Psychoeducation

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 Concept of Psycho education

When behavioral or psychological difficulties arise, people need specific information about what is happening

the diagnosis, the meaning of specific symptoms, what is known about the causes, effects, and implications of

the problem in question.

Families need help in understanding why the person denies that anything is wrong, why there is resistance to

taking medications or being hospitalized, and why very often the family itself is blamed by the patient and

health care professionals.

Families need timely, basic education about the painful and long-term effects. They also need information on

management and coping skills; information about why certain medications are being used and their side effects;

an understanding of the reasons and implications for noncompliance with prescriptions or following through
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with recommended treatment.

 What is Psycho education
Psycho education is the education of a person in subject areas that serve the goals of treatment and
rehabilitation. Psycho education involves teaching people about their problem, how to treat it, and how to
recognize signs of relapse so that they can get necessary treatment before their difficulty occurs again. Family
psychoeducation includes teaching coping strategies and problem-solving skills to families, friends, and/or
caregivers to help them deal more effectively with the individual.
Frequently psychoeducational training involves patients with schizophrenia, depression, anxiety disorders,
psychotic illnesses, eating disorders, and personality disorders, as well as patient training courses in the context
of the treatment of physical illnesses.
Psychoeducation also has the function of contributing to the destigmatization of psychological disturbances and
to diminish barriers to treatment. The relapse risk is in this way lowered; patients and family members, who are
more well-informed about the disease, feel less helpless. Important elements in the Psychoeducation are:
Emotional discharge (understanding to promote, exchange of experiences with others concerning, contacts etc.)
Support of a medication or psychotherapeutic treatment, as co-operation is promoted between the mental health
professional and patient (Compliance, Adherence).
Assistance to self-help (e.g. training, as crisis situations are promptly recognized and which steps then to be
undertaken to be able to help the patient).
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 Definition Of Psycho education

In 1984 Barter Defined psycho education as the use of education techniques , methods

and approaches to aid in the recovery from the disability effect of mental illness or as

an adjunct to the treatment of mentally ill usually within the framework of another

or going treatment approach or as part of a research work.

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 The History of Psychoeducation

The concept of psychoeducation was first noted in the medical literature, in an article by John E. Donley
Psychotherapy and re-education in The Journal of Abnormal Psychology, published in 1911.

The popularization and development of the term psychoeducation into its current form is widely
attributed to the American researcher C.M. Anderson in 1980 in the context of the treatment of
schizophrenia. His research concentrated on educating relatives concerning the symptoms and the
process of the schizophrenia. Also, his research focused on the stabilization of social authority and on
the improvement in handling of the family members among themselves.

. Finally, C.M. Andersons research included more effective stress management techniques. Psychoeducation
in behavior therapy has its origin, in the patients 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.
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 Stages of Psycho education
It involves two satges (Aubin, 2000):

First stage: A health care professional inform the patient and their caregivers about the illness. This

involves, explaining symptoms, illness pattern, treatment options, preventive measures and

prognosis.

Second stage: The patients inform the professionals about their symptoms, beliefs about causation

factors that improve or worsen symptoms, fears and effects of illness on their daily functioning.

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 Models of Psychoeducation

The various psychoeducational models can be categorised into four approaches (Zipple and 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 are 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 utilise support groups designed to engage the familes 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 consist 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)
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 Steps in Psychoeducation
The main steps are:
Assessment: this focusses on factors that may influence the outcome of the disorders in a patient namely
The comorbid disorders present or likely to reoccur
The characteristics likely to contribute to illness management skills
Exploring the patients views about his or her illness and the treatment like; (a) belief about the causes of
their suffering, (b) reason behind and unsuccessful treatment (c) nature of treatment setting in the past
determing patients past experiences in collaborative decision making about treatment.
Implementation:
education regarding requirement and practicalities of treatment. It is concerned with what can be
expected from treatment and how the family members are expected to respond or act.
Resolution of any discrepancy between patients expectation and preferences.
Personal cost benefit analysis about specific treatment decision
Conveying information about side effect of medication.
Follow up:
Patients opinion about the outcome
Jointly deciding whether to continue as it is adjusting to current intervention (dose, timing, frequency)
or to change the intervention. 8
 Types of psychoeducation

Single and Group Psychoeducation

Psychoeducation can take place in one-on-one discussion or in groups and by psychologists ,

Psychiatric Social worker and physicians.

In the groups several patients are informed about their illnesses at once. Also, exchanges of

experience between the concerned patients and mutual support play a role in the healing

process.

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 How does it work?
Psycho-education works by improving the knowledge patients and their families have and providing a greater
understanding of the importance and benefits of medication. Families are encouraged to keep a journal of
pertinent information so they have a reference to consult.

Information is provided on medication, prognosis, alleviating and aggravating factors. Early signs of relapse are
described and actively monitored. Families are helped to understand how high expressed emotion environments
can perhaps help to maintain or aggravate symptoms.

This crucial information allows families to plan and adapt around the reality of prolonged emotional or behavioral
difficulty; it enables them to put the situation into perspective and to begin to modify their own lives as necessary.
Participants are taught skills that change their lifestyle, enhance their therapy and assist them to live more
productive and fulfilled lives.

Family psycho education reduces distress, confusion, and anxiety within the family, which may in turn help the
individual recover. Children, adolescents and adults learn skills that will complement their therapy and may
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reduce the use of more costly treatment modalities.
 Efficacy of psycho education

Extended studies have noted that eleven or more individual psycho educational sessions were

significantly more effective than treatment alone in preventing relapse at 918 months.

