Mental illness,physical abuse and burden of care on relatives: a study of acute psychiatric admission patients

As mental health care policies increasingly emphasize treatment and care in community settings, there has been concern over the burden that families of mentally ill people might suffer as a result. We conducted a study of the prevalence of abuse faced by relatives of patients admitted during a 6-month period to the acute psychiatric unit of a busy general hospital, who had previously been living with a relative. Patients and their relatives were assessed using semi-structured interview schedules. The experience of burden and the specific experiences of abuse since the onset of their relative's illness were recorded. In total, 32 (32%) of the 101 relatives had been struck on at least one or two occasions. Verbal abuse, threats and temper outbursts were reported by over 50% of the relatives. Principal correlates of abuse were diagnosis, concurrent drug misuse and a poor pre-morbid relationship between carer and patient.     

Hospital vs. outreach treatment of patients with mental retardation and psychiatric disorders: a controlled study

The aim of this study was to investigate the effectiveness of specialized hospital treatment vs. outreach treatment of patients with mental retardation and serious mental illness. A total of 50 patients were randomly assigned to either the hospital treatment (n=25) or the outreach treatment group (n=25). The outcome measures included psychiatric symptoms, family burden, costs and hospital admissions. At most observation points (up to 28 weeks) and at all endpoints the two groups were equivalent with regard to psychiatric symptoms. The burden on carers did not increase significantly during the outreach treatment. Treatment costs were lower for the outreach treatment. Of the 25 patients who received outreach treatment, four had to be admitted to the specialized hospital. Aggressive behaviour, social competence and number of previous psychiatric hospitalizations were found to be predictors of treatment outcome. It is concluded that outreach treatment represents an effective and efficient alternative to hospital treatment for patients with mental retardation and psychiatric disorders.     

Effects of Group Psychoeducational Intervention for Family Members of People with Schizophrenia Spectrum Disorders: Results on Family Cohesion,Caregiver Burden,and Caregiver Depressive Symptoms

Abstract:

Families constitute a primary source of care for people with severe mental illness but often face substantial difficulties in fulfilling their role. Family psychoeducational interventions have been developed to address these problems with established efficacy and effectiveness. Among the variants of family psychoeducation, the relatives group is particularly understudied internationally, and in Greece no study has explored its effectiveness. The present study endeavors to assess the effectiveness of relatives-group psychoeducation in improving family cohesion, alleviating caregivers’ burdens, and reducing depressive symptomatology in relatives of those suffering from schizophrenia spectrum disorders. In total, 131 people took part in the study, 83 received intervention, and 48 were assigned to the control (treatment as usual). The research instrument consisted of the Family Ritual Scale, the Family Burden Scale, and CES-D. A self-constructed questionnaire was used to collect the sociodemographic data of relatives and patients as well as patient clinical profiles. The research instrument was administered in a face-to-face interview at three time points: baseline, completion of intervention, and one-year follow-up. The results demonstrated that psychoeducation had a beneficial effect for family cohesion, global family burden, objective family burden, and relatives’ depressive symptomatology throughout the study period. A nonsignificant finding was observed for subjective family burdens. Interestingly, linear regression models revealed that relatives of people who had suffered from schizophrenia spectrum disorders for more than ten years displayed the greatest improvement when attending a psychoeducational group. Psychoeducation constitutes a valuable nonstigmatizing intervention that empowers relatives of people with severe mental illness and enables them to cope effectively with the illness.     

The opinion of caregivers on aspects of schizophrenia and major affective disorders in a Nigerian setting

Background In Nigeria the burden of caring for persons with severe mental disorders rests largely on families whose attitudes to these conditions have not been explored. Objectives To assess the opinion of relatives of 75 schizophrenics and 20 major affective disorder cases on aspects of the disease and compare with the responses of relatives of cancer, infertility and sickle cell disease (SCD) cases. Method Caregivers were assessed using a burden questionnaire that contained items on etiological beliefs and attitudes to illness. Results The responses of relatives of the two psychiatric illness groups were similar. The single most important etiological factors were that “it is Satan's work” (35.8 %) and “it is a natural illness“ (23.2 %). Other factors were “genetic” (9.5 %), “witchcraft” (10.5 %) and “curse by enemies” (10.5 %). This was similar to the opinion of cancer and infertility caregivers; but different from SCD where the most important causative factors were “genetic” (41.5 %) and “natural” (21.5 %). Psychiatric caregivers had higher frequency of anger and stigma. Over two-thirds of psychiatric caregivers felt glad caring for the patient and would not like the patient institutionalized. Most families were thought to be supportive and there was an impression that caring had made family emotional ties closer. Conclusions These families were tolerant and would cooperate with health authorities. Causative models are influenced by available knowledge and practices in the culture. To actualize the potential of families to play useful community psychosocial roles, there is a need for public mental health literacy and welfare support. Accepted: 10 July 2001     

