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Psychoeducation for
patients with schizophrenia
and their families
Expert Rev. Neurother. 8(7), 10671077 (2008)

Christine
Rummel-Kluge and
Werner Kissling
Author for correspondence
Department of Psychiatry
& Psychotherapy, Klinikum
rechts der Isar der
Technischen Universitt,
Mhlstr. 26, 81675
Mnchen, Germany
Tel.: +49 89 4140 6676
Fax: +49 89 4140 6688
christine.rummel@lrz.tum.de
In this review, the current evidence for the efficacy of psychoeducation, a nonpharmacological
treatment strategy in the treatment of patients with schizophrenia and their families, is
assessed by summarizing meta-analyses/reviews and important single studies published after
the recent meta-analyses. It was found that psychoeducation for patients with schizophrenia
and their families can reduce the relapse rates of these patients; long-term family interventions
(i.e., with durations of more than 3 months) are particularly helpful. However, there are still
unsolved questions in this area. Therefore, future research needs are a further focus of this
review; for example, on the questions of how to adapt programs for stable outpatients and
their families, and the minimum effective dose of psychoeducation. Finally, new approaches in
the area of psychoeducation, such as including quality-of-life issues, offering psychoeducation
formats for combined diagnoses, family and patient peer-to-peer programs, and focusing on
gender aspects are discussed.
KEYWORDS: caregiver family patient peer psychoeducation relative schizophrenia

Schizophrenia is a disorder of thinking and per-
ception in which people in an acute phase of the
illness do not ascribe their symptoms to a men-
tal disorder [1]. In general, for schizophrenia to
be diagnosed, at least two characteristic symp-
toms, such as delusions, hallucinations, dis-
organized speech, grossly disorganized or cata-
tonic behavior, or negative symptoms (i.e.,
affective flattening, alogia or avolition) must be
present for a significant portion of time during
a 1-month period [2]. The course of schizo-
phrenia may be very variable, ranging from
remission to chronic illness. Schizophrenia has
been observed all over the world; the prevalence
among adults is reported to be approximately
0.51.5% [2]. The main pharmacological treat-
ment of schizophrenia is with antipsychotic
medication [35]. One important nonpharmaco-
logical treatment strategy for patients in a post-
acute stage of the illness is psychoeducation.
Modern treatment guidelines, such as those
from the American Psychiatric Association, rec-
ommend psychoeducation as part of the treat-
ment for schizophrenia [6]. To qualify for psych-
oeducation, patients with schizophrenia should
have at least some insight into the disease and
should to some extent be able to assign their
symptoms to the illness.
Psychoeducation is defined as systematic,
structured, didactic information on the illness
and its treatment, and includes integrating emo-
tional aspects in order to enable the patients as
well as family members to cope with the illness
[79]. Psychoeducation is usually carried out in
groups, mostly in separate groups for patients
and in separate groups for family members,
takes place over a certain period of time, and has
a predefined number of regular sessions; for
example, twice per week in patient groups [79].
Psychoeducation in schizophrenia should be
offered for in- and outpatients, during hospitali-
zation is a good time to start psychoeducation,
and can then be finished outside the hospital
setting. Participating in psychoeducation can
reduce relapse rates of patients with schizophre-
nia and improve compliance, quality of life and
their concept of the illness [1013]. Family
psychoeducation in schizophrenia can positively
influence the course of the patients illnesses [14]
and can reduce the relapse rates of the patients
[15,16], but can also help the families and patients
to cope better with the mental illness [1720].

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 Review Rummel-Kluge & Kissling
Frequency of psychoeducation in schizophrenia
We recently showed that psychoeducation in schizophrenia
was offered in 72% of all psychiatric hospitals in Germany,
Austria and Switzerland [21], and approximately 40% of the
inpatients with schizophrenia in these hospitals actually partic-
ipated in psychoeducation for schizophrenia in the year 2003.
Family members or friends of these patients took part in 13%
of the cases, assuming one family member per patient. Similar
results on patient and family psychoeducation in schizophrenia
were shown in the USA: within the implementation of the
Texas Medication Algorithm Project Patient and Family Edu-
cation Program, only 18.8% of patients with schizophrenia
received group psychoeducation, with a mean number of
encounters of 1.7 [22]. In the Schizophrenia Patient Outcomes
Research Team (PORT) client survey, 8% of the patients
stated that their families had been participating in a support or
educational program [23].
Evidence for efficacy of psychoeducation in
schizophrenia
In the following sections, the current state of knowledge about
the efficacy of psychoeducation will be summarized on the basis
of the most recent meta-analyses/reviews. In addition to effi-
cacy, further emphasis will be placed on the limitations of this
literature and on recommendations for future research.
In 2002, Pekkala and Merinder included ten randomized,
controlled studies in their Cochrane meta-analysis on psycho-
education for schizophrenia in order to assess the efficacy of
add-on psychoeducational interventions compared with stan-
dard treatment [24]. The evidence showed that any kind of psy-
choeducational intervention significantly decreased relapse or
re-admission rates at 918 months follow-up compared with
standard treatment. The authors estimated that 12 relapses
could be avoided, or at least postponed, if 100 patients with
schizophrenia received psychoeducation. Most studies used
group interventions and included education for family mem-
bers. Eight of the ten studies included outpatients only. Com-
pliance with medication significantly improved in only one
study at 12-month follow-up; in general, findings for secondary
outcomes such as knowledge gain and global level of function-
ing, indicated that psychoeducation has a positive effect on a
persons well-being [12]. The possible influence of different for-
mats or durations of psychoeducation could not be analyzed
owing to the paucity of studies. The authors concluded that the
evidence suggested that psychoeducation is a useful part of
treatment in schizophrenia and should be attractive for policy-
makers due to the fact that it is a short and comparatively inex-
pensive intervention. However, the authors call for more well-
designed and reported studies to further investigate the efficacy
of psychoeducation: well-standardized psychoeducation pro-
grams should be used in future trials. Standardized outcomes,
such as compliance, relapse and re-admission, psychosocial
1068
functioning, quality of life, and insight into the illness, should
be recorded for all trials in order to allow better comparability
of studies. To identify the efficacy of different formats of psy-
choeducational interventions, further studies are also needed.
In 1996, Penn and Mueser published a review on psycho-
social treatment for schizophrenia, investigating social skills
training, family intervention (including psychoeducational
approaches) and cognitive therapy techniques [25]. The authors
found that there is sufficient evidence suggesting that long-
term family interventions aiming at education and improve-
ment of coping skills reduce the patients vulnerability to
relapses over a period of 12 years. This shows that these treat-
ment gains, once obtained, are rather stable and are maintained
for years. Penn and Mueser also stated that family interventions
provide advantages for both patients and their families; the
families might benefit especially from a reduction in family
burden. However, the authors state that it remains unclear what
kind of family intervention is best (e.g., single- versus multiple-
family approaches, hospital- vs home-based approaches, psycho-
educational and behavioral approaches vs supportive family
management) for what patients (e.g., stabilized outpatients vs
inpatients). An important reason for this seems to be that the
mechanisms underlying the efficacy of family interventions are
still unclear. Separating the components of the different inter-
ventions and then comparing their efficacy might be a helpful
approach in finding out what the real efficacious mechanism is,
as there is a significant overlap of the therapeutic techniques
used in most family interventions. Further research must be
carried out on those families and patients who do not benefit
from these interventions in order to develop new programs
especially suited for their needs. In addition, it would be help-
ful for future research to identify criteria for the minimum
amount of a family intervention (i.e., the number of sessions
over a certain period of time) and to standardize follow-up
periods. This would allow better comparisons between different
studies.
In 2001 Pitschel-Walz et al. studied the effects of additionally
including relatives in family interventions in the treatment of
schizophrenia [26]. The family intervention programs studied
aimed at educating the relatives and improving their ability to
better cope with the illness. The main outcome criterion was
the relapse rate of the patients. Pitschel-Walz et al. demon-
strated that the relapse rate can be reduced by 20% if family
members of patients with schizophrenia are included in the
treatment of the patients by family interventions. Results were
particularly good for family interventions with durations of
more than 3 months. The type of family intervention (psychoe-
ducationally or therapeutically oriented) did not influence the
positive effect on the relapse rates: both approaches showed sta-
tistically significantly better results than the usual standard
treatment. The authors concluded that psychoeducation for
patients and their families should become a basic part of a com-
prehensive psychosocial treatment and should be offered to all
patients with schizophrenia. For future research, the fact that at
Expert Rev. Neurother. 8(7), (2008)

