Though psychiatrists taking part in a recent study demonstrated that
they were knowledgable about using medication to prevent relapse in
schizophrenia patients, they often failed do a good job of communicating those
treatment plans to patients.
In addition, the psychiatrists only offered psychoeducation, which has been
shown to increase medication compliance, to about one-third of their
The findings come from a survey of 50 psychiatrists working with 100
patients in Germany in 2002 and appeared in the November Psychiatric
To recruit a sample of psychiatrists and patients, primary investigator
Johannes Hamann, M.D., presented information about the study at morning rounds
in eight psychiatric hospitals in southern Germany.
Hamann is a psychiatry resident at the Technischen Universität Munchen
He recruited 50 psychiatrists who were treating inpatients with
schizophrenia and surveyed each about two patients who were about to be
discharged from inpatient care.
When psychiatrists were asked about how long they thought each patient
should receive relapse-prevention therapy with antipsychotic medications, for
75 percent of the patients they cited time frames that agreed with the German
Psychiatric Association's Guidelines for the Treatment of Schizophrenia.
The German guidelines for treating schizophrenia are similar to those of
APA and specify that patients experiencing their first episode of
schizophrenia should receive one to two years of relapse-prevention treatment.
According to the guidelines, those with previous episodes require at least
four years of relapse-prevention treatment.
Hamann found that for 26 of the 100 patients, psychiatrists did not discuss
relapse prevention or maintenance therapy before discharge, and in 26
additional cases they had not discussed a clear time frame for continuing with
treatment. "Psychiatrists gave correct recommendations for relapse
prevention for only 33 of 100 patients and recommended time frames that were
too short for the remaining 15 patients," according to the report.
There was also a discrepancy between what psychiatrists said they told
patients and what the patients said psychiatrists told them about treatment.
Of the 92 patients who agreed to be interviewed, 71 reported that their
physicians had neither discussed maintenance therapy with them nor mentioned a
specific time frame for continuing treatment (physicians said they did not
discuss continuing treatment or give clear time frames for treatment for 52
In addition, the physicians in the study stated that for 78 patients, they
had taken some measure to improve medication compliance, yet offered
psychoeducation to only 30 patients.
Psychoeducation was defined as a "structured intervention" used
by physicians in a group or individual sessions with patients involving a
manual or specific literature. Informal talks with patients and families did
"There is, to my knowledge, no evidence that chronic patients do not
profit from psychoeducation," Hamann told Psychiatric News.
Most of the patients who received psychoeducation were younger or had a
shorter duration of illness, the study found.
Hamann speculated that "doctors distinguish between patients for whom
they believe psychoeducation to be reasonable," such as younger
patients. "Probably the older or more chronic patients are seen as
`hopeless cases' for whom psychoeducation may not change anything," he
Nor could Hamann account for the fact that physicians in the study only
offered depot injections to a minority of patients (16) and contacted the
physician who would be treating the patient after hospital discharge in only
"Neglecting to communicate with patients for whatever reason seems
especially inappropriate in view of results from studies on physician-patient
communication that show effective communication.. .improves health
outcomes," Hamann and collegues wrote.
Hamann said that doctor-patient communication can be improved through
shared decision making regarding schizophrenia treatment.
More specifically, physicians should offer patients information about a
number of treatment options, and both physicians and patients could benefit
from communication skills training.
Communication skills training for patients should take into account"
illness-specific" problems such as thought disturbance, he said.
Such training may also seek to improve patients' social skills.
"Physicians' and Patients' Involvement in Relapse Prevention
With Antipsychotics in Schizophrenia" is posted at▪