Intérêt de l’éducation thérapeutique chez les malades souffrant de schizophrénie : le programme SCHIZ’EDUC

Abstract

The therapeutic treatment of schizophrenic disorders includes psychotropic drugs, especially antipsychotics and non-drug interventions: Therapeutic Education (TE), psychotherapy, cognitive remediation, psychosocial rehabilitation. The TE has been the subject of various national and international recommendations: French Federation of Psychiatry (2003), American Psychiatric Association (2006), German Society of Psychiatry, Psychotherapy and Neurology, National Institute for Health and Clinical Excellence (2009) and World Federation of Societies of Biological Psychiatry (2012). Between 1998 and 2009, the COCHRANE meta-analysis by Xia et al. (2011) surveys 44 randomized and controlled studies, representing a total of 5142 participants. The results are favorable to TE programs on several parameters: the incidence of error observation to treatment appears to be less important in (for) patients following a TE program. The relapse rate was lower among patients who received TE, which also results in a decrease of the risk of patients’ rehospitalization, the general health status of patients, their life quality and their level of satisfaction towards the medical care. Thus, treating four patients, by using TE, provides a clinical improvement for an additional patient, compared to conventional care. Literature and recommendations emphasize the importance of involving patients’ families in TE programs. The psychoeducational intervention's objectives are to help the patient to recognize and accept the limitations imposed by the functional impact of the disease, to “destigmatize” the disease, to guide the patient towards a preventive approach (recognizing prodromal symptoms of relapsing) and to enhance the patient's motivation to follow a treatment. We present “SCHIZ’EDUC” a transversal, multidisciplinary and operational program of TE, recently certified, designed for people with schizophrenia in the stable phase of the disease and for their families. It was developed within the CHU Clermont-Ferrand Psychiatry Hospital with the support of the cross TE Hospital Department and with the participation of the Unafam Association. The program has three modules according to the needs of participants: knowing the disease, treatment guidelines and develop autonomy. It uses varied and entertaining media and it involves different professionals: nurses, psychiatrists, workers.