least a third of all patients with schizophrenia do not have rela-
tives, are not in regular contact with their relatives or have rela-
tives that are not interested in becoming involved with coping
with schizophrenia, has to be taken into consideration for the
development of psychosocial programs especially designed for
the needs of these patients. The authors call for further studies
focusing on and evaluating the process of integrating family
interventions into clinical routine treatment and particularly
studying the long-term outcomes in more detail.
McFarlane et al. summarized the literature on family psycho-
education in schizophrenia in a review in 2003 [27]. The
authors conclude that family psychoeducation has established
its efficacy and effectiveness as an evidence-based practice.
However, they criticize the fact that the use of family psycho-
education in routine clinical practice is very limited. For future
research, they recommend focusing more on patients/consum-
ers experiences and outcomes to find out what the minimal
ingredients for such approaches are by designing studies to
explicitly identify the smallest dose of family psychoeducation.
A further goal is to refine the interventions in order to address
different types of families with different problems and different
durations of illness more properly, and to assess the outcomes
of interventions, modified for specific subgroups (e.g., people
with other cultural backgrounds). More research is also needed
in order to learn more about the implementation barriers for
family psychoeducation, such as funding, clinicians attitudes,
transportation and geographic factors and stigmata. The
authors conclude that a very immediate implication is that
family psychoeducation is not difficult to conduct as long as
adequate training and supervision are available.
Glynn et al. studied the potential impact of the recovery
movement on family interventions for schizophrenia in a review
published in 2006 [28]. The authors found that existing family
interventions share many characteristics (community-based,
stress achieving personal goals, giving hope and focusing on
resources) with the recovery movement that has been growing in
the mental health field over the past few years. However, estab-
lished family interventions are generally based on older models
of persisting, chronic psychiatric illness. To adjust these inter-
ventions to the newer recovery movement where consumers are
thought to gain as much responsibility as possible for their
recovery, the authors suggest expanding the definition of family
to interested relatives, to find ways to bring together consumer
and treatments, to include families as a part of the treatment
team, to increase the offers of effective family interventions and
to promote research on these issues.
Pfammatter et al. draw conclusions from meta-analyses on
the efficacy of psychological therapy in schizophrenia in a
review in 2006 and found that psychoeducational coping-ori-
ented interventions with families and relatives are effective
adjuncts to pharmacotherapy [29]. The authors found that
family psychoeducation increases the knowledge of the dis-
order among the participants and caused a shift from high- to
low-expressed emotion.
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Psychoeducation in schizophrenia Review
Summary of the reviews & derived future
research needs
To summarize the results of these reviews, psychoeducational
approaches for patients with schizophrenia and their family
members can reduce the relapse rates of these patients. Long-
term family interventions (i.e., those with durations of more
than 3 months) are particularly helpful. The recovery move-
ment might bring a change of attitudes towards the consumers
to family interventions: old models of consumers as being
treated for a chronic disease may change into seeing the con-
sumers as gaining as much responsibility as possible for their
recovery. One issue that still remains unsolved is the question
of which psychoeducational format (e.g., hospital- vs home-
based approaches, psychoeducational and behavioral
approaches vs supportive management, and single- vs multi-
ple-family approaches) is best for which patient (e.g., stabi-
lized outpatients vs inpatients) and during which phase of the
illness. Future research is needed to identify criteria for the
minimum, yet still efficacious amount of psychoeducation,
and must focus on patients with schizophrenia who do not
have supporting families, because families participating in
family interventions or psychoeducation seem to play a sub-
stantial part in the efficacy for the reduction of relapses of the
patients. Standardized psychoeducational programs, out-
comes and follow-up periods, especially studying long-term
outcomes, should be used in future studies. In particular, more
emphasis should be placed on assessing suicidal ideation in
future studies, as this important topic has not been studied
sufficiently to date.
One study by Cunningham et al. found that the partici-
pants of a brief interventional package for outpatients with
schizophrenia comprising a simple, educational part (a
15-min educational video plus three booklets) and a protocol
for the management of side effects of antipsychotics, had an
improvement in insight and treatment attitudes, but also an
increase of suicidal ideation [30]. The authors concluded that
enhanced insight might be associated with increased suicidal
ideation. Even though this brief educational intervention does
not fulfill the definition of psychoeducation, this aspect must
be investigated further [79]. If there really was an increase of
suicidal ideation/suicidality due to psychoeducation, the
interventions would have to be adjusted in order to further
cover this issue. More well-designed and reported studies are
thus necessary in order to solve the above-mentioned questions
and especially to examine the components of efficacy of psycho-
education, because the principle of how psychoeducation
works is still unknown.
As the above-described reviews do not include all the publi-
cations of the last 5 years, newer studies are summarized
below. For better readability, we will provide studies on
patient psychoeducation (where no families were included)
and studies on family psychoeducation in separate paragraphs
in the following section.
1069
 Review Rummel-Kluge & Kissling
Patient psychoeducation in schizophrenia: recently
published studies
Culturally sensitive psychoeducational approach
Shin and Lukens assessed the effects of psychoeducation for
Korean Americans with schizophrenia in 2002 [31]. Results of
this study were a significant reduction of symptom severity and
perception of stigma as well as an improvement in coping with
the illness after treatment. For reaching culturally diverse popu-
lations, a culturally sensitive psychoeducational intervention
can be a helpful short-term treatment instrument, as this exam-
ple for Korean American with schizophrenia demonstrated. An
adaptation of psychoeducational methods to the specific partic-
ipants may be necessary in order to really reach the participants
and thus enable them to benefit from the intervention.
Timing of psychoeducational approaches
Feldmann et al. published a study on the timing of psycho-
educational psychotherapeutic interventions in schizophrenia
in 2002 [32]. Psychoeducation showed the greatest preventive
effect in patients with a medium duration of illness of
47 years. These patients seem to accept the illness and do not
yet adhere to fatalistic or idiosyncratic assumptions, as patients
with a long duration of illness often do. In patients with a short
duration of illness, psychoeducation did not show optimal
results, as these patients often still deny their illness. Patients
are more willing to become involved in psychoeducation if they
are becoming familiar with the illness, but have not been
involved with it for years. This duration of illness of 47 years
seems to be the optimal time to benefit from psychoeducation
by a reduction of relapse rates.
Improving compliance with appointment by
psychoeducation
In 2007, Agara and Onibi showed in a small, randomized, con-
trolled trial in Nigeria that group psychoeducation was effective
for improving patients compliance with scheduled clinic
appointments after discharge during a 9 month follow-up [33].
Psychoeducation as active control groups
Bechdolf et al. studied the differential efficacy of group cogni-
tivebehavioral therapy (CBT) in comparison with patient
psychoeducation in patients with schizophrenia in a randomized,
controlled study [34,35]. After 6 months follow-up, patients in the
CBT group were hospitalized significantly less often than those
in the psychoeducation group; after 24-months follow-up, there
were no statistically significant differences between the groups.
On a descriptive level, as the authors stated, patients in the CBT
group had 92 days of hospitalization compared with 163 days in
the psychoeducation group after 24 months. However, one
important limitation of this study is that on average patients in
the CBT group participated in 11.9 sessions, whereas patients in
the psychoeducation group participated in only 6.4 sessions. Psy-
choeducation was used as an active control condition in this
1070
study; thus the focus of the study was not on the efficacy of
psychoeducation; and as there was no non-intervention control
group, the efficacy of psychoeducation cannot be judged
adequately from it.
A further study using psychoeducation as an active compari-
son condition is the study by Cather et al. comparing func-
tional CBT (fCBT) in schizophrenia with psychoeducation [36].
Aims of the study, published in 2004, were to evaluate the feasi-
bility of the new cognitivebehavioral approach for persisting
psychotic symptoms, such as auditory hallucinations, and to
compare fCBT with psychoeducation. Results of this study
were that fCBT is feasible, but no significant between-group
differences were found on symptom reduction. However,
within-group effect sizes suggested an advantage for fCBT in
reducing auditory hallucinations. Again, owing to the design of
this study, new evidence on the efficacy of psychoeducation in
schizophrenia cannot be found in it.
Xiang et al. compared the efficacy of a community re-entry
module (CRM) for patients with schizophrenia with a psycho-
education group in China and published the results of the 2-year
follow-up in 2007 [37]. They found that patients participating
in the CRM, consisting of a standardized, structured social
skills training program with 16 sessions, had significantly lower
relapse and rehospitalization rates and significantly higher re-
employment rates compared with patients participating in
group psychoeducation. However, the contents and methods of
the psychoeducational intervention, which again was used for
an active control group, were not described.
On a single study basis, these recently published studies on
psychoeducation for patients with schizophrenia show:
Culturally sensitive adaptation of psychoeducation can be
successful;
One study showed that optimal results for reducing relapse
rates were achieved for participants with duration of illness of
47 years;
Cognitivebehavioral group therapy may be superior to
group psychoeducation in regard to rehospitalization;
No significant between-group differences on symptom
reduction were found between functional cognitive therapy
and psychoeducation;
One study in China showed that a structured social skills
training program was superior to psychoeducation;
Group psychoeducation can improve compliance with out-
patients appointments.
Bifocal psychoeducation (for patients & family
members) in schizophrenia: short-term approaches
In the Psychosis Information Project (PIP) study, published in
2006, Pitschel-Walz et al. showed that patients with schizo-
phrenia participating in a brief, eight-session psychoeducational
program with separate groups for patients and their families
Expert Rev. Neurother. 8(7), (2008)

