatric disorders experience usually do have poorer prognostic
outcomes than adults; in many case these manifest in episodic symptom relapses, frequent readmission to
mental hospital, and gross impairment in social functioning. The significant impact of psychotic disorders
in adolescents extends to their families because, after discharge from mental hospital, management and
aftercare of them comes to family from the inpatient mental health setting. For child and adolescent
patients, the responsibility of monitoring, managing and supporting their conditions typically moves to
the parents, as the majority of these patients reside with their families. Very often, families and parents
feel overtaxed or burdened, stigmatized, and could not match up them with expected level of care to
patients, or even they question the diagnosis and treatment recommendations, which can in turn
contribute to poor treatment, low medication adherence, insufficient support, relapse, and frequently
rehospitalization. Parents report a sense of burden and feelings of anxiety, anger, and helplessness when
their child develops a primary psychotic disorder such as schizophrenia or BPAD. Individual and family
outcomes are further impacted by patients’ ability to adhere to treatment and medication and the level of
expressed emotion within the family environment. In children and adolescent populations more intensive
pyshcoeducational models are required. Models like Behavioral Family Management, psychoeducational
multiple family group (PMFG) intervention and Family-to-Family Education Program emerged as mostly
effective interventions for adolescent and children group. The hallmark of these interventions is inclusion
of a psychoeducational element that combines therapeutic factors with the imparting of information and
therapeutic support to enable patients to engage in behavioral change. The behavioral family model
focuses on behavioral changes that influence family communication and problem-solving techniques. The
family educational model, centred on intensive engagement of several families together, provides
evidence-based education about mental illness and its treatment and guidelines for recovery. The
psychoeducational multiple family group intervention positively influences a number of social and
clinical factors associated with the management of schizophrenia, including extending periods of
remission, lowering relapse rates, reducing inpatient stays, increasing knowledge, enhancing medication
adherence rates, and promoting family support and problem-solving skills training. In case of children
and adolescents with mood disorders interventions like parent and family group sessions with the focus
on “developing strategies to deal with negative family cycles, the stress of parenting a child with a mood
disorder and specific issues for managing manic and depressive symptoms” were shown to have some
effectiveness. In addition to that children and adolescents are given the social skills training (Gearing,
2008). Ruffolo et al (2005; 2006) at the University of Michigan had examined the PMFG for
parents/primary caregivers of children with serious emotional disturbances (SED), specifically Attention
Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). The intervention is

Deepanjan, Page
based on a problem-solving ideology that emphasizes the raising of social supports and increasing
knowledge of child mental illness to foster parental empowerment. Pollio et al (2005) examined a school-
based brief psychoeducational intervention and found that this intervention is an effective programme for
parents with mentally ill children and adolescents. Miklowitz et al (2004) developed a specific model of
family intervention especially for adolescents as “Family Focussed Therapy for Adolescents (FFT-A).
This model was developed for the adolescents with mood disorders with the aims like:
a. Make sense of cycling mood and influencing factors,
b. Recognize their vulnerability to the disease and plan to prevent or delay future symptoms,
c. Accept medications,
d. Accept the illness,
e. Manage stressors,
f. Promote a stable family environment (Miklowitz et al., 2004).
B. Women-
In women psychoeducational models were tried by few researchers, like Zanarini & Frankenburg (2008)
where they did a randomized trial of psychoeducation for women with borderline personality disorder.
The main objective of this study was to determine whether being taught the latest information concerning
borderline personality disorder (BPD) leads to a decline in core BPD symptoms and an improvement in
psychosocial functioning. Fifty-five late adolescent women participated in a rigorous diagnostic
assessment and 50 met DIB-R and DSM-IV criteria for BPD. All 50 were informed that they met criteria
for BPD. Then 30 were randomized to a psychoeducation workshop that took place within a week of
diagnostic disclosure. The other 20 were assigned to a waitlist and participated in the workshop at the end
of this 12-week study. Authors commented that informing patients about BPD immediately after
diagnostic disclosure could be helpful to reduce the severity of two of the core elements of borderline
psychopathology-e.g., general impulsivity and unstable relationships. Broto et al (2008) examined the
effectiveness of psychoeducation among the females with early-stage cervical and endometrial cancer.
Because cervical and endometrial cancer has been associated with significant sexual difficulties (Female
Sexual Arousal Difficulty or FSAD) in at least half of women following hysterectomy. Authors applied
three session psychoeducational intervention (PED) targeting FSAD in 22 women with early-stage
gynecologic cancer. The PED consisted of three, 1-h sessions that combined elements of cognitive and
behavioral therapy with education and mindfulness training. Results shown that there was a significant
positive effect of the PED on sexual desire, arousal, orgasm, satisfaction, sexual distress, depression, and
overall well-being, and a trend towards significantly improved physiological genital arousal and perceived
genital arousal. Sherman et al (In press: abstract taken from Science Directory) conducted a study on 249
patients early stage breast cancer to examine the physical, emotional, and social adjustment of them as
well as to compare the impact of psychoeducation (which was done by videotapes) and telephone
counseling, or psychoeducation plus telephone counseling as interventions that address the specific needs
of women during the diagnostic, postsurgery, adjuvant therapy, and ongoing recovery phases of breast
cancer. These authors found that psychoeducation by videotapes and telephone counseling were equally
effective in decreasing the side effect distress and side effect severity and increased psychological well-
being during the adjuvant therapy phase. Cousineau et al (2008) had tested the effectiveness of a brief
online education and support programme for female infertility patients. For this these females very often
do have psychological morbidities in the forms of depression and anxiety. These authors tried an online
format of psychoeducation over 190 female patients who were recruited from three US fertility centres.
They found that such online patient education intervention can have beneficial effects in several
psychological domains and may be a cost effective resource for these females.
Summary, conclusion & future direction:

Providing optimal care to the population of individuals with severe mental illness requires multiple
provisions of services to families. The failure to achieve even minimal family involvement and
cooperation in the treatment process may be emerge as great concern in the long run. In the simplest
terms: we need to offer family psychoeducation to more families, and we need to develop an evidence
base for complementary family services. Implementing family psychoeducation is a challenge, and to
maximize its positive effect we need to know the critical aspects, or mediators, of various family
psychoeducation models. At the same time psychoeducation has to be individualized or tailor-made for
each patient or each family unit. Every psychoeducational model cannot be applied over all family units
indiscriminately. Additionally, without considering few factors like illness related, socio-demographic,
socio-cultural and family factors psyhcoeducation cannot be successful.

Deepanjan, Page
References:
Akkerman, R.L. & Ostwald, S.K. (2004). Reducing anxiety in Alzheimer's disease family caregivers: The
effectiveness of a nine-week cognitive-behavioral intervention. American Journal of Alzheimer’s
disease and Other Dementias, 19(2), 117-123. Full Text of the Article Downloaded from:
http://aja.sagepub.com/content/19/2/117. on 27/09/2010.
Andlin-Sobocki, P., Wittchen, H.U., 2005. Cost of anxiety disorders in Europe. European Journal of Neurology, 12
(Suppl. 1), 39–44. As cited in C Kluge-Rummel., G Pitschel-Walz, W Kissling, W. (2009).
Psychoeducation in anxiety disorders: Results of a survey of all psychiatric institutions in Germany,
Austria and Switzerland. Psychiatry Research, 169, 180–182.
Bauml J, Pitschel-Walz G. Psychoedukation bei schizophrenen Erkrankungen. Stuttgart, Germany: Schattauer;
2003. Article in German. As cited in: J Baüml, T Frobo¨se, S Kraemer, M Rentrop, and G Pitschel-
Walz (2006). Psychoeducation: A basic psychotherapeutic intervention for patients with schizophrenia
and their families. Schizophrenia Bulletin, 32(1), S1-S9. Downloaded from
http://schizophreniabulletin.oxfordjournals.org on September 6, 2010.
Bauml, J., Frobose, T., Kraemer, S., Rentrop, M. and Pitschel-Walz, G. (2006). Psychoeducation: A basic
psychotherapeutic intervention for patients with schizophrenia and their families. Schizophrenia
Bulletin, 32(1), S1-S9. Downloaded from http://schizophreniabulletin.oxfordjournals.org on
September 6, 2010. (Major Reference).
Bae, S.W. & Kung, W.W. (2000). Family intervention for Asian Americans with a schizophrenic patient in the
family. American Journal of Orthopsychiatry, 70(4), 532-541. (Abstract).
Bäuml, Josef, et al. Psychoeducation: A Basic Psychotherapeutic Intervention for Patients with Schizophrenia and
Their Families. Schizophrenia Bulletin. 2006 32 (Supplement 1): S1-S9.
Beale, I.L. (2006). Scholarly literature review: Efficacy of psychological interventions for pediatric chronic
illnesses. Journal of Pediatric Psychology 31(5), 437–451.
Biegel, D. E., Sales, E., & Schulz, R. (1991). Family caregiving in chronic illness. Newbury Park, CA: Sage
Publications. As cited in: McDonnell, M.G., Short, R.A., Berry, C.M., Dyck, D.G. (2003). Burden in
schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality.
Family Process, 42, 91-103.
Brotto, L.A., Heiman, J.R., Goff, B., Greer, B., Lentz, G.M., Swisher, E., Tamimi, H., Blaricom, A.V. (2008). A
