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A Randomized Controlled Trial of a Private-Sector Inpatient-Initiated Psychoeducation Program for Schizophrenia

Dr. Vickar is affiliated with the Department of Psychiatry, Christian Hospital, 11125 Dunn Rd., Suite 213, St. Louis, MO 63136 (e-mail: gmv7127{at}bjc.org). Dr. Vickar is also with the Department of Psychiatry, Washington University in St. Louis. Dr. North is with the Department of Veterans Affairs North Texas Health Care System, Dallas, Texas. Dr. North is also with the Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, with which Mr. Downs is affiliated. Ms. Marshall is with Trinity Hospice, Sunset Hills, Missouri. An earlier version of this study was presented at the Institute for Psychiatric Services, Boston, October 29 to November 2, 2003, and at the Institute for Psychiatric Services, Chicago, October 2 to 5, 2003.

OBJECTIVES: Psychoeducation programs have been demonstrated to reduce relapse and be cost-effective for schizophrenia in academic settings, although this has not been examined in private care inpatient settings. METHODS: A total of 57 consecutive patients hospitalized for an exacerbation of schizophrenia symptoms were randomly assigned to receive treatment as usual or Schizophrenia Treatment and Education Programs (STEPS), an intensive inpatient-initiated psychoeducation program in a private-sector treatment setting. At six months, 54% of the original sample was reassessed. RESULTS: Rehospitalization over six months was significantly less frequent among STEPS participants than among usual care participants (20% versus 56%, p=.038, Hedge's g effect size=.76). CONCLUSIONS: This controlled study demonstrated subsequent reduction of costly rehospitalization among patients randomly assigned to STEPS, although study attrition of 46% over six months may diminish the confidence in the findings. This is the first study to demonstrate effectiveness of inpatient-initiated psychoeducation in private-sector care. Larger, more comprehensive studies are needed to replicate these findings and identify the active components of the intervention yielding these apparent gains.

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