Training Long-Term Schizophrenic Inpatients in Illness Self-Management: A Randomized Controlled Trial

Abstract

Although far behind that of other developed countries, Japanese psychiatry has started shifting from hospital-based to community-based services. For many long-term inpatients, it is necessary not only to provide welfare work but also to strengthen their ability to live outside the hospital. In order to determine whether long-term inpatients with schizophrenia could learn and retain knowledge related to self-management of illness, we conducted a randomized controlled trial. The subjects were 32 inpatients with schizophrenia (ICD-10) who agreed voluntarily to participate in this study. Their mean age was 46.8 years, the mean number of years after onset was 20.5, and the mean duration of current hospitalization was 4.0 years. They were randomly assigned to the training group of the Community Re-Entry Program or to occupational rehabilitation activities. Each program consisted of 18 1-h sessions, twice a week. The results showed that knowledge of self-management of illness was significantly better in the training group than in the control group immediately and 1 year after training. Retention of knowledge 1 year after training was negatively correlated with the number of years after onset of illness. REHAB scores were significantly better in the training group than in the control group after training. Discharge rates 1 year after training were significantly higher in the training group (10/14; 71.4%) than in the control group (3/15; 20.0%). We conclude that improvement of knowledge and the high rate of discharge in the training group suggest the effectiveness of the program. Of the 10 patients in the training group who were discharged after training, 9 lived alone in the community and 8 received home-visit service by psychiatric nurses of the ward from which they were discharged. This suggests that the high discharge rate of patients in the training group was the result of the improvement of relationships between patient and nurses and/or improvement of the patients’ attitude to treatment from training in self-monitoring of warning signs.