Brief group psycho education was also more effective than treatment alone in preventing relapse or

readmission to hospital by 1 year.

Combining the results from all trials, relapse rates at 918 months follow up were significantly lower in

the psycho education group than in the control group.

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 Scopes of Psychoeducation in mental disorders

Psychoeducation in combination with medication has been used successfully in relation to

people :

with schizophrenia,

bipolar disorder,

attention-deficit/hyperactivity disorder (ADHD),

and depression, as well as assisting their family and caregivers. People being treated for, or
who are attempting to prevent depression, often require ongoing assistance to change their
behavior and life style.

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 Contraindications of Psycho education

Some patients with schizophrenia may find it difficult to participate in a program of psycho

education if the program requires the patient to play an active role.

Psychoeducation is a specific form of education. It is aimed at helping persons with a mental

illness or anyone with an interest in mental illness, to access the facts about a broad range of

mental illnesses in a clear and concise manner. It is also a way of accessing and learning

strategies to deal with mental illness and its effects.

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 Family psycho education a special focus

Definition:

Family psychoeducation is a method based on clinical findings for training families to

work together with mental health professionals as part of an overall clinical treatment

plan for their family members. Family psychoeducation has been shown to improve

patient outcomes for persons with schizophrenia and other major mental illnesses.

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 Purpose of Family Psychoeducation

The goal of family psychoeducation is to prevent patients with severe mental illnesses
from relapsing, and to promote their re-entry into their home communities, with
particular regard for their social and occupational functioning.

To achieve that goal, family psychoeducation programs seek to provide families with the
information they need about mental illness and the coping skills that will help them deal
with their loved one's psychiatric disorder.

An associated goal of these programs is support for the patients' families. Families
experience many burdens (financial, social, and psychological) in serving as long-term
caregivers for their loved ones. Although the primary focus of family psychoeducation
groups is improved patient outcomes, an essential intermediate goal is to promote the
well-being of the family.
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 Models of Family psycho education

There are several different models of family psycho education. Although they include many common elements,
these different models include: single- and multiple-family groups; mixed groups that include family members
and consumers (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 evidence suggests that multi-family groups, which bring together several patients and their families, lead
to better outcomes than single-family psycho education groups. Lasting a minimum of nine months, the
programs provided their participants with information about mental illness, its symptoms and treatment;
medication and its side effects; how to communicate with a person with mental illness; and techniques for crisis
intervention and mutual problem-solving.

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 Psycho education in BPAD
Psychoeducation can be defined as a mutual process that attempts to improve a patients illness management skills
through the bidirectional sharing of relevant information.
In psycho education a lower level of psychological ability than in other approaches is needed, so it is cheaper and
easier to evaluate. It only requires extensive knowledge of the illness and its management and communication skills.
Aims of Psycho education in BPAD
Providing information, assistance, insight and support to the patient and his family.
Enhancing illness awareness and destigmatization preventing .
Enhancing treatment compliance .
Avoiding drug abuse.
Identifying relapse symptoms
Stress Management.
Enhancing knowledge and coping of psychosocial consequence of past and future episodes.
Preventing suicidal behavior.
Improving interpersonal and social functioning.
Increasing well- being and quality of life. 17
 Psychosocial Issues in BPAD
Emotional consequences of affective episodes.

Problems associated with stigmatization.

Interpersonal difficulties.

Problems in learning to discriminate normal from abnormal moods.

Academic and occupational problems.

Marriage, family, child bearing and parenting issue.

Concerns about genetic transmission.

Sudden life events.

Stressful environment.

Uncongenial home environment.

Faulty parental demands.

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 Models used in BPAD
Psycho education model in BPAD may follow any one of the model mentioned above. Comprehensive model is
most widely used.

Information Model

Pharmacological : it includes information regarding treatment, medication, deviation to take medicine, its
effects, side effects and importance of regular compliance. (regarding mood stabilizers and its major side
effects, regarding lithium carbonate that is serum lithium estimation, side effects, and patient is advised to
drink excessive water to prevent from dehydration)

Non pharmacological: it includes signs, symptoms of the illness that is mania, depression, mixed, and
various causes of mental illness role of stressors, life events, and expressed emotions in the exacerbations
of the symptoms. Course and prognosis of the illness, prevalence rate and genetic vulnerability are also
included.

Skill training Model

It includes issues like stigma, prevention of being critical towards patient and relapse prevention, sleep
hygiene, early signs and symptoms, substance abuse counseling, suicidal prevention.
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 Psycho education intervention in Schizophrenia

Pekkala & Merinder found in his study that Psycho education added to standard treatment for schizophrenia reduces

relapse.

It is supposed that increased knowledge enables people with schizophrenia to cope more effectively with their illness.

Psycho educational interventions involve interaction between the information provider and the mentally ill person. The

evidence shows a significant reduction of relapse or readmission rates. It may be estimated that around twelve relapses can

be avoided, or at least postponed, for around a year if 100 patients receive psycho education.

There seems to be some suggestion that psycho education may improve compliance with medication but the extent of

improvement remains unclear.

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 Conclusion

Psycho education intervention help to improve patients compliance with medication

and to deal with various psychosocial consequences of the illness. Thus mental illness

and psycho education are complementary treatment approaches that if administered

conjointly will offer more effective for the patients with mental disorders.

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Thank You

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