had significantly lower rehospitalization rates after 12 and
24 months compared with patients who received the standard
treatment without psychoeducation [12]. The 7-year follow-up
of this study showed that even after 7 years, statistically signifi-
cant and clinically important differences were found: the mean
number of hospitalizations was 1.5 in the intervention group
compared with 2.9 in the control group; and the mean number
of hospital days was 75 in the intervention group compared
with 225 in the control group [13].
Aguglia et al. replicated the results of the PIP study in a
randomized, controlled study with 150 participants, pub-
lished in 2007 [38]. The authors found that patients with
schizophrenia participating in a short, eight-session add-on
psychoeducation program for patients and families had statis-
tically significantly fewer hospitalizations and hospital days
after a follow-up period of 1 year compared with the control
group with standard treatment.
These recently published studies on a brief, eight-session
bifocal psychoeducation (for patients and their family members)
in schizophrenia showed a reduction in hospitalization days after
1 year, and one study still found a reduction after 7 years.
Family psychoeducation in schizophrenia:
recently published studies
Long-term psychoeducational interventions for families
In 2003, McDonell et al. reported a study of multiple family
group therapy (MFGT) for caregivers of patients with schizo-
phrenia over 2 years, integrating psychoeducation and behav-
ioral family therapy [39]. MRGT did not reduce family burden
when compared with a standard treatment group. The authors
found that young patient age and the caregivers awareness of
their patients suicidal ideation, not the actual report of suicidal
ideation by the patient, as well as low levels of caregiver
resources were predictors of burden. A large discrepancy
between patient-reported (60%) and family awareness (17%)
of patient suicidal ideation was found in this study. This
implies that caregivers need to be informed about the risk and
warning signs of suicide in patients with schizophrenia in order
to be able to react adequately if necessary. In order not to
increase the burden by such information, the caregivers must be
provided with appropriate coping resources and professional
support. Possible modifications of the MFGT could be to focus
more on the needs of the caregivers, as the program was actually
designed with the focus on the management of the patients in
the context of their families.
Chien and Wong compared a culturally sensitive family
psychoeducational intervention of 18 sessions in 9 months
(patients participated in six educational workshop sessions),
conducted by a trained psychiatric nurse, versus standard care
for schizophrenia in Hong Kong [40]. Participants in the
psychoeducational group had significantly greater improve-
ments in families and patients functioning, and families bur-
den of care. The number and durations of rehospitalizations
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Psychoeducation in schizophrenia Review
over the 12-month follow-up were significantly lower in the
intervention group. This psychoeducation program, addressing
the specific cultural and family needs in a Chinese population,
improved the psychosocial health condition of the whole fam-
ily and the patients risk of rehospitalization over a 12-month
follow-up.
In 2007, Carr et al. reported a randomized, controlled study
on family interventions in Italy [41]. The authors compared the
effects of an informative educational group program with an
additional more intensive behavioral management group pro-
gram and with treatment as usual. The educational program
consisted of 24 sessions for 1618 participants with compre-
hensive contents on schizophrenia. The additional support
group had 48 sessions for eight to nine participants who had
previously taken part in the educational program and involved
training in communication and coping skills in the first part,
and emphasized mutual support and network building in the
second part. Differences were seen after 12 months in regard to
compliance, which was greater in those patients whose families
participated in the maximum intervention group (education
plus support) compared with treatment as usual. The authors
conclude that effective family interventions in schizophrenia
probably requires continuing administration of important ele-
ments, or continuing informal support in order to deal with
changes in the state of the illness.
Short-term psychoeducational interventions for families
Yamaguchi et al. studied the direct effects of short-term
psychoeducational intervention for relatives of patients with
schizophrenia in Japan [42]. The relatives participated in three
or four sessions of psychoeducation, each lasting approxi-
mately 2 h, within 2 months. The groups were small, consist-
ing of two to six participants, and were led by two to three
doctors, a nurse and a social worker. The sessions were divided
into an interactive lecture part (information about schizophre-
nia, rehabilitation, social support programs and management
of patient behaviors) and an intensive discussion, taking
advantage of the small groups. Results showed that both state
and trait anxiety were significantly lower after the interven-
tion. Subjective burden, distress and depression significantly
decreased. Both families with high and those with low
expressed emotion benefit from the intervention, but the
effectiveness on subjective burden and depression was signifi-
cantly higher in families with a high level of expressed emo-
tions. This study shows that even short-term psychoeduca-
tional interventions seem to be effective for relatives of
patients with schizophrenia in regard to subjective burden,
depression and anxiety, and may even be especially useful for
families with high-expressed emotions. As such, short-term
interventions are much easier to implement in routine clinical
treatment, further studies are justified in order to verify these
findings in randomized, controlled trials and to assess the
long-term effects of such short-term psychoeducational family
interventions.
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 Review Rummel-Kluge & Kissling
Peer co-moderated support group compared with
professionally led psychoeducation
In a randomized, controlled trial, Chien et al. assessed the
effects of a peer co-moderated mutual support group compared
with professional psychoeducation and standard care for Chi-
nese families of patients with schizophrenia [43,44]. The main
contents and goals of the 12 sessions in the support groups
were: establishing trust and common goals (two sessions); shar-
ing and understanding more about individual concerns and
emphasizing specific Chinese cultural issues (two to three ses-
sions); understanding of important needs of themselves, the
patient and the family (three sessions including the patient);
learning coping mechanisms and patient management from
group members (three sessions); and preparation of group ter-
mination (one to two sessions). A peer leader, selected by group
members and participating in a professional-led 2-day training
workshop, worked together with a professional group facilita-
tor. The psychoeducation groups (12 sessions) were conducted
by two trained nurses; the content and format of psychoeduca-
tion were that of McFarlane [16]. The mutual support inter-
vention was associated with consistently greater improvements
in patient and family functioning, and rehospitalization and
stable use of mental health services at 12-month follow-up
compared with psychoeducation and standard care; at
18-month follow-up the number of re-admissions did not
decrease significantly, but their duration did. The results of this
study showed that mutual peer co-moderated support groups
giving emphasis to specific Chinese cultural characteristics and
issues were an effective family intervention for Chinese people.
Family psychoeducation focusing on functional outcomes
Magliano et al. reported a randomized study in 2006 in which
family psychoeducation was compared with a waiting-list con-
trol group at baseline and 6 months later in a real-world setting
in Italy [45]. The study focused on the impact of the interven-
tion on functional outcomes, such as patients personal and
social functioning, and social network. Statistically significant
improvements were found in the intervention group in global
and social functioning, social relationships, interest in obtain-
ing a job, maintenance of social interests, and management of
social conflicts. Family burden improved significantly in both
groups, whereas the relatives social contacts and perception of
professional support significantly increased only in the psycho-
education group. These results show that psychoeducational
family interventions have a significant impact on functional
outcomes in patients with schizophrenia and their families in
real-world settings, and not only in experimental settings.
However, further studies to assess the long-term outcomes of
such interventions in real-world trials are needed.
Cost-analysis of family psychoeducation
Mino et al. focused on a medical cost analysis of family psycho-
education for schizophrenia in a Japanese study, published in
2007 [46]. The authors found that the medical cost of the
1072
patients whose relatives attended psychoeducation was signifi-
cantly lower than those of the patients whose relatives belonged
to the control group. Mean total medical costs for the psychiat-
ric illnesses of the patients were 500,000 (US$4330) in the
psychoeducation group versus 710,000 (US$6150) in the
control group for the follow-up period of 9 months. These
results show that direct medical costs could be reduced com-
pared with the control group by family psychoeducation
through the prevention of rehospitalization. As health economic
aspects of psychoeducation have not been sufficiently studied
so far, further studies, particularly those assessing indirect costs,
are urgently needed.
On a single-study basis, these recently published studies on
psychoeducation for families of patients with schizophrenia
show:
A maximum intervention group (education plus support) for
relatives may be superior to treatment as usual in regard to
patients compliance after 12 months.
Caregivers need information about the potential risk of suicide
and its warning signs in patients with schizophrenia. In order
not to increase the family burden with this information,
appropriate coping resources and support for the families
should be provided.
Short-term psychoeducational interventions with small
group sizes may be effective for relatives of patients with
schizophrenia in regard to subjective burden, depression and
anxiety, and may even be especially useful for high expressed
emotion families.
A peer co-moderated mutual support group, giving emphasis
to specific cultural aspects, may be superior in terms of patient
and family functioning and patient rehospitalization compared
with professional psychoeducation and standard care.
Psychoeducational family interventions may have a signifi-
cant impact on functional outcomes in patients with schizo-
phrenia (e.g., on global and social functioning, social rela-
tionships, interest in obtaining a job and management of
social conflicts) and their families (e.g., on social contacts and
perception of professional support) in real-world settings.
A psychoeducational program addressing specific cultural and
family needs may improve the psychosocial health condition
of the whole family and the patients risk of rehospitalization
over a 12-months follow-up.
Direct medical costs of patients with schizophrenia could be
reduced by family psychoeducation by approximately a third
compared with a control group without family psychoeducation.
Newly developed strategies & approaches in
psychoeducation in schizophrenia
In 2006 Sibitz et al. reported results of a pilot study on a new psy-
choeducational approach, equally emphasizing quality of life as
well as disease-related topics. Quality of life, knowledge of illness,
Expert Rev. Neurother. 8(7), (2008)

