Friedman, J.; (2004) Patient as partner: Therapeutic information provision for people suffering with severe mental health problem. Doctoral thesis , University of London.

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Abstract

Few short-term psychosocial interventions have been devised for people in the acute stages of psychosis. The studies on psychoeducation for people with psychosis have focused on those in the chronic stages of illness. There is, however, increasing evidence to suggest that it is possible to intervene early in the course of a psychotic episode. This study aims to assess the utility of a personalised psychoeducation package with a group of 16 inpatients diagnosed with acute psychosis. The scores of each participant were compared at three time points: prior to the intervention; post intervention and at six weeks follow-up. The five main areas assessed for change were: psychiatric symptomatology; insight; illness representations; compliance; and satisfaction. There was evidence that this approach, together with routine care, may augment changes in psychiatric symptoms as measured by the Brief Psychiatric Rating Scale and the Brief Symptom Inventory. The findings of the study indicate that of those available for data collection, 46.15% significantly improved on Unusual Thought Content; 38.46% on Conceptual Disorganisation; and 38.46% on Paranoid Ideation. All change data was analysed using the Reliable Change Index. In addition, the findings show that approximately 50% of the participants improved on at least one area of insight, as measured by the Scale to Assess Unawareness of Mental Disorder. The dimensions of insight measured included awareness of having a mental disorder (53.85% of the participants available for data collection improved); awareness of the achieved effects of medication (46.15% improved); and awareness of the social consequences of having a mental disorder (53.85% improved). Approximately one third of participants improved and a further third deteriorated on one of the four illness representations measured using the Illness Perceptions Questionnaire-Revised. These included Consequences, Personal Control, Treatment Control and Illness Coherence. Only one participant improved on compliance with treatment, as operationalised for the purpose of this study. The majority of participants (78.57%) reported satisfaction with their care, as measured by the UKU-ConSat. The useful elements of this psychoeducation package appear to be an individualised approach, a collaborative therapist-patient relationship and a brief number of sessions. These seem to allow participants to learn active means of controlling their illness. This study is a useful preliminary investigation of a new personalised psychoeducation package for participants in the acute stages of psychosis. A larger scale randomised controlled trial, utilising a more robust design is advocated.

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