Relapse prevention in patients with schizophrenia : A nursing intervention study

Abstract

This thesis describes a study into the development and testing of a nursing intervention with a view to preventing psychotic relapses in patients suffering from schizophrenia or a related disorder. The purpose of the intervention is to recognise the early signs of an oncoming psychotic relapse. If warning signs signalling the onset of a psychosis are adequately recognised at an early stage, action may be taken to prevent a serious psychotic episode and to help the patient regain his equilibrium. Following a general introduction in chapter 1, chapter 2 describes the results of a literature review. Chapter 3 focuses on a number of methodological aspects of developing interventions for nursing practice. Chapters 4 and 5 describe the results of an exploratory study into existing early recognition and early intervention practices. The study was carried out so as to gain a better understanding of the early recognition and early intervention methods that are already in place. In addition, the study focused on how patients, their families and health care professionals experienced those methods. A total of 25 qualitative interviews were held in six different settings. The two chapters are concluded by a schematic presentation showing the outlines of an early recognition and early intervention protocol. This schematic structure was worked out in greater detail in chapter 6.The draft protocol was presented for validation to a number of experts in the field of schizophrenia care. It was also tested in nine case studies on feasibility in nursing practice. Chapters 7 and 8 report on research that was carried out into the effects of the intervention protocol by means of a randomised controlled trial (RCT). Chapter 7 describes the results of a survey among nurses who participated in the RCT in the experimental group. A large majority of the nurses concluded that relapse prevention plans contributed greatly to the treatment of patients. They were optimistic about the practical application possibilities of working with a relapse prevention plan as part of their nursing relationship with the patients Chapter 8 of this thesis discusses the quantitative effects of intervention. The relapse percentage in the experimental group was 12.5% versus 26.2% in the control group. This difference is not significant (X2(1)=2.445; p=.12). The relative risk of a psychosis for patients in the control group was more than twice the risk rate for patients in the experimental group (1/RR=2.095 / CI 95%: 0.79<X<5.0). No significant or interpretable differences between the two groups could be discerned at the level of a number of secondary outcome variables (insight, quality of working alliance and use of anti-psychotic drugs). The results of the RCT are analysed in greater detail at the end of Chapter 8.