psychoeducational intervention for sexual dysfunction in women with gynecologic cancer. Archives of
Sexual Behavior, 37(2), 317-329. (Abstract).
Campbell, T.L. & Patterson, J.M. (1995). The effectiveness of family interventions in the treatment of
physical illness. Journal of Marital and Family Therapy, 21(4), 545-583. (Abstract).
Colom, F., Vieta, E., Moreno-Sánchez, J., Martínez-Arán, A., Torrent, C., Reinares, M., Manuel Goikolea, J.,
Benabarre, A., Comes, M. (2004). Psychoeducation in bipolar patients with comorbid personality
disorders. Bipolar Disorder, 6, 294–298.
Colom, F., Vieta, E., Reinares, M., Martinez-Aran, A., Torrent, C., Goikolea, J. et al. (2003). Psychoeducation
efficacy in bipolar disorders: Beyond compliance enhancement. Journal of Clinical Psychiatry, 64,
1101-1105.
Colom, F., Vieta, E., Sanchez-Moreno, J., Martinez-Aran, A., Torrent, C., Reinares, M. et al. (2004).
Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disorders, 6, 294-
298.
Coon, D.W., Thompson, L., Steffen, A., Sorocco, K., Gallagher-Thompson, D. (2003). Anger and depression
management: Psychoeducational skill training interventions for women caregivers of a relative with
dementia. The Gerontologist, 43(5), 678-689. (Abstract)
Cousineau1, T.M., Green, T.C., Corsini, E., Seibring, A., Showstack, M.T., Applegarth, L., Davidson, M., Perloe,
M. (2008). Online psychoeducational support for infertile women: A randomized controlled trial.
Human Reproduction, 23(3), 554–566. Downloaded from: Downloaded from
humrep.oxfordjournals.org.
Creed, F. (1990). Psychological disorders in rheumatoid arthritis: A growing consensus? Annals of the Rheumatic
Diseases, 49, 808-812. Downloaded from ard.bmj.com on September 27, 2010 - Published by
group.bmj.com.
Das, S., Saravanan, B., Karunakaran, K.P., Manoranjitham, S., Ezhilarasu, P., Jacob, K.S. (2006). Effect of a
structured educational intervention on explanatory models of relatives of patients with schizophrenia.
Randomised controlled trial. British Journal of Psychiatry, 188, 286–287.
Depp, C., Krisztal, E., Cardenas, V., Oportot, M., Mausbach, B., Ambler, C., Leung, L., Gallagher-Thompson, D.
(2003). Treatment options for improving wellbeing in dementia family caregivers: The case for
psychoeducational interventions. Clinical Psychologist, 7(1), 21 – 31. (Abstract).
Dixon, L., Adams, C., Huckstead, A. (2000). Update on family psycho-education for schizophrenia. Schizophrenia
Bulletin, 26(l), 5-20. (Major Reference).
Dixon, L., Lyles, A., Scott, J. et al. (1999). Services to families of adults with schizophrenia: From treatment
recommendations to dissemination. Psychiatric Services, 50, 233-238.
Donker, T., Griffits, K.M., Cuijpers, P., Christensen, H. (2009). Psychoeducation for depression, anxiety and
psychological distress: A meta-analysis. Child and Adolescent Psychiatry and Mental Health, 7:79
Downloaded from: http://www.biomedcentral.com/1741-7015/7/79.
Drake, R.E., Mercer-McFadden, Mueser, K.T., McHugo, Bond, Q.R. (1998). Review of integrated mental health
and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24(4), 589-608.
Falloon, I.R.H. & Pederson, J. (1985). Family management in the prevention of morbidity of schizophrenia: The
adjustment family unit. British Journal of Psychiatry, 147, 156-163.
Falloon, I.R.H.; Boyd, J.L.; McGill, C.W.; Ranzani, J.; Moss, H.B.; and Gilderman, A.M. (1982). Family
management in the prevention of exacerbation of schizophrenia: A controlled study. New England
Journal of Medicine, 306, 1437-1440.

