title: [Therapeutic benefit of a registered psychoeducation program on treatment adherence, objective and subjective quality of life: French pilot study for schizophrenia].
abstract: BACKGROUND
  In schizophrenic disorders, supportive psychosocial therapies have been used as adjuncts to pharmacotherapy to help alleviate residual symptoms and to improve social functioning and quality of life. Among these therapies, psychoeducational therapies showed a significant efficacy on improving drug adherence and on reducing relapses. However, according to the French Health Agency, fewer than 10% of psychiatric structures in France offer registered psychoeducation programs. Caregiver apprehension of patients' depressive reactions to the awareness of the disease could underlie the underuse of psychoeducation therapies. Indeed, the psychoeducation programs' impact on objective and subjective quality of life is discussed among the literature. In this context, we conducted a retrospective, monocentric, open-labelled and non-controlled pilot study to measure the impact of a registered psychoeducation program on objective and subjective quality of life of patients suffering from schizophrenia. Secondary objectives included measures of the effects on drug observance and awareness of the disease.
  
  
  METHODS
  We included stabilized patients over the age of eighteen suffering from schizophrenia. Referent psychiatrics were asked to inform the patient of the diagnosis and to prescribe psychoeducation therapy. From 2011 to 2014, we offered three ambulatory programs, each program including fifteen two-hour group sessions. The groups were opened for three to six patients and managed by two caregivers. Themes discussed during the sessions included: schizophrenic disease, treatments, relationships to family, diet, social issues, toxics, relaxation. Objective and subjective quality of life were evaluated one month before and one month after the program using respectively the global assessment functioning (GAF) and the subjective quality of life (SQoL) scales. The Medical Adherence Rating Scale (MARS) and the French IQ8 scale evaluated respectively drug adherence and awareness of the disease. All patients gave their written consent for the study. Based on medical records and scales, we compared data before and after the program using the Wilcoxon test, adapted for small samples.
  
  
  RESULTS
  Fourteen patients, with a mean age of 37.6 years, were included. All patients had a chronic antipsychotic treatment and four benefitted from a bitherapy with a mood stabilizer. The mean length of disease was 15.3 years, with a mean number of 3.4 hospitalizations before inclusion. The participation rate was nearly twelve sessions out of fifteen. Mean GAF score before the program was 48/100. After the program, mean GAF score was significantly increased to 54/100 (P=0.008). As to SQoL score, we found a significant difference of the sub item psychological well-being from 3.2/5 before the program to 3.8/5 after the program (P=0.03). Global SQoL score and other sub items (self-esteem, resilience, and physical well-being) showed a slight but not significant improvement. The sub items family relationships and sentimental life were diminished, non-significantly. Concerning the drug adherence, the mean MARS score was significantly increased from 6.1 to 6.4/8 (P=0.03). Comparison of the insight IQ8 scale showed a slight but non-significant increase. When asked to note the program, patients were globally very satisfied, with a mean rate of 8.6/10. Of fourteen patients, one needed to be hospitalized three years after program.
  
  
  CONCLUSIONS
  This retrospective study on a small sample of patients suffering from schizophrenic disorder pointed out a significant improvement on drug adherence, objective quality of life and psychological well-being, after an eight-month registered program of psychoeducational therapy. These results are in line with a recent report from the Cochrane group who reported a significant raise of GAF associated with psychoeducational therapies. The literature data for subjective quality of life are more contradictory. Despite the small sample and evaluation means that need to be corrected in further studies, we reproduced the results described in the literature regarding the improvement on drug adherence. However, the stability of these effects should be checked in the medium and long term.
  
  
  CONCLUSIONS
  Adjunctive psychoeducation therapy has a positive impact on reducing relapses in schizophrenia. In this study, we showed a significant benefit on drug adherence, objective quality of life and psychological well-being on a small sample of patients and provide arguments for the development of psychoeducation programs which are currently underrepresented in France. Our results encourage conducting a further prospective multicenter controlled study on a larger sample to clarify the benefit of psychoeducational therapy on objective and subjective quality of life in schizophrenia.
authors.affiliation: Service hospitalo-universitaire de santé mentale et thérapeutique, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Psychiatrie adulte secteur G05, CHU de Pointe-à-Pitre/Abymes, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe. Electronic address: florence.sauvanaud@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Sauvanaud
authors.affiliation: Service hospitalo-universitaire de santé mentale et thérapeutique, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Centre médico-psychologique, rue Mathurin-Régnier, 75014 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Kebir
authors.affiliation: Service hospitalo-universitaire de santé mentale et thérapeutique, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Centre médico-psychologique, rue Mathurin-Régnier, 75014 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Vlasie
authors.affiliation: Service hospitalo-universitaire de santé mentale et thérapeutique, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Centre médico-psychologique, rue Mathurin-Régnier, 75014 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Doste
authors.affiliation: Service hospitalo-universitaire de santé mentale et thérapeutique, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Centre médico-psychologique, rue Mathurin-Régnier, 75014 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Amado
authors.affiliation: Service hospitalo-universitaire de santé mentale et thérapeutique, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Centre médico-psychologique, rue Mathurin-Régnier, 75014 Paris, France.
authors.forename: M-O
authors.initials: MO
authors.lastname: Krebs
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D017028:Caregivers; D005195:Family Relations; D005260:Female; D005602:France; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011788:Quality of Life; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D012565:Schizophrenic Psychology; D000074822:Treatment Adherence and Compliance
chemical_list: D014150:Antipsychotic Agents
keywords: Medication adherence; Psychoéducation; Quality of life; Qualité de vie; Schizophrenia; Schizophrénie; Socio-environmental therapy; Thérapies psychosociales; Éducation thérapeutique