competence and control beliefs significantly increased, and the
concept of illness significantly changed in a positive way [10].
However, these findings, including quality-of-life topics on an
equal basis with topics directly related to the disease, must be
confirmed in a randomized controlled trial design.
In 2006, Pollio et al. reported the evaluation of a compact
format of psychoeducation for combined diagnoses: a 1-day
psychoeducation workshop for families and friends of people
with severe mental illness, including schizophrenia, bipolar dis-
order, major depression and other affective disorders was used
to disseminate basic information to the participating families
[47]. The workshop started with three lectures: one on descrip-
tive and diagnostic information on schizophrenia and mood
disorders; one on the biological basis of mental illness, includ-
ing neurochemistry and genetics; and one on medication and
other treatment options. Informal discussion groups met dur-
ing lunch, and in the afternoon two breakout sessions with a
brief didactic presentation followed by discussion of area
resources, success stories, ask the doc, religion and legal gram and the Arbeitsbuch PsychoEdukation bei Schizophrenie
rights took place. From workshop start to finish, control of
daily life, effectiveness in crisis situation, knowledge on
obtaining community resources and knowledge about mental
illness and treatment increased significantly, whereas feelings
of guilt decreased. Short-term goals of the workshops were
achieved throughout. Even though such a short intervention is
not designed for long-term gains, families seem to benefit from
such workshops and might get into contact with more intensive
services more easily. Furthermore, the implementation of such
short-term interventions for families with different diagnoses in
routine clinical settings seems to be much easier than the
implementation of diagnosis-specific long-term interventions.
However, such long-term interventions have proved to be more
efficacious than short-term interventions.
Peer-led patient and family education programs have been
developed during recent years [4851]. After having participated
in special training (five-step curriculum) [50,51], stable, carefully
selected patients and relatives of patients with schizophrenia
work as group moderators themselves. One important advan-
tage of this method is the high credibility of these moderators:
when a patient with schizophrenia who is currently taking anti-
psychotic medication for relapse prevention himself talks about
side effects of antipsychotics, he is much more credible for the
participating patients than a professional who has himself never
experienced those side effects. Family-member moderators can
function as positive role models as well; for example, when shar-
ing their experiences of coping with the psychiatric illness of a
family member. Short-term outcomes on knowledge of illness,
concept of illness and attitudes towards medication in the peer-
led groups were similar to or even better than those in compara-
ble groups with professional moderators. However, long-term
outcomes need to be evaluated in further trials.
A further new approach was started by McWilliams et al. in
2007 by looking at gender aspects in psychoeducation for care-
givers in schizophrenia [52]. The authors found gender differences
www.expert-reviews.com
Psychoeducation in schizophrenia Review
in the amount and type of knowledge gained during psycho-
education: female caregivers gained more knowledge overall and
especially in the areas signs and symptoms, recovery and
caregiver support, whereas males gained more knowledge
about risk factors. Summarizing these results, family interven-
tions may be improved by adjusting specific gender aspects in
order to be able to further reduce burden and improve the out-
comes for the patients with schizophrenia.
The patients perspective was the focus of a study by Sibitz
et al., published in 2007, on the important topic of what has an
effect in psychoeducation in schizophrenia [53]. The authors
found that receiving information and exchanging information
with peers was essential for the participants. Overemphasis on
illness-related information seems to cause defensive reactions,
but integrating quality-of-life aspects was appreciated by the
participants.
Standardized psychoeducational programs in schizophrenia
have been developed recently: the Alliance Psychoeducation Pro-
(APES) program [54,55]. The developments of the two above-
mentioned programs with comprehensive working material,
such as CD-ROMs, films and workbooks, were sponsored by
pharmaceutical companies. Even though such sponsoring can be
seen critically or ambivalently [56], both programs are non-medi-
cation-specific and have introduced psychoeducation in schizo-
phrenia into many hospitals and will certainly help to further
raise the participation rates in psychoeducation [54]. One impor-
tant approach of the Alliance psychoeducation program is to
integrate the whole psychiatric team (e.g., physicians, psycho-
logists, nursing staff and social worker) into moderating the
psychoeducation groups. This approach offers the availability of
many more moderators than the traditional concept of only phy-
sician and psychologist moderators. However, adequate training
and supervision for these moderators must be assured.
Expert commentary
Psychoeducation for patients with schizophrenia and their fam-
ilies can reduce the relapse rates of these patients. In clinical set-
tings, being treated with antipsychotic medication and then
being invited to participate in psychoeducation and start the
group while still being hospitalized has been shown to be a
practicable method for patients with schizophrenia. This com-
bination of medication and psychoeducation for patients seems
to be essential. For the families of these patients, psychoeduca-
tion groups should be offered parallel to the patients groups.
Long-term family interventions (i.e., those with durations of
more than 3 months) were shown to be particularly helpful.
However, to date, there still remain unsolved questions in this
area: which psychoeducational format (e.g., minimal dose of
psychoeducation, hospital- vs home-based approaches, psycho-
educational and behavioral approaches vs supportive manage-
ment, and single- vs multiple-family approaches) is best for
which patient (e.g., stabilized outpatients vs inpatients) in
1073
 Review Rummel-Kluge & Kissling