Deepanjan, Page
Falloon, I.R.H.; Boyd, J.L.; McGill, CW.; Razani, J.; Moss, H.B.; and Gilderman, A.M. (1982). Family
management in the prevention of exacerbations of schizophrenia. New England Journal of Medicine,
306, 1437–1440. (Abstract)
Freeman, J.B., Choate-Summers, M.L., Garcia, A.M., Moore, P.S., Sapyta, J.J., Khanna, M.S., March, J.S., Foa,
E.B., Franklin, M.E. (2009). The Pediatric Obsessive-Compulsive Disorder Treatment Study II:
rationale, design and methods. Child and Adolescent Psychiatry and Mental Health, 3:4. Downloaded
from http://www.capmh.com/content/3/1/4 on 25/09/2010.
Gearing, R.W. (2008). Evidence-based family psychoeducational interventions for children and adolescents with
psychotic disorders. Journal of Canadian Academy of Child and Adolescents Psychiatry, 17, 3-11.
Gibbons, J. S., Horn, S. H., Powell, J. M., & Gibbons, J. L. (1984). Schizophrenic patients and their families: A
survey in a psychiatric service based on a DGH unit. British Journal of Psychiatry, 144, 70-77.
Gitlin, M.J., Swendsen, J., Heller, T.L., Hammen, C. (1995). Relapse and impairment in bipolar disorder. American
Journal of Psychiatry, 152, 1635–1640.
Goldman, C.R. & Quinn, F.L. (1988). Effects of a patient education program in the treatment of schizophrenia.
Hospital and Community Psychiatry, 39(3), 282–286.
Goldstein, M.J.; Rodnick, E.H.; Evans, J.R.; May, P.R.; and Steinberg, M.R. (1978). Drug and family therapy in the
aftercare of acute schizophrenics. Archives of General Psychiatry, 35, 1169-1177.
Gonzalez, S., Steinglass, P., Reiss, D. (1989). Putting the illness in its place: discussion groups for families
with chronic medical illnesses. Family Process, 28(1), 69-87.
Goode, K.T., Haley, W.E., Roth, D.L., Ford, G.R. (1998). Predicting longitudinal changes in caregiver physical and
mental health: A stress process model. Health Psychology, 17, 190-198.
Gould, M., Greenberg, N. & Hetherton, J. (2007). Stigma and the military: evaluation of a PTSD psychoeducational
program. Journal of Traumatic Stress. 20(4), p. 505-515. (Abstract).
Gray, M.J., Elhai, J.D., & Frueh, B.C. (2004). Enhancing patient satisfaction and increasing treatment compliance:
Patient education as a fundamental component of PTSD treatment. Psychiatric Quarterly, 75(4), 321-
332.
Harkness, L. & Zador, N. (2001). Treatment of PTSD in Families and Couples. In Wilson, J, Friedman, M. & Lindy
J. (Eds) Treating Psychological Trauma and PTSD (pp. 335-353). New York: Guilford Press.
Helzer, J. E., Canino, G. J., Yeh, E. K., Bland, R. C., Lee, C. K., Hwu, H. G., & Newman, S. (1990). Alcoholism-
North American and Asia. Archives of General Psychiatry, 47, 313-319. (Abstract).
Hepburn, K.W., Lewis, M., Sherman, C.W., Tornatore, J. (2003). The Savvy Caregiver Program: Developing and
testing a transportable dementia family caregiver training program. The Gerontologist, 43(6), 908-915.
(Abstract)
Hoffman, P.D., Fruzzetti, A.E., Buteau, E., Neiditch, E.R., Penney, D., Bruce, M.L., Hellman, F., Struening, E.
(2005). Family Connections: A program for relatives of persons with borderline personality disorder.
Family Process, 44(2), 217-225. (Abstract).
Hogarty, G.E., Anderson, C.M., Reiss, D.J. et al. (1986). Family psychoeducation, social skills training, and
maintenance chemotherapy in the aftercare treatment of schizophrenia. I. One-year effects of a
controlled study on relapse and expressed emotion. Archives of General Psychiatry, 43, 633-642.
Hogarty, G.E., Anderson, C.M., Reiss, D.J. et al. (1991). Family psychoeducation, social skills training, and
maintenance chemotherapy in the aftercare treatment of schizophrenia. II. Two-year effects of a
controlled study on relapse and adjustment. Environmental-Personal Indicators in the Course of
Schizophrenia (EPICS) Research Group. Archives of General Psychiatry, 48, 340-347.
Hogarty, G.E. & Anderson, C.M. (1986). Medication, family psycho-education and social skills training: First year
relapse results of a controlled study. Psychopharmacology Bulletin, 1986, 22, 860–862. (Abstract)
Hogarty, G.E.; Anderson, C.M.; Reiss, D.J.; Kornblith, S.J.; Greenwald, D.P.; Ulrich, R.F.; and Carter, M. (1991).
Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare
treatment of schizophrenia: II. Two-year effects of a controlled study on relapse and adjustment.
Archives of General Psychiatry, 48, 340–347. (Abstract)
Hogarty, G.E.; Anderson, CM.; Reiss, D.J.; Kornblith, S.J.; Greenwald, D.P.; Javana, CD.; Madonia, M.J. (1986).
The Environmental/ Personal Indicators in the Course of Schizophrenia Research Group. Family
psychoeducation, social skills training and maintenance chemotherapy in the aftercare treatment of
schizophrenia: I. One year effects of a controlled study on relapse and expressed emotion. Archives of
General Psychiatry, 43, 633-642.
Hogarty, G.E.; Anderson, CM.; Reiss, D.J.; Kornblith, S.J.; Greenwald, D.P.; Ulrich, R.F.; and Carter, M. (1991).
Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare
treatment of schizophrenia: II. Two-year effects of a controlled study on relapse and adjustment.
Archives of General Psychiatry, 48, 340-347.
Huband, N., McMurran, M., Evans, C., Duggan, C. (2007). Social problem-solving plus psychoeducation for adults
with personality disorder: Pragmatic randomized controlled trial. British Journal of Psychiatry, 190,
307-313.
Judge, K.S., Yarry, S.J., Orsulic-Jeras, S. (2010). Acceptability and feasibility results of a strength-based skills
training program for dementia caregiving dyads. The Gerontologist, 50(3), 408-417. (Abstract)
Kang, J. & Acton, G.J. (2001). Interventions to reduce the burden of caregiving for an adult with dementia: A Meta-
Analysis. Research in Nursing and Health, 24, 349-360. Downloaded from:
http://ot.creighton.edu/community/EBLP/Question5/Acton%202001%20Interventions%20to
%20reduce%20the%20burden%20of%20caregiving.pdf. (Date of Download- 27/09/2010).
Kleinman, A., & Good, B. (1985). Culture and depression. Berkeley: University of California Press. (Taken from
Google Books).
Kluge-Rummel, C. & Kissling, W. (2008). Psychoeducation in schizophrenia: New developments and approaches in
the field. Current Opinion in Psychiatry, 21, 168–172.

