Chulalongkorn Medical Journal


Introduction : Relapse is common in schizophrenia. Therefore, schizophrenia patients are vulnerable groups which require special attention. The relapse can cause patients' distress and result in re-admission in psychiatric hospitals. A symptom self-management program (SSMP) has been developed to improve the patients' self-management ability to decrease early symptoms of psychotic relapse. Objective : To evaluate the effect of SSMP on psychotic relapse in patients with chronic schizophrenia. Setting : An out-patient clinic of a psychiatric hospital. Research design : Randomized control trial. Patients : There were eligible 80 patients with chronic schizophrenia who participated in this study. Methods : The samples were randomized by a computerized program, 40 of them were in the experimental group that received SSMP together with routine care, while the other 40 were in the control group that received only routine care. The experimental group underwent 4 phases which were: 1) problem assessment and needs identification; 2) preparation for symptom self-management; 3) practice for symptom self-management; and, 4) evaluation for symptom self-management. The psychotic relapse was indicted by the elevation on remitted psychotic symptom in hallucination, delusion, or disorganized thinking, up to 6 scores measured by the Brief Psychiatric Rating Scale (BPRS). Results : The findings revealed that the patients with chronic schizophrenia in the experimental group 1 month after receiving the program was significantly lower than that of the control group at the level .05. The psychotic relapse rate of the control group was 69.2% (9 cases) as compared to 30.8% (4 cases) in the experimental group. In addition, the difference between the proportion of patients with chronic schizophrenia in the experimental group after receiving the program had lower frequency of psychotic relapse than the control group (Kolmogorov Smirnov Z = 4.52, p-value = 0.05). Conclusion : Psychotic relapse was significantly lower in the experimental group.



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