which phase of the illness is still unclear. However, it seems to be
very plausible that there is a doseresponse relationship of
psychoeducational interventions. As most of the studies finding
benefits in family psychoeducation were conducted with
recently discharged or exacerbated individuals who subsequently
had a heightened risk for relapse, these results may not be gener-
alizable to stable outpatients, who are the vast majority of
patients. Thus, to identify what benefits may ensue when these
stable outpatients and their families participate in psychoeduca-
tion, and how the psychoeducational interventions need to be
adapted for these participants seems to be an important issue in
the dissemination of family psychoeducation.
Future research should therefore focus these participants, but
also on the minimum effective psychoeducation dose (dose
response relationship), on those patients with schizophrenia
who do not have supporting families willing to participate in
family psychoeducation, on standardized outcomes and follow-
up periods, and on the working principle of psychoeducation,
since it is still unknown how psychoeducation actually works.
Furthermore, it needs to be acknowledged that schizophrenia is
not a homogenous disorder and that differences in the out-
comes between studies might not only be due to different
designs and different intervention packages, but also due to dif-
ferent populations studied: the presence or absence of cognitive
disturbances seems to be a key element for the ability to learn
and profit from such interventions.
Five-year view
During the next 5 years, standardized, manualized psycho-
educational programs in schizophrenia, such as the previously
mentioned Alliance Psychoeducation Program and the APES
program, will contribute to improving the amount and the
quality of psychoeducation that is conducted [54,55]. In most of
the psychiatric hospitals, psychoeducation in schizophrenia will
be considered as part of the routine clinical treatment within
the next 5 years.
For smaller hospitals, where diagnosis-specific psychoeduca-
tional groups are difficult to assemble due to a lack of sufficient
patients with the same diagnosis, broader psychoeducational
programs combining several psychiatric diagnoses will be devel-
oped and implemented [57]. Several aspects and contents that
are discussed during the psychoeducational sessions are appro-
priate for patients with schizophrenia and patients with an