Deepanjan, Page
Koenigsberg, H.A. & Handley, R. (1986). Expressed emotion: From predictive index to clinical construct. American
Journal of Psychiatry, 143, 1361-1373.
Köttgen, C.; Sönnichsen, I.; Mollenhauer, K.; and Jurth, R. (1984). Group therapy with the families of schizophrenic
patients: Results of the Hamburg Camberwell-family-interview study III. Journal of Family
Psychiatry, 5, 84–94. (Abstract)
Kulhara P, Chakrabarti S, Avasthi A, Sharma A, Sharma S. (2009). Psychoeducational intervention for caregivers of
Indian patients with schizophrenia: A randomized-controlled trial. Acta Psychiatrica Scandinavica,
119, 472–483.
La salvia, T.A. (1993). Enhancing addiction treatment through psychoeducational groups. Journal of Substance
Abuse Treatment, 10(5), 439-444. (Abstract).
Leff, J., Berkowitz, R., Shavit, N., Strachan, A., Glass, I., & Vaughn, C. (1989). A trial of family therapy v. a
relatives group for schizophrenia. British Journal of Psychiatry, 154, 58-66.
Leff, J.; Berkowitz, R.; Shavit, N.; Strachan, A.M.; Glass, I.; and Vaughn, C. (1990). A trial of family therapy
versus a relatives’ group for schizophrenia. British Journal of Psychiatry, 157, 571–577.
Leff, J.; Kuipers, L.; Berkowitz, R.; Eberlein-Vries, R.; and Sturgeon, D. (1982). A controlled trial of social
intervention in the families of schizophrenic patients. British Journal of Psychiatry, 141, 121–134.
Leff, J.P.; Kuipers, L.; Berkowitz, R.; and Sturgeon, D. (1985). A controlled trial of social intervention in the
families of schizophrenia patients: Two-year follow-up. British Journal of Psychiatry, 146, 594-600.
Leff, J.P.; Kuipers, L.; Berkowitz, R.; Eberlein-Fries, R.; and Sturgeon, D. (1982). A controlled trial of social
intervention in schizophrenia families. British Journal of Psychiatry, 141, 121-134.
Lehman, A.F., & Steinwachs, D.M. (1998). Patterns of usual care for schizophrenia: Initial results from the
schizophrenia patient outcomes research team (PORT) client survey. Schizophrenia Bulletin, 24(1),
11-20.
Lehman, A.F., Steinwachs, D.M., and PORT co-investigators. (1988). At Issue: Translating research into practice:
The Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations.
Schizophrenia Bulletin, 24(1), 1-10.
Lim, J. & Zebrack, B. (2004). Caring for family members with chronic physical illness: A critical review of
caregiver literature. Health and Quality of Life Outcomes, 2:50. This article is available from:
http://www.hqlo.com/content/2/1/50.
Lincoln, T.M., Wilhelm, K., Nestoriuc, Y. (2007). Effectiveness of psychoeducation for relapse, symptoms,
knowledge, adherence and functioning in psychotic disorders: A meta-analysis. Schizophrenia
Research, 96 (1-3), 232-245.
Madrid, E. & Swansosn, J. (1995). Psychoeducational groups for young adults with genital herpes: Training group
facilitators. Journal of Community Health Nursing, 12(4), 189-198. (Abstract)
Magliano, L., Fiorillo, A., Malangone, C., De Rosa, C., Maj, M. (2006). Patient Functioning and Family Burden in
a Controlled, Real-World Trial of Family Psychoeducation for Schizophrenia and the Family
Intervention Working Group. Psychiatric Services 57, 1784–1791.
McFarlane, W.R.; Link, B.; Dushay, R.; Marchal, J.; and Crilly, J. (1995a). Psychoeducational multiple family
groups: Four-year relapse outcome in schizophrenia. Family Process, 34, 127–144. (Abstract)
McFarlane, W.R.; Lukens, E.; Link, B.; Dushay, R.; Deakins, S.A.; Newmark, M.; Dunne, E.J.; Horen, B.; and
Toran, J. (1995b). Multiple-family groups and psychoeducation in the treatment of schizophrenia.
Archives of General Psychiatry, 52, 679–687.
McWilliams, S., Hill, S., Mannion, N., et al. (2007). Caregiver psychoeducation for schizophrenia: Is gender
important? European Psychiatry, 22, 323–327. As cited in: C Kluge-Rummel. & W Kissling. (2008).
Psychoeducation in schizophrenia: New developments and approaches in the field. Current Opinion in
Psychiatry, 21, 168–172.
Miklowitz, D.J., Elizabeth, G.L., Jeffrey, R.A., Teresa, S.L., Richard, S.L. (2003). A randomized study of family-
focused psychoeducation & pharmacotherapy in the outpatient management of bipolar disorder.
Archives of General Psychiatry, 60, 904-912.
Miklowitz, D.J., George, E.L., Axelson, D.A., Kim, E.Y., Birmaher, B., Schneck, C., et al. (2004). Family focused
treatment for adolescents with bipolar disorder. Journal of Affective Disorders, 82 Suppl 1, S113-128.
Miklowitz, D.J.; Goldstein, M.J.; and Falloon, I.R.H. (1983). Premorbid and symptomatic characteristics of
schizophrenics from families with high and low levels of expressed emotion. Journal of Abnormal
Psychology, 92, 359-367.
Miklowitz, D.J.; Goldstein, M.J.; Falloon, I.R.H.; and Doane, J.A. (1984). Interactional correlates of expressed
emotion in the families of schizophrenics. British Journal of Psychiatry, 144, 482-487.
Mingyuan, Z., Heqin, Y., Chengde, Y., Jianlin, Y., Qingfeng, Y., Peijun, C., Lianfang, G., Jizhong, Y., Guangya,
Q., Zhen, W., Jianhua, C., Minghua, S., Jushan, H., Longlin, W., Yi, Z., Buoying, Z., Orley, J., and
Gittelman, M. (1993). Effectiveness of psychoeducation of relatives of schizophrenic patients: A
prospective cohort study in five cities of China. International Journal of Mental Health, 22, 47-59.
Olmsted, M.P., Daneman, D., Rydall, A.C., Lawson, M.L., Rodin, G. (2002). The effects of psychoeducation on
disturbed eating attitudes and behavior in young women with type 1 diabetes mellitus. International
Journal of Eating Disorders, 32(2), 230-239. (Abstract).
Ostwald, S.K., Kenneth, K.W., Caron, W., Burns, T., Mantell, R. (1999). Reducing caregiver burden: A randomized
psychoeducational intervention for caregivers of persons with dementia. The Gerontologist, 39(3),
299-309. Downloaded from: http://ot.creighton.edu/community/EBLP/Question5/ostwald%20et%20al
%201999%20Reducing%20caregiver%20burden.pdf. (Date of Download- 27/09/2010).
Pai, S., Channabasavanna, S.M., Nagarajaiah, M., Raghuram, R. (1985). Home care for chronic mental illness in
Bangalore: An experiment in the prevention of repeated hospitalization. British Journal of Psychiatry,
147, 175–179.
Pariante, C. M., & Carpiniello, B. (1996). Family burden in relatives of schizophrenics and of people with mental
retardation: A comparative study. European Psychiatry, 11, 381-385. As cited in: McDonnell, M.G.,

