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Clinical Practice Guidelines For Psychoeducation.19
Clinical Practice Guidelines For Psychoeducation.19
Clinical Practice Guidelines For Psychoeducation.19
Associate Professor of Psychiatry, Institute of Psychiatry, 1Professor of Psychiatry, WBMES and Consultant Psychiatrist, AMRI
XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 05/17/2024
Hospitals, Kolkata, West Bengal, 2Assistant Professor of Psychiatry, Government Medical College, Jammu and Kashmir, India
Received: 12th December, 2019, Accepted: 16th December, 2019, This is an open access journal, and articles are distributed under the terms of
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VARIOUS TYPES OF PSYCHOEDUCATION been shared and discussed. It may be useful to hand over
printed material after each session, which highlights in
According to the target population, psychoeducation can simple language the salient features of the topics discussed
be individual, family, group, or community based. in that particular session.
interventions for other psychiatric disorders, including 3. Etiologies and triggering factors
bipolar disorder, major depression, obsessive‑compulsive 4. Symptoms of mania and hypomania
disorder, substance abuse, and borderline personality 5. Symptoms of depression and mixed episode
disorder. 6. Course and outcome of bipolar disorder.
Psychoeducation for schizophrenia their lives. Almost all patients of bipolar disorder think of
Initial discussions should start by encouraging the patients discontinuing medications at some point of time during
to come out with their understanding of the disorder. the course of illness. This occurs quite commonly during
Once this area has been clarified, a common denominator the euthymic phase or in those with comorbid substance
between layman’s knowledge of illness and scientific abuse or personality disorder. The areas that need to be
textbook knowledge of illness is gradually developed. covered while targeting better treatment adherence are as
The basic message should be that schizophrenia is caused follows:
by biological factors in combination with psychological 1. Mood stabilizers
stress. Hence, both medications and psychosocial 2. Antimanic agents
interventions are essential for management. Apart from 3. Antidepressants
the essential components mentioned before, other 4. Serum levels of lithium, carbamazepine, and valproate
information specific to the illness which needs to be 5. Pregnancy and genetic counseling
shared includes 6. Psychopharmacology versus alternative therapies
• Meaning of the term “Schizophrenia” 7. Risks associated with treatment withdrawal.
• Positive and negative symptoms
• Neurobiological origin of symptoms
A detailed discussion about the side effects of the commonly
• Stress‑vulnerability‑coping model
used medications and the ways of handling them is essential
• Various medicines and their side effects
for getting rid of several myths among the patients in
• Psychosocial measures
relation to medications. Fears of becoming “dependent for
• Psychotherapeutic interventions and suicide
life” on these medications or “losing sharpness of mind”
prevention
are some of the well‑publicized misconceptions regarding
• Early warning signs and relapse prevention
psychotropics which force patients to discontinue medicines
• Long‑term course and outcome, including remission
abruptly. Such myths must be gradually dispelled by careful
and recovery.
discussion.
PSYCHOEDUCATION FOR BIPOLAR DISORDER
Avoiding substance misuse
The working group on psychoeducation in bipolar disorder More than half of bipolar disorder patients have comorbid
defines psychoeducation as information‑based behavioral substance abuse. Alcohol is the most frequently misused
training aimed at adjusting lifestyle to cope with bipolar drug among bipolar patients. This is associated with more
disorder. The components include increasing the awareness depressive episodes, greater problems with adherence,
of illness, treatment adherence, early detection of relapse, and poor recovery. Sometimes, substance use can trigger a
and avoidance of potential triggers such as illegal drugs and full‑blown affective episode. Psychoeducation must involve
sleep deprivation. knowledge about alcohol and other drugs and their harmful
effects on patients with bipolar disorder.
