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Method. A catchment-wide service was set up for community-based patients. Patients who
indicated an interest in education groups were randomly allocated to either an education group
or a waiting list control group. Those who attended groups were compared with the control
group.
Results. About one-quarter of community-based patients showed interest in attending edu
cation groups. Those who attended showed no change in mental state or compliance with
medication (already high) but significant gains in quality of life,social functioning and social
networks.
Conclusions. For patients who choose to attend education groups significant gains in social
functioning and quality of lifeare possible without specific skils training.
to distinguish
programmes
including
side-effects.
among
Since
medication
has been
of interest
because
of its
1985).
employ
a control
group
(Goldman
& Quinn,
199
200
ATKINSON ET AL
Method
Study population
A register of patients with schizophrenia living in
follow up.
Assessment measures
known to psychiatric
Contact
Patients were contacted
by letter in the first
instance. Concerns over patient's awareness of their
diagnosis meant the word schizophrenia was not
mentioned in the letter, and the full nature of the
groups was not disclosed. Patients were invited to
agree to an interview at home (or clinic) to discuss
the new service. Patients who did not agree to meet
with
the researcher
(JH)
at this
stage
were
thus
Design
(SADS)
(Mannuzza
lIlR
(American PsychiatricAssociation, 1987).Ten
geographical areas, each containing approximately
50 patients, were delineated, it being estimated that
each area would give one education group (of
approximately
10) and one control group. Even
tually eight geographical groups were formed, with
some attempt to put patients of similar functioning
together. Random allocation to education group or
waiting list control group occurred after this had
was
dubious,
the
corresponding
201
EDUCATIONGROUPSFOR SCHIZOPHRENIA
Table1
Topicscoveredineducationgroups
1 Whatdoesschizophrenia
meantoyou?
2 Whatisschizophrenia?
3 Problem
solvingmanageig
symptoms
4
(x2=17.3,P=0.008).Outcome
ofpriorillnessfor
Treatmentofschizophrenia
5 Problem
solving-medication
andusside-effects
6
7
RehabihtatioriCommunityresources
Problemsolvingemployment,
leisure
8 Earlysignsofrelapse
9
Problemsolvingmana@ng
relapseandsymptoms
10 Whatcauses
schizophrenia?
11 Problemsolving-usingalcoholandotherdrugs
12 Fanikes
andschizophrenia
13 Problem
solving-relations
withthefanily,
managing
negative
feelings
Seventy-three
14 Relating
toother
people-famll@
friends
andothers
15 Problem
solving-social
skille,
assertiveness,
tellingpeople
about
(@2=
yourillness
10.9,
P=0.004).
Only
one
person
was
cur
16 Stress
17 Problem
solving-stress
management,
withdrawal
18 Usingservices
Impact of groups
aspects
andpatient's
rights
20 Wheredoyougofromhere?
non-parametric tests were used to confirm the
results of the t-tests. In all cases the non-parametric
tests gave similar results to the I-tests.
Results
Group acceptance
Of the 515 people on the register 146 (28%)
accepted a place in a group of whom 73 were
randomly allocated to education groups and 73 to
the control condition.
Of those accepting, 63% were men and 37% were
women, the same ratio as on the register. The
Table2
Meantotalscoresof assessments
nPre-groups.dnPost-group&dnFollow-ups.dQuality
oflife
controls
20.7Social
attenders73
5759.8 62.418.017.161
5360.3 685'11618.957
5158.2
6@919.0
522.6
502.52.0'1.2
FunctioningSchedule
controls
11Social
attenders73
572.9
2.52.5 1562
2.4t3
t358
NetworkSchedule-btal contacts
controls
10.7-.
attenders73
sigreticant
at 0.05;, sigmflcant
5213.1 118'10.38.656
5013.5
17.510.8
ATKINSON ET AL
202
+4.0, controls 2.
0; z3.l,
P0.002).
Factor 2
2.1,
0.004)
in
the
direction
of
attenders
P=0.0001)
and at
Response rate
Although the interest in the groups could be seen as
low, a response rate of about a quarter in a total
EDUCATIONGROUPSFOR SCHIZOPHRENIA
major US study (Kelly & Scott, 1990). Some people
actively rejected the groups as unnecessary as they
were doing
airight' while others refused by
avoiding the researcher, having received the original
letter. The difficulty of getting some patients
involved in any form of treatment/rehabilitation is
well known, and we did not go beyond three visits
to the person's home in trying to contact them to
avoid accusations of harrassment. Although all the
people contacted had a clear diagnosis of schizo
phrenia all were not necessarily in current contact
203
of life cannot
simply be attributed
to the
at
follow
up
(r= 0.06).The
ATKINSON ET AL
204
account
for the increases in the number of
confidants
reported, indicating that the group
members were able to have closer relationships
Effects
of a patient
L.,
Fmia,
S.
B.,
COHEN,
C.,
et
al
(1988)
An
Clinicalimplications
M.
deficit
syndrome.
Schizophrenia
Relapse
10,
in schizophrenia.
137, 801805.
J. E. (1990)
Medication
Bulletin,
compliance
and
K@wiscv@,
M.,
GOLDBERG,
D.
&
VAUGHAN,
M.
(1977)
L.
J.,
LELANDER-SINGH,
M.
&
Luica
A.
(1991)
Limitations
Only a minority
of patients
were
interested
in
groups@
MNuzzA,
The groups
require comparisons
therapy
Affective
Disorders and Schizophrenia
L(fetime
Version.
National Institute for Mental Health. Grant MH2141I.
R. (1962)
The
Brief
Psychiatric
PILSECKER,
about
C.
(1981)
Hospital
classes
educate
schizophrenics
Psychiatry,
32,
60-61.
POWELL, B. J., OTHMER,
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