An etiology and progress of major mental illnesses (psychiatric diseases) is a product of complex interaction between biological and environmental factors. With biopsychiatric vulnerability to mental illness and lack of coping skill to deal with socialenvironmental stress, outpatients are often relapsed. One of important strategy to prevent relapse involves to educate them an active coping method in which patients have a longterm compliance for psychiatric drug therapy and willingness to taking care of themselves, as well as knowledge of mental illness being under treatment. Despite of emerging concern and interest, it is just beginning to diffuse clinical and theoretical implications of the active coping method. Of course, very few attention has been given to the active c )ping method with regard to nursing service.
This study is an attempt to evaluate the efficacy in terms of relapse prevention of medication and symptom selfcare education (MSSE) as one of active coping method for psychiatric patients who were discharged. The patients were educated to take care of themselves with regard to taking medication and managing symptoms. This exploratory study was designed to do a quasiexperiment of pretestposttest with a nonequivalent control group. A dependent variable for the study include relapse warning symptoms and social skill with an independent variable being MSSE.
Subjects of 137 patients who were discharged from a mental hospital in Pusan were selected to be assigned randomly to the experiment and control group, with each group consisting of 20. Only 28 subjects who have been remained for whole research period of 29 weeks, from August 19,1996 to March 8, 1997, were included for the analysis in this study. A pretest was given before implementing MSSE to both experiment and control grop. When the subject finished MSSE, lasting 12 weeks, they were given a posttest(t.ime 1), followed by a follow-up test in 2 month later(time 2).
A program developed by Liberman at UCLA, with revised to have relevance to Korean, was adopted to educate the patients. An instrument to measure the dependent variable consists of relapse warning symptoms(RWS) scale of including 42 items, positive negative symptom (PNS) scale of 30 items, social behavior (SB) scale of 23 items, interpersonal relationship change (IRC) scale of 25 items, and self-esteem (SE) scale of 25 items. Data were collected by observing the subjects doing role-play and interviewing them.
Data were analyzed by nonparametric statistical techniques, including Wilcoxon test and Kruskal -Wallis test. The result findings are summarized as follow:
1. Subjects who attended MSSE reported less PNS at both time 1 (Z=4.166, p=0.000) and time 2(Z = 3.889, p = 0.000) than those who are in control group. Also, those who were assigned to the experiment group had less RWS at time 2 than ttheir counterpart in the control did. This indicates that MSSE have an of feet of reducing relapse symptoms.
2. Those who were in the experiment group scored higher than their counterpart in SB at time 1(z= -3. 450, p=0.000)and time 2(Z=-3.716, p=0.000). No significant differences were found between the two group in terms of IRC and SE at both time 1 and time 2. It is shown that MSSE has a little effect in improving social skill.
3. For subjects under experiment several differential soores over time 1, time 2, and time 3 were found in terms of RWS, PNS, and SB, all of which were statistically significant. No significant differences were observed across the test in terms of IRC and ES. On the other hand, chi-square statistics indicated that for the control group statistically significant differences were not among the three tests in terms of RWS, PNS, SB, IRC, and SE.
The study concluded that medication and symptom self-care education by a psychiatric nurse for discharged patients make some contribution to reduction in relapse symptoms and to improvement of social skill. It was suggested to complement the educational program, MSSE, with techniques For skill training.
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