Effectiveness of psychoeducational intervention in prison psychiatry – a randomized controlled trial

INTERVENTION: Intervention 1: For this study, a slightly shortened and modified version of the APES manual (Arbeitsbuch PsychoEdukation bei Schizophrenie – mit Manual für die Gruppenleitung; Bäuml et al., 2005; Kogan & Friedenstab, 2016) was implemented, in addition to the treatment as usual, as described below. The intervention was performed based on a combination of teaching and interactive group work and discussion. Each session began with the presentation of a key topic and was followed by a gathering and subsequent discussion of information shared by the participants, thus providing time and room for emotional relief. Participants were handed a personal folder for all of the materials given to them at each session. Topics covered in the psychoeducational intervention were as follows: A modified psychoeducational program, as described in Kogan & Friedenstab (2016): 1. Introduction 2. Disease concept, symptomatology and diagnostic process 3. What happens in the brain? Medication and side effects 4. Vulnerability and stress model (causes of Schizophrenia) 5. Psychosis, addiction and delinquency 6. Psychotherapy and psychosocial treatment strategies 7. Preventing relapses, early warning signs, long‐acting injections (depot), crisis or emergency plans 8. Conclusion The psychoeducational intervention consisted of 8 group sessions, which were conducted twice a week for 50 minutes by the CI and her team of psychologists. Group sizes varied between 1 and 4 participants, depending on the fluctuating number of potential participants at any given time. Group‐rules were introduced in the first session and highlighted the importance of confidentiality and the understanding that personal information about other group members should not be shared with other patients outside the group. Intervention 2: The control group received TAU provided by the staff of the psychiatric department, including medical treatment and antipsychotic medication in addition to psychosocial therapies (such CONDITION: F20 ‐ Schizophrenia INCLUSION CRITERIA: F20.x Diagnosis, Incarceration expected to last 3 months at least PRIMARY OUTCOME: The primary objective was to determine whether there is a difference in knowledge about the illness before and after psychoeducation in an intervention group compared to a control group.; The Knowledge Questionnaire (KQ) was utilized to measure the primary objective. The KQ (Wissensfragebogen; Pitschel‐Walz, 1997) is a multiple‐choice questionnaire consisting of 21 questions that are related to the topics discussed in the psychoeducational group concerning symptoms, causes, medication and early warning signs.; The knowledge questionnaire contains 21 questions with a total of 107 possible answers (each question has between 4 and 8 answers to choose from) of which 70 should be recognized as correct. The sum of the correct answers minus the sum of the wrong answers forms the "knowledge score"; thereby a maximum of 70 points can be achieved. The KQ was administered to measure the level of knowledge before and after intervention. SECONDARY OUTCOME: The secondary objectives were as follows:; 1. To assess the level of patient‐rated symptom severity versus physician‐rated symptom severity on admission in the intervention group compared to the control group.; 2. To determine rehospitalization rates in the intervention group compared to the control group.; 3. To examine the level of adherence at discharge in the intervention group compared to the control group.; To assess the key objectives, as stated above, the following psychological test battery was utilized at two testing times. ; ; Structured Interview ; After having consented to participate in the study, the CI assessed the patients with a structured interview including questions concerning sociodemographic variables (e.g. age, nationality, marital status, number of children, education), clinical variables (e.g. number of prior psychiatric treatments, mental illness in the family) and questions concerning incarceration (e.g. number of prior incarcerations, reason(s) for current incarceration). This information was crosschecked with the information contained in the case file of the patient and where necessary corrected in the data sheet.; ; Structured Clinical Interview for DSM‐IV Axis II Disorders:; The Structured Clinical Interview II (SCID‐II) (First et al., 1997) is designed to assess Axis II (personality disorders) according to DSM‐IV in a psychiatric population. This is considered to be a valid and reliable tool for assessing personality disorders (Lobbestael, et al., 2011; Zanarini et al., 2000) and has been used with offenders (Beaudette & Stewart, 2016; Ullrich et al., 2008). A research assistant (a psychologist working in the psychiatric department) conducted the two‐part administration of the SCID II (the questionnaire and the subsequent structured interview) and allocated scores according to the manual.; ; Positive and Negative Syndrome Scale; The Positive and Negative Syndrome Scale (PANSS) (Kay et at., 1987; Kay et al. 1989) is a typological and dimensional assessment tool used for measuring the symptom severity of patients with schizophrenia. A Structured Clinical Interview for the Positive and Negative Scale (SCI‐PANSS) was utilized in order to adopt a standardized procedure and optimize objectivity. ; ; The Eppendorfer‐Schizophrenie‐Inventar (ESI) (Maß et al., 2000; Maß, 2001) is a questionnaire for the self‐assessment of disturbances in several cognitive and perceptual areas. Four schizophrenia‐specific dimensions, and one control scale, are observed: attention and speech impairment (AS); ideas of reference (IR); auditory uncertainty (AU); deviant perception (DP). The control scale frankness (FR) describes the persons readiness to admit to one’s own minor violations against socially desired behavioral rules.