Key issues
One main treatment of schizophrenia is pharmacological treatment with antipsychotic medication; one important nonpharmacological
treatment strategy is psychoeducation, which is recommended by modern treatment guidelines.
Psychoeducation is defined as systematic, structured, didactic information about the illness and its treatment, and includes integrating
emotional aspects in order to enable the participants (patients as well as family members) to cope with the illness.
Evidence from meta-analyses showed that psychoeducation for patients with schizophrenia and their families can reduce the relapse
rates of these patients and have other positive effects on the patients and their families, such as reduction of burden. Longer
interventions (3 months) are more effective than short-term interventions.
Single studies on patient psychoeducation found that a culturally sensitive adaptation of psychoeducation can be necessary and can
influence its outcomes positively; optimal results for reducing relapse rates were achieved in a study for participants with durations of
illness of 47 years. Psychoeducation can improve compliance with outpatients appointments. Cognitivebehavioral group therapy or
a structured social skills training program may be superior to group psychoeducation in regard to rehospitalization. No between-group
differences were found on symptom reduction between functional cognitive therapy and psychoeducation.
Single studies on family psychoeducation found that even short, eight-session bifocal psychoeducational approaches can have an
impact on reduction of hospitalization days. Caregivers should be provided with information on suicide risks/warning signs and the
appropriate coping resources and support. A peer co-moderated, culturally sensitive support group may be superior to professional
psychoeducation and standard care in terms of patient and family functioning and patient rehospitalization. Functional outcomes in
patients and families (e.g., social relationships/contacts and interest in obtaining a job) may be positively influenced by
psychoeducation. Culturally sensitive psychoeducational family approaches may improve the psychosocial health of the whole family
and the patients risk of rehospitalization over a 12-month follow-up. Direct medical costs of patients with schizophrenia could be
reduced by approximately a third through family psychoeducation.
Future research should focus on the minimum effective dose of psychoeducation, on which psychoeducational format is best for which
patient, on those patients with schizophrenia who do not have supporting families, on standardized outcomes and follow-up periods,
and on the working principle of psychoeducation.
New approaches in the area of psychoeducation are the increasing quality-of-life issues, offering a compact format of psychoeducation
for combined diagnoses in the form of 1-day workshops for families and friends, peer-to-peer groups for patients and families,
focusing on gender aspects as well as using standardized psychoeducation programs including the entire treatment team as
psychoeducation moderators.
As a speculative view on how psychoeducation will evolve in 5 years time, psychoeducation will be considered part of routine clinical
treatment, psychoeducational groups for combined diagnoses will be implemented in smaller hospitals, peer-to-peer psychoeducation
will increase, and more shared decision-making and quality-of-life issues will be integrated into psychoeducational sessions.

1074 Expert Rev. Neurother. 8(7), (2008)

 Psychoeducation in schizophrenia Review

affective disorder; for example, warning signs, pharmacother-
apy and dealing with family members. Other aspects, such as
diagnosis and symptoms for example, need to be explained in
detail, with reference to the specific diagnosis.
Furthermore, more peer-to-peer psychoeducation for patients
and their relatives will also be conducted. As described earlier,
the peer-to-peer concept is a new, promising strategy, where
patients or family members function as group moderators, but
at the same time as positive role models [4851].
A further new approach in this area might be for more shared
decision-making components to be integrated into psychoeduca-
tional sessions. The aim of shared decision-making is to decrease
the informational and power asymmetry between doctors and
patients by increasing the patients information and their control
over treatment decisions [58]. In addition to the regular psycho-
educational sessions, where patients are informed about medica-
tion, patients in psychoeducational sessions with shared deci-
sion-making components are encouraged to actively incorporate
their own views and expectations on the therapy into the deci-
sion process. In that way, patients are not only informed, but also
actively integrated into the choice of their own medication. Role
plays allowing the participants to prepare themselves for
dialogues on medication decisions for relapse prevention with
their treating physicians, could take place in the psycho-
educational sessions. Long-term compliance might be improved
by the integration of such shared decision-making components,
as patients might accept a treatment more readily if they are
included in the decision for it. In addition, it has been shown
that the implementation of shared decision-making has
increased the uptake of psychoeducation [59]. Other components
in psychoeducation that might become increasingly important
are topics concerning quality of life: focusing more on this topic,
considered especially important by the participants themselves,
seems to be in the spirit of our times [10,11,53,60].
In addition to these different formats of interventions, as
regards content future psychoeducation will be dealing much
more with the recovery movement and remission in schizo-
phrenia as these topics are of increasing interest for patients,
their families and professionals [28,6163].
Financial & competing interests disclosure
Christine Rummel-Kluge and Werner Kissling are authors of the Alliance
Psychoeducation Program, which has been supported by Pfizer; the authors
have received lecture/workshop honoraria and grants from Pfizer.
The authors have no other relevant affiliations or financial involvement
with any organization or entity with a financial interest in or financial
conflict with the subject matter or materials discussed in the manuscript
apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.

Schizophrenia. 2nd Ed. American Psychiatric treatment of schizophrenia: results of the