Deepanjan, Page
Short, R.A., Berry, C.M., Dyck, D.G. (2003). Burden in schizophrenia caregivers: impact of family
psychoeducation and awareness of patient suicidality. Family Process, 42, 91-103.
Perry, A., Tarrier, N., Morriss, R., McCarthy, E., & Limb, K. (1999). Randomized controlled trial of efficacy of
teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment.
British Medical Journal, 318(7177), 149-153.
Pitschel-Walz, G., Bäuml, J., FrobÖse, T., Gsottschneider, A., Jahn, T. (2009). Do individuals with schizophrenia
and a borderline intellectual disability benefit from psychoeducational groups? Journal of Intellectual
Disabilities, 13(4) 305-320.
Pitschel-Walz, G., Bäuml, J., Bender, W., Engel, R.R., Wagner, M., Kissling, W. (2006). Psychoeducation and
compliance in the treatment of schizophrenia: results of the Munich Psychosis Information Project
Study. Journal of Clinical Psychiatry, 67(3), 443-452.
Plasse, B.R. (2000). Components of engagement: women in a psychoeducational parenting skills group in substance
abuse treatment. Social Work with Groups, 22(4), 33-50. (Abstract).
Pollio, D.E., North, C.S., Reid, D.L/, et al. (2006). Living with severe mental illness: What families and friends
must know: Evaluation of a one-day psychoeducation workshop. Social Work, 51, 31–38. As cited in:
C Rummel-Kluge & W Kissling (2008). Psychoeducation in schizophrenia: New developments and
approaches in the field. Current Opinion in Psychiatry, 21, 168–172.
Rabinowitz, Y.G., Mausbach, B.T., Thompson, L.W., Gallagher-Thompson, D. (2007). The relationship between
self-efficacy and cumulative health risk associated with health behavior patterns in female caregivers
of elderly relatives with Alzheimer’s dementia. Journal of Aging and Health, 19(6), 946-964.
(Abstract).
Robinson, J., Sareen, J., Cox, B.J., Bolton, J. (2009). Self-medication of anxiety disorders with alcohol and drugs:
results from a nationally representative sample. Journal of Anxiety Disorders, 23, 38–45.
Ruffolo, M. C., Kuhn, M. T. & Evans, M. E. (2005). Support, empowerment, and education: A study of multiple
family group education. Journal of Emotional and Behavioral Disorders, 13(4), 200-212.
Ruffolo, M. C., Kuhn, M. T. & Evans, M. E. (2006). Developing a parent-professional team leadership model in
group work: work with families with children experiencing behavioral and emotional problems. Social
Work, 51(1), 39-47.
Rummel- Kluge, C., Pitschel-Walz, G., Kissling, W. (2009). Psychoeducation in anxiety disorders: Results of a
survey of all psychiatric institutions in Germany, Austria and Switzerland. Psychiatry Research, 169,
180–182.
Rummel, C.B., Hansen, W., Helbig, A., Pitschel-Walz, G., Kissling, W. (2005). Peer-to-peer psychoeducation in
schizophrenia: a new approach. Journal of Clinical Psychiatry, 66, 1580-1585.
Rummel-Kluge, C., Pitschel-Walz, G., Baüml, J., Kissling, W. (2006). Psychoeducation in schizophrenia—results
of a survey of all psychiatric institutions in Germany, Austria, and Switzerland. Schizophrenia
Bulletin, 32(4), 765–775.
Scazufca, M. & Kuipers, E. (1998). Stability of expressed emotion in relatives of those with schizophrenia and its
relationship with burden of care and perception of patients' social functioning. Psychological
Medicine, 28, 453-461.
Shankar, R. & Rao, K. (2005). From burden to empowerment: the journey of family caregivers in India. In:
Sartorius N, Leff J, Lo´pez-Ibor JJ, Okasha A, eds. Families and mental disorders. Chichester,
England: John Wiley & Sons, Ltd, 2005:259–290. As cited in: Kulhara P, Chakrabarti S, Avasthi A,
Sharma A, Sharma S. (2009). Psychoeducational intervention for caregivers of Indian patients with
schizophrenia: A randomized-controlled trial. Acta Psychiatrica Scandinavica, 119, 472–483.
Sherman, D.W., Haber, J., Hoskins, C.N., Budin, W.C., Maislin, G., Shukla, S., Cartwright-Alcarese, F., Beyer, C.,
Feurbach, R., Ortu, M., Rosedale, M. Roth, A. (In Press). The effects of psychoeducation and
telephone counseling on the adjustment of women with early-stage breast cancer. Applied Nursing
Research (In Press). (Abstract taken from Science Directory).
Shin, S.K. & Lukens, E.P. (2002). Effects of psychoeducation for Korean Americans with chronic mental illness.
Psychiatric Services, 53(9), 1125-1131.
Smith, J.V. & Birchwood, M.J. (1987). Specific and non-specific effects of educational intervention with families
living with a schizophrenic relative. British Journal of Psychiatry, 150, 645–652.
Solomon, P. (1996). Moving from psychoeducation for families of adults with serious mental illness. Psychiatric
Services, 47 (12), 1364-1370.
Stark, M.J. (1989). A psychoeducational approach to methadone maintenance treatment . Journal of Substance
Abuse Treatment, 6(3), 169-181.
Tarrier, N., Lowson, K.; and Barrowclough, C. (1991). Some aspects of family interventions in schizophrenia: II.
Financial considerations, British Journal of Psychiatry, 159, 481–484.
Tarrier, N.; Barrowclough, C.; Vaughn, C.; Bamrah, J.S.; Porceddu, K.; Watts, S.; and Freeman, H. (1988). The
community management of schizophrenia: A controlled trial of a behavioural intervention with
families to reduce relapse. British Journal of Psychiatry, 153, 532–542.
Tarrier, N.; Barrowclough, C.; Vaughn, C.; Bamrah, J.S.; Porceddu, K.; Watts, S.; and Freeman, H. Community
management of schizophrenia: A two-year follow- up of a behavioural intervention with families.
(1989). British Journal of Psychiatry, 625-628.
Telles, C, Karno, M., Mintz, J., Paz, G., Arias, M., Tucker, D., and Lopes, S. (1995). Immigrant families coping
with schizophrenia: Behavioral family intervention v. case management with a low-income Spanish-
speaking population. British Journal of Psychiatry, 167, 473-479.
Thara, R., Padmavati, R., Lakshmi, A., Karpagavalli, P. (2005). Family education in schizophrenia: A comparison
of two approaches. Indian Journal of Psychiatry, 47, 218–221.
Thompson, C.A., Spilsbury, K., Hall, J., Birks, Y., Barnes, C., Adamson, J. (2007). Systematic review of
information and support interventions for caregivers of people with dementia. BMC Geriatrics 2007,
7:18. Article Downloaded from: http://www.biomedcentral.com/1471-2318/7/18. On 27/09/2010.

