Rummel Christine B, Hansen Wulf-Peter, Helbig Alexandra, Pitschel-Walz Gabriele, Kissling Werner
Department of Psychiatry and Psychotherapy, Center for Disease Management, Technical University Munich, Möhlstrasse 26, 81675 Munich, Germany.
J Clin Psychiatry. 2005 Dec;66(12):1580-5. doi: 10.4088/jcp.v66n1214.
To evaluate the feasibility of the first peer-to-peer psychoeducation program in schizophrenia.
We developed a 5-step curriculum for structured training of peer moderators. In step 1, peer moderators participate in regular psychoeducation, and in step 2, they participate in workshops on knowledge about schizophrenia and moderation techniques. In step 3, peer moderators conduct peer-to-peer groups in the presence of a mental health professional, and in step 4, they conduct the groups independently with regular supervision. Further peer moderators are recruited in step 5. Psychoeducation by trained peer moderators comprises 8 60-minute group sessions (warm-up, symptoms, diagnosis, causes, medication, psychosocial therapy, warning signs, coping with schizophrenia) with 6 to 10 patients per group. The feasibility of the 5-step curriculum was evaluated by conducting a pilot study of 7 peer groups with 2 peer moderators. Evaluation of peer-moderated groups was done from January 2003 to July 2004 using inpatients of a university hospital who had schizophrenia or schizoaffective disorder according to ICD-10. The primary outcomes of interest were change in knowledge and concept of illness from baseline to endpoint.
Two peer moderators conducted psychoeducational groups with a total of 49 patients in the presence of a physician (step 3). On the whole, conduction of peer-moderated groups worked well. Knowledge of illness increased significantly (N = 44, p < .001), and concept of illness changed significantly in 3 subscales: trust in physician (N = 40, p = .002) and trust in medication (N = 40, p = .001) increased, and negative treatment expectations decreased (N = 40, p = .001). Subjective assessments of peer moderators by participating patients were positive.
First results suggest that peer-to-peer psychoeducation in schizophrenia according to the 5-step curriculum is feasible and may be comparable to professional psychoeducation in regard to short-term outcomes.
评估首个精神分裂症同伴互助心理教育项目的可行性。
我们为同伴主持者的结构化培训制定了一个五步课程。在第一步中，同伴主持者参与常规心理教育，在第二步中，他们参加关于精神分裂症知识和主持技巧的工作坊。在第三步中，同伴主持者在心理健康专业人员在场的情况下开展同伴互助小组活动，在第四步中，他们在定期监督下独立开展小组活动。在第五步中招募更多的同伴主持者。由经过培训的同伴主持者开展的心理教育包括8次60分钟的小组课程（热身、症状、诊断、病因、药物治疗、心理社会治疗、警示信号、应对精神分裂症），每组有6至10名患者。通过对由2名同伴主持者带领的7个同伴小组进行试点研究，评估五步课程的可行性。2003年1月至2004年7月，对一所大学医院中根据国际疾病分类第10版（ICD - 10）诊断为精神分裂症或分裂情感性障碍的住院患者参与的同伴主持小组进行评估。感兴趣的主要结果是从基线到终点疾病知识和观念的变化。
两名同伴主持者在一名医生在场的情况下（第三步）为总共49名患者开展了心理教育小组活动。总体而言，同伴主持小组的活动开展得很顺利。疾病知识显著增加（N = 44，p <.001），疾病观念在3个分量表上有显著变化：对医生的信任（N = 40，p =.002）和对药物治疗的信任（N = 40，p =.001）增加，负面治疗预期降低（N = 40，p =.001）。参与患者对同伴主持者的主观评价是积极的。
初步结果表明，根据五步课程开展的精神分裂症同伴互助心理教育是可行的，并且在短期结果方面可能与专业心理教育相当。