References
Papers of special note have been highlighted as:
of interest
of considerable interest
1 Byrne P. Managing the acute psychotic
episode. BMJ 334(7595), 686692 (2007).
2 Diagnostic and Statistical Manual of Mental
Disorders. Fourth Edition, DSM IV-TR.
American Psychiatric Association,
Washington DC, USA (2000).
3 Davis JM, Chen N, Glick ID. A meta-
analysis of the efficacy of second-generation
antipsychotics. Arch. Gen. Psychiatry 60(6),
553564 (2003).
4 Leucht S, Barnes TR, Kissling W,
Engel RR, Correll C, Kane JM. Relapse
prevention in schizophrenia with new-
generation antipsychotics: a systematic
review and exploratory meta-analysis of
randomized, controlled trials. Am. J.
Psychiatry 160(7), 12091222 (2003)
5 Geddes J, Freemantle N, Harrison P,
Bebbington P. Atypical antipsychotics in
the treatment of schizophrenia: systematic
overview and meta-regression analysis. BMJ
321(7273), 13711376 (2000).
6 American Psychiatric Association. Practice
Guideline for the Treatment of Patients with
Association, Washington DC, USA (2004).
7 Buml J, Pitschel-Walz G. Psychoedukation
bei schizophrenen Erkrankungen. Schattauer,
Stuttgart, Germany (2003).
8 Hornung WP, Kieserg A, Feldmann R,
Buchkremer G. Psychoeducational training
for schizophrenic patients: background,
procedure and empirical findings. Patient
Educ. Couns. 29(3), 257268 (1996).
9 Hayes R, Gantt A. Patient
psychoeducation: the therapeutic use of
knowledge for the mentally ill. Soc. Work
Health Care 17, 5367 (1992).
10 Sibitz I, Gossler R, Katschnig H,
Amering M. Knowing enjoying better 15
living a seminar for persons with
psychosis to improve their quality of life
and reduce their vulnerability. Psychiatr.
Prax. 33(4), 170176 (2006).
11 Kilian R, Holzinger A, Angermeyer MC.
It may be somewhat more demanding
sometimes, but also more interesting.
Psychiatrists evaluate the impact of
psychoeducation on outpatient treatment
of schizophrenia] Psychiatr. Prax. 28(5),
209213 (2001).
12 Pitschel-Walz G, Buml J, Bender W,
Engel RR, Wagner M, Kissling W.
Psychoeducation and compliance in the
Munich PIP-Study. J. Clin. Psychiatry
67(3), 443452 (2006).
13 Buml J, Pitschel-Walz G, Volz A,
Engel RR, Kissling W. Psychoeducation in
schizophrenia: rehospitalisation and
hospital days 7 year follow-up of the
Munich Psychosis Information Project
Study. J. Clin. Psychiatry 68, 854861
(2007).
14 Corrigan PW, Liberman RP, Engel JD.
From noncompliance to collaboration in
the treatment of schizophrenia. Hosp.
Community Psychiatry 41(11), 12031211
(1990).
Hogarty GE, Anderson CM, Reiss DJ et al.
Family psychoeducation, social skills
training, and maintenance chemotherapy in
the aftercare treatment of schizophrenia. II.
Two-year effects of a controlled study on
relapse and adjustment. Environmental-
Personal Indicators in the Course of
Schizophrenia (EPICS) Research Group.
Arch. Gen. Psychiatry 48(4), 340347
(1991).
16 McFarlane WR, Lukens E, Link B et al.
Multiple-family groups and
psychoeducation in the treatment of
schizophrenia. Arch. Gen. Psychiatry 52(8),
679687 (1995).

www.expert-reviews.com 1075
 Review Rummel-Kluge & Kissling
17 Jungbauer J, Bischkopf J, Angermeyer M.
Belastungen von Angehrigen psychisch
Kranker. Entwicklungslinien, Konzepte
und Ergebnisse der Forschung. Psychiatr.
Prax. 28, 105114 (2001).
18 Jungbauer J, Wittmund B, Angermeyer MC.
Der behandelnde Arzt aus Sicht der
Angehrigen: Bewltigungsressource oder
zustzliche Belastung? Psychiatr. Prax. 29,
279284 (2002).
19 Sherman MD. The support and family
education (SAFE) program: mental health
facts for families. Psychiatr Serv. 54(1),
3537 (2003).
20 Addington J, Coldham EL, Jones B et al.
The first episode of psychosis: the
experience of relatives. Acta Psychiatr.
Scand. 108, 285289 (2003).
21 Rummel-Kluge C, Pitschel-Walz G,
Buml J, Kissling W. Psychoeducation in
schizophrenia: results of a survey of all
psychiatric institutions in Germany,
Austria, and Switzerland. Schizophr. Bull.
32(4), 765775 (2006).
22 Toprac MG, Dennehy EB, Carmody TJ
et al. Implementation of the Texas
Medication Algorithm Project Patient and
Family Education Program. J. Clin.
Psychiatry 67, 13621372 (2006).
23 Dixon L, Lyles A, Scott J et al. Services to
families of adults with schizophrenia: from
treatment recommendations to
dissemination. Psychiatr Serv. 50(2),
233238 (1999).
24 Pekkala E, Merinder L. Psychoeducation
for schizophrenia. Cochrane Database
Syst. Rev. (2), D002831 (2002).
Concise meta-analysis on psychoeducation
in schizophrenia.
25 Penn DL, Mueser KT. Research update on
the psychosocial treatment of schizophrenia.
Am. J. Psychiatry 153(5), 607617 (1996).
26 Pitschel-Walz G, Leucht S, Buml J et al.
The effect of family interventions on
relapse and rehospitalization in
schizophrenia a meta-analysis.
Schizophr. Bull. 27(1), 7392 (2001).
Comprehensive meta-analysis
summarizing effects of family interventions
on relapse and rehospitalization rates of
patients with schizophrenia.
27 McFarlane WR, Dixon L, Lukens E,
Lucksted A. Family psychoeducation and
schizophrenia: a review of the literature. J.
Marital Fam. Ther. 29(2), 223245 (2003).
Comprehensive review focusing on
implementation barriers in psychoeducation
and how to overcome them.
1076
28 Glynn SM, Cohen AN, Dixon LB, Niv N.
The potential impact of the recovery
movement on family interventions for
schizophrenia: opportunities and obstacles.
Schizophr. Bull. 32(3), 451463 (2006).
29 Pfammatter M, Junghan UM,
Brenner HD. Efficacy of psychological
therapy in schizophrenia: conclusions form
meta-analyses. Schizophr. Bull. 32(S1),
S64S80 (2006).
30 Cunningham ODG, Carroll A, Fattah S,
Clyde Z, Coffey I, Johnstone EC.
A randomized, controlled trial of a brief
interventional package for schizophrenic
out-patients. Acta Psychiatr. Scand. 103,
362369 (2001).
31 Shin S-K, Lukens EP. Effects of
psychoeducation for Korean Americans
with chronic mental illness. Psychiatr. Serv.
53, 11251131 (2002).
32 Feldmann R, Hornung WP, Prein B,
Buchkremer G, Arolt V. Timing of
psychoeducational psychotherapeutic
interventions in schizophrenic patients.
Eur. Arch. Psychiatry Clin. Neurosci. 252,
115119 (2002).
33 Agara AJ, Onibi OE. Effects of group
psychoeducation (GPE) on compliance
with scheduled clinic appointments in a
neuro-psychiatric hospital in Southwest
Nigeria: a randomized control trial (RCT).
Ann. Acad. Med. Singapore 36, 272276
(2007).
34 Bechdolf A, Knost B, Kuntermann C et al.
A randomized comparison of group
cognitivebehavioral therapy and group
psychoeducation in patients with
schizophrenia. Acta Psychiatr. Scand. 110,
2128 (2004).
35 Bechdolf A, Khn D, Knost B, Pukrop R,
Klosterktter J. A randomized comparison
of group cognitivebehavioral therapy and
group psychoeducation in acute patients
with schizophrenia: outcome at 24 months.
Acta Psychiatr. Scand. 112, 173179
(2005).
36 Cather C, Penn D, Otto MW, Yovel I,
Mueser KT, Goff DC. A pilot study of
functional cognitive behavioral therapy
(fCBT) for schizophrenia. Schizophr. Res.
74, 201209 (2005).
37 Xiang Y-T, Weng Y-Z, Li W-Y et al.
Efficacy of the community re-entry module
for patients with schizophrenia in Beijing,
China: outcome at 2-year follow-up. Br. J.
Psychiatry 190, 4956 (2007).
38 Aguglia E, Pascalo-Fabrici E, Bertossi F,
Bassi M. Psychoeducational intervention
and prevention of relapse among
schizophrenic disorders in the Italian
community psychiatric network. Clin.
Pract. Epidemol. Ment. Health 3, 7 (2007).
39 McDonell MG, Short RA, Berry CM,
Dyck DG. Burden in schizophrenia
caregivers: impact of family
psychoeducation and awareness of patient
suicidality. Fam. Proc. 42, 91103 (2003).
40 Chien WT, Wong K-F. A family
psychoeducation group program for Chinese
people with schizophrenia in Hong Kong.
Psychiatr. Serv. 58(7), 10031006 (2007).
41 Carr G, Montomoli C, Clerici M,
Cazzullo CL. Family interventions for
schizophrenia in Italy: randomized
controlled trial. Eur. Arch. Psychiatry
Clin. Neurosci. 257, 2330 (2007).
42 Yamaguchi H, Takahashi A, Takano A,
Kojima T. Direct effects of short-term
psychoeducational intervention for relatives
of patients with schizophrenia in Japan.
Psychiatry Clin. Neurosci. 60, 590597
(2006).
43 Chien W-T, Chan SWC. One-year
follow-up of a multiple-family group
intervention for Chinese families of
patients with schizophrenia. Psychiatr.
Serv. 55, 12761284 (2004).
New approach of using peer-led
co-moderation.
44 Chien W-T, Chan SWC, Thompson DR.
Effects of a mutual support group for
families of Chinese people with
schizophrenia: 18-month follow-up. Br. J.
Psychiatry 189, 4149 (2006).
New approach of using peer-led
co-moderation.
45 Magliano L, Fiorillo A, Malangone C, De
Rosa C, Maj M and the Family
Intervention Working Group. Patient
functioning and family burden in a
controlled, real-world trial of family
psychoeducation for schizophrenia.
Psychiatr. Serv. 57(12), 17841791 (2006).
46 Mino Y, Shimodera S, Inoue S, Fujita H,
Fukuzawa K. Medical cost analysis of
family psychoeducation for schizophrenia.
Psychiatry Clin. Neurosci. 61, 2024 (2007).
Focusing on health economics in
psychoeducation.
47 Pollio DE, North CS, Reid DL,
Miletic MM, McClendon JR. Living with
severe mental illness what families and
friends must know: evaluation of a one-day
psychoeducation workshop. Soc. Work
51(1), 3138 (2006).
New approach with a compact format of
psychoeducation across diagnoses.
Expert Rev. Neurother. 8(7), (2008)