Deepanjan, Page
Vaughan, K.; Doyle, M.; McConaghy, N.; Blaszczynski, A.; Fox, A.; Tarrier, N. (1992). The Sydney intervention
trial: A controlled trial of relatives' counselling to reduce schizophrenic relapse. Social Psychiatry and
Psychiatric Epidemiology, 27(1), 16-21.
Vieta, C.F., Martinez-Aran, A., Reinares, M., Goikolea, J.M., Benabarre, A., Torrent, C., Comes, M., Corbella, B.,
Parramon, G., Corominas, J. (2003). A randomized trial on the efficacy of group psychoeducation in
the prophylaxis of recurrences in bipolar patients whose disease is in remission. Archives of General
Psychiatry, 60(4), 402-407.
Xiong, W., Phillips, M.R., Hu, X., Wang, R., Dai, Q., Kleinman, J., and Kleinman, A. (1994). Family-based
intervention for schizophrenic patients in China: A randomized controlled trial. British Journal of
Psychiatry, 165, 239-247.
Yamaguchi, H., Takahashi, A., Takano, A., Kojima, T. (2006). Direct effects of short-term psychoeducational
intervention for relatives of patients with schizophrenia in Japan. Psychiatry and Clinical
Neuroscience, 60, 590–597. As cited in: C Rummel-Kluge & W Kissling (2008). Psychoeducation in
schizophrenia: New developments and approaches in the field. Current Opinion in Psychiatry, 21,
168–172.
Zanarini, M.C. & Frankenburg, F.R. (2008). A preliminary, randomized trial of psychoeducation for women with
borderline personality disorder. Journal of Personality Disorder, 22(3), 284-290.
Zhang, M., Wang, M., Li, J., and Phillips, M.R. (1994). Randomized-control trial of family intervention for 78 first-
episode male schizophrenic patients: An 18-month study in Suzhou, Jiangsu. British Journal of
Psychiatry, 165(Suppl 24):96-102.
Zhang, M., Wang, M., Li, J., Phillips, M.R. (1994). Randomised-control trial of family intervention for 78 first
episode male schizophrenic patients. An 18-month study in Suzhou, Jiangsu. British Journal of
Psychiatry, 165(Suppl 24), 96–102.