Illness awareness
Most of the patients of bipolar disorder have poor insight DETECTING EARLY WARNING SIGNS
into their condition. If the patient does not gain insight
into his condition, he would be unlikely to take interest in Detecting early warning signs is a very important step for
the subsequent sessions of psychoeducation. Emphasizing preventing a full‑blown episode. It is very important to
the medical model of the illness helps in reducing stigma emphasize that a hypomanic episode needs to be identified
related to the illness. It is also taught that the illness has a and acted upon very quickly as it may quickly escalate to a
biological origin, though triggering factors may be either manic state. It also needs to be addressed that many patients
biological or psychological. enjoy the initial mood elevation of the hypomanic episode
and hence have a tendency not to report the symptoms to
The issues addressed cover the following areas: family members or psychiatrists. It is also important to give
1. Introduction the patient and family members an emergency plan of what
2. What is Bipolar Disorder? is to be done in case of a relapse.
may be of use in a day‑to‑day life. relapse prevention are discussed. The role of various drugs
and their side effects is discussed.
PSYCHOEDUCATION FOR ANXIETY AND
DEPRESSIVE DISORDERS Craving and relapse
In this session, the role of craving in causing relapse is
Psychoeducation has become an important step in the discussed. This also includes the role of various triggering
management of anxiety and depressive disorders. After factors and how to avoid them. The methods of controlling
the diagnosis of anxiety and depressive disorder and craving are also discussed.
performing necessary assessments, the mental health
professionals should provide detailed information to the Utilizing free time
patient regarding the symptoms, causes, various treatment The importance of finding alternate sources of pleasure is
options, side effects of medications, need for adherence, discussed along with the need to “decondition” the concept
and overall course and outcome of the disorder. Apart from of substance with “good times” and “enjoyment.”
medications, the role of nonpharmacological measures
such as activity scheduling and regular physical exercise Adaptation to a new life
is emphasized. Passive psychoeducation is very popular in The patient is taught to adopt and gradually accept the new
patients with anxiety disorders. This involves passing on to role of a “substance‑free individual.”
the patients’ various resources such as books, pamphlets,
or videos which explain clearly various aspects of anxiety PSYCHOEDUCATION FOR PERSONALITY
disorders. Unlike active psychoeducation, here the DISORDERS
therapist does not interact actively with the patient while
imparting education about the illness. The primary objective of the psychoeducation program
is to make the patients aware of personality disorders in
PSYCHOEDUCATION FOR SUBSTANCE USE general, and the particular personality disorder with which
DISORDER he has been diagnosed. Initially, a baseline idea regarding
the patient’s knowledge about his own diagnosis is obtained
Group psychoeducation is one of the cornerstones of and what according to him would help him. The concepts
psychosocial management of patients with substance use of personality and personality disorder are discussed.
disorder. Such groups educate patients about substance How personality disorders can cause problems to affected
misuse and its consequences. Such groups usually deal with individuals is highlighted. The particular personality
individuals in precontemplation and contemplation phase disorder which affects the individual is discussed in detail.
of change and help in increasing their motivation to abstain. The patient is also encouraged to point out those features
Typical group psychoeducation for substance abuse must that are present in him from a written checklist consisting of
highlight certain points which are as follows:. various maladaptive personality traits. As psychoeducation
progresses, the attempt is gradually made to make the
Medical complications patient aware of his maladaptive traits. Once the patient
Detailed discussion of physical and psychological develops some insight, detailed psychoeducation of the
complications is carried out. Many times, patients have biological and psychological factors, leading to his current
wrong conceptions about physical illness, for example, they maladaptive traits is carried out. However, in cases with
think that they are alright as long as they do not have obvious severe personality disorders, one has to gradually work
physical symptoms. Such misconceptions are cleared. through the areas where the patient takes recourse to denial.
of care for these groups of patients include parallel and Financial support and sponsorship
sequential models. In the parallel model, separate specialists Nil.
treat the comorbid disorders separately. In the sequential
model, the primary condition is treated first followed by the Conflicts of interest
comorbid condition. The group psychoeducation model for There are no conflicts of interest.
patients with dual diagnosis relies on an integrated holistic
approach where the same team deals with the treatment of REFERENCES
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