Schizophrenia: a five-year follow-up of patient outcome following psycho-education for caregivers.

INTRODUCTION: There is evidence that psycho-education courses for caregivers of individuals with schizophrenia improve the short-term outcome of the condition. However, most of the outcome studies are limited to two-year follow-up. MATERIALS AND METHODS: This study is a five-year retrospective case-control follow-up of an original cohort of 63 patients and their 101 caregivers who completed a six-week Caregiver Psycho-education Programme (CPP) for schizophrenia and psychosis between 2002 and 2005, and 60 controls, matched for age, gender and severity of their psychotic illness. RESULTS: Patients whose caregivers learned more from the six-week psycho-education course had a significantly longer time to relapse (P = 0.04) and a significantly shorter length of stay during their first relapse (P < 0.05). Patients whose caregivers attended the six-week psycho-education course (regardless of how much the caregivers learned) had a significantly better outcome than controls. This included a significantly smaller number of relapses (P < 0.01), longer time to relapse (P < 0.01), shorter length of stay during their first relapse (P < 0.01) and smaller number of bed days over five years (P < 0.01). The odds ratio of controls relapsing, although insignificant at one year, was 4.13 (1.85-9.21) at five years. Outcome was not affected by either the numbers of caregivers attending for each patient, or caregiver gender. DISCUSSION AND CONCLUSIONS: This study, which is among the first to examine outcome over five years, supports the efficacy of psycho-education for caregivers in improving outcome for patients. Caregivers should be encouraged to take up psycho-education where it is available.

Telepsychiatry and carer education for schizophrenia.

OBJECTIVE: Despite the scientific evidence, most families of people with schizophrenia in Europe never receive a carer education programme. We evaluated whether a carer education course delivered by telepsychiatry was as effective as a carer education course delivered in situ. METHOD: We delivered the carer education course for schizophrenia simultaneously to a carers group in rural north west Ireland (remote) via three ISDN lines and live to a carers group in a city (host). We compared knowledge gains using the Knowledge Questionnaire before and after each course. RESULTS: Fifty-six carers of people with schizophrenia participated in the trial. At baseline, participants at the remote and host centers did not differ in terms of knowledge about schizophrenia. After the course, carers at both centers improved significantly and the knowledge gains between groups were equivalent at 6 weeks. CONCLUSION: Telepsychiatry can deliver effective carer education programmes about schizophrenia and may provide one solution to bridging the chasm between scientific evidence and clinical reality.

Effects of stimulus representation and cue category level on exposure (flooding) therapy.

The present study was an attempt to examine the role of cue category level (symptom-contingent vs. hypothesized cues) and mode of stimulus presentation (in vivo vs. imaginal) in exposure (flooding) therapy. Sixty-four speech phobics were randomly assigned to one of eight conditions. Exposed to either one of the two cue category conditions, subjects received either two sessions of in vivo exposure, two sessions of imaginal exposure, or two sessions consisting of either an imaginal followed by an in vivo exposure or vice versa. Results support the predictions of Levis & Hare (1977) that the inclusion of hypothesized cues is not necessary in the treatment of analogue phobias or simple clinical cases. These data also support and extend several previous findings that in vivo exposure produces more rapid anxiety decrement than imaginal exposure. Finally, a variant of the usual in vivo procedure is described which apparently is effective, yet does not require the assemblage of a large audience for each in vivo exposure.