48 Dixon L, Stewart B, Burland J,
Delahanty J, Lucksted A, Hoffman M.
Pilot study of the effectiveness of the
family-to-family education program.
Psychiatr. Serv. 52, 965967 (2001).
49 Dixon L, Lucksted A, Stewart B et al.
Outcomes of the peer-taught 12 week
family-to-family education program for
severe mental illness. Acta Psychiatr. Scand.
109, 207215 (2004).
New approach of a peer-to-peer
intervention for families.
50 Rummel C, Pitschel-Walz G, Kissling W.
Family members inform family members
family members as group moderators for
psychoeducational groups in schizophrenia.
Psychiatr. Prax. 32, 8792 (2005).
New approach of a peer-to-peer
intervention for families.
51 Rummel C, Hansen WP, Helbig A,
Pitschel-Walz G, Kissling W. Peer-to-peer
psychoeducation in schizophrenia: a new
approach. J. Clin. Psychiatry 66,
15801585 (2005).
New approach of a peer-to-peer
intervention for patients
with schizophrenia.
52 McWilliams S, Hill S, Mannion N,
Kinsella A, OCallaghan E. Caregiver
psychoeducation for schizophrenia:
is gender important? Eur. Psychiatry 22,
323327 (2007).
New aspect of studying gender aspects
in psychoeducation.
www.expert-reviews.com
Psychoeducation in schizophrenia
53 Sibitz I, Amering M, Gssler R,
Unger A, Katschnig H. Patients
perspective on what works in
psychoeducational groups for
schizophrenia. Soc. Psychiatry Psychiatr.
Epidemiol. 42(11), 909915 (2007).
54 Rummel-Kluge C, Pitschel-Walz G,
Kissling W. A fast implementable
psychoeducation program for
schizophrenia. Psychiatr. Serv. 58,
1226 (2007).
55 Buml J, Pitschel-Walz G, Berger H,
Gunia H, Heinz A, Juckel G. Arbeitsbuch
PsychoEdukation bei Schizophrenie (APES).
Schattauer, Stuttgart, Germany (2005).
56 Klimitz H. Psychoeducation in
schizophrenic disorder psychotherapy or
infiltration? Psychiatr. Prax. 33, 372379
(2006).
57 Rabovsky K, Stoppe G. Die Rolle der
Psychoedukation in der stationren
Behandlung psychisch Kranker. Eine
kritische bersicht. Nervenarzt 77,
538548 (2006).
58 Charles C, Gafni A, Whelan T. Shared
decision-making in the medical encounter:
what does it mean (or it takes at least two to
tango). Soc. Sci. Med. 44, 681692 (1997).
59 Hamann J, Langer B, Winkler V et al.
Shared decision making for in-patients with
schizophrenia. Acta Psychiatr. Scand. 114,
265273 (2006).
60 Kilian R, Lindenbach I, Angermeyer MC.
sometimes I have doubt about myself,
when Im not doing well. Effect of an
Review
ambulatory psychoeducational group
program from the subjective perspective of
patients with schizophrenic illnesses.
Psychiatr. Prax. 28(4), 168173 (2001).
61 Lasser RA, Nasrallah H, Helldin L et al.
Remission in schizophrenia: applying
recent consensus criteria to refine the
concept. Schizophr. Res., 96 (13), 223231
(2007).
62 Andreasen NC, Carpenter WT Jr, Kane JM
et al. Remission in schizophrenia: proposed
criteria and rationale for consensus. Am. J.
Psychiatry 162 (3), 441449 (2005).
63 Amering M, Schmolke M. Recovery.
Das Ende der Unheilbarkeit. Psychiatrie
Verlag, Bonn (2007). English translation
Wiley-Blackwell, Chichester, UK
(In Press).
Affiliations
Christine Rummel-Kluge
Department of Psychiatry & Psychotherapy,
Klinikum rechts der Isar der Technischen
Universitt, Mhlstr. 26, 81675 Mnchen,
Germany
Tel.: +49 89 4140 6676
Fax: +49 89 4140 6688
christine.rummel@lrz.tum.de
Werner Kissling
Department of Psychiatry & Psychotherapy,
Klinikum rechts der Isar der Technischen
Universitt, Mhlstr. 26, 81675 Mnchen,
Germany
1077