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Government of India

CENTRAL INSTITUTE OF PSYCHIATRY, RANCHI

PSYCHOEDUCATION IN PSYCHIATRIC DISORDER

Etymology of Psychoeducation as a method of psychotherapeutic treatment:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 1

Therapeutic Factors of Psychoeducation:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 2

Peer-to-Peer Psychoeducation Approach:

Passive & Active Psychoeducation Models:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 3

Therapeutic Role of Psycho-education in schizophrenia:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 4

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 5

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 6

Efficacy of Psychoeducation in BPAD:

Therapeutic Role of Psycho-education in anxiety & other neurotic disorders:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 7

Therapeutic Role of Psycho-education in personality disorders:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 8

Therapeutic Role of Psycho-education in substance addiction:

Therapeutic Role of Psycho-education in dementia & Alzheimer’s disease:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 9

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 10

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 11

Psychoeducation: Why it is so important & Recent trends:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 12

Transcultural aspects of psychoeducation:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 13

Limitation of psychoeducation: Critical Analysis:

Psychoeducation: limited to psychiatry or applicable to physical disorders too:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 14

Status of Psychoeducation in India:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 15

Psychoeducation to special population:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 16

Summary, conclusion & future direction:

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 17

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 18

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 19

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 20

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 21

Psychoeducation in Psychiatric Disorders Akulandisamy, Shajan, M.A., B., 22

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