Caregiver burden and psychotic patients' perception of social support in a Nigerian setting

  Background: In Nigeria, there are no national social welfare and community rehabilitation programmes for the mentally ill. Families have to bear the major burden of care. The present study aimed to assess the severity of indices of burden among relatives of 75 schizophrenics and 20 major affective disorder cases, to identify the factors associated with burden, to assess the relationship between caregiver burden and patients' perception of social support, and to compare these with equivalent data for cancer patients' relatives. Method: Caregivers were assessed, using a burden questionnaire and Goldberg's General Health Questionnaire (GHQ-12). Patients were assessed for perception of social support from the extended family. Results: Clinical severity and burden indices were similar for the psychiatric illness groups. However, relatives of patients with psychotic symptoms, unco-operative behaviour, marital instability and unemployment had significantly higher GHQ scores; while patients from such families perceived a wider social support network. Financial burden was greater than effect on family routines. Disruption of family routines, GHQ scores and (inversely) size of family network patient expected support from, predicted global rating of burden. Although clinical severity and disruption of family routines for cancer patients were higher; relatives of psychiatric patients had higher GHQ scores, more family disharmony and greater social stigma. Conclusions: Disturbed behaviour is a greater determinant of severity of burden than psychiatric diagnosis; hence adequacy of treatment is a first step in reducing caregiver burden. The tolerance shown by this group of relatives implies that they have strong potentials for playing useful roles in community care. Research and policy should consider measures to strengthen extended family network ties in developing countries. Accepted: 13 November 2000     

Asperger's Disorder,Criminal Responsibility and Criminal Culpability

In the seminal 2002 case of Atkins v. Virginia, the United States Supreme Court held that executing the mentally retarded violates the Eighth Amendment's ban on cruel and unusual punishment. The Court did not set forth guidelines for defining mentally retarded and instead left it to the states to define the issue individually. State definitions for mental retardation or intellectual disability were examined, including documentation of procedures for Atkins claims. Results indicated significant differences between states in definitions and procedures. Not all states had a statutory ban on executing the mentally retarded, and while most states subscribed to a three-pronged definition modeled after clinical psychiatric definitions, most failed to operationalize the prongs. Additionally, states differed on the burden of proof required to show mental retardation, which party bears that burden, the timing of the showing, who makes the determination of mental retardation, and the standard used to review the determination. In addition to documenting definitions of mental retardation and criminal procedures for Atkins claims in states with the death penalty, this study sought to identify an ideal definition for intellectual disability in capital cases. While aspirational, a single definition would better satisfy the mandate of the Atkins decision by providing consistent protection to criminal defendants across states.     

Burden on key relatives of patients with schizophrenia vs neurotic disorders: a pilot study

The burden perceived by the key relatives of 27 schizophrenics and 19 patients with neurotic disorders, both with at least a minimal degree of personal/social disability and a current exacerbation of symptoms, was assessed by a self-administered questionnaire. Only modest quantitative and qualitative differences between the two samples of key relatives were found. The burden perceived by the relatives of schizophrenics was more closely related to the patients' personal/social disability than that reported by the relatives of neurotic patients. The psycho-pathological features of schizophrenic patients that were perceived as the most burdensome were negative symptoms, whereas the burden reported by the relatives of neurotic patients was predominantly related to obsessive/compusive and anxiety symptoms.     

Family caregiver burden in mental illnesses: The case of affective disorders and schizophrenia – a qualitative exploratory study

Background: Caregivers of people with mental illnesses often experience a wide range of burdens. Although many studies have confirmed burdens among family caregivers of mentally ill relatives in general, specific knowledge regarding the concrete everyday hassle and existential sorrows from the caregiver? subjective reasoning perspective is lacking. Furthermore, there is little evidence on the possible different effects of affective disorders and schizophrenia on the quality of burden; this is also true with regard to the role of cultural traditions and lay beliefs. Aims: The aim of this study was to explore the specific burdens experienced by caregivers of patients with schizophrenia and affective disorders. Methods: A qualitative study was conducted by semi-structured interviews with 45 caregivers of patients with schizophrenia and affective disorders. Data were analysed by qualitative content analysis. Results: Eleven encumbering themes resulted from the interviews including incertitude, unawareness, emotional burden, stigma and blame, financial burden, physical burden, restriction in routine, disruption in routine, dissatisfaction with family, relatives, and acquaintances, troubles with patients’ adherence to medication, and problems with health services and governmental support. Conclusions: Caring for a person with mental illness affects caregivers emotionally, financially, physically, and it elicits some restrictions in their routine (daily hassles). Finally, it causes conflicts in family relationships. Despite some differences regarding perceived burden among caregivers of schizophrenia and affective disorders, a common pattern of burden could be identified. Thus, authorities should provide adequate financial, educational, and psychosocial supports for caregivers of mental illnesses.     

Que fait-on quand on nomme ? Le handicap psychique face aux figures de la folie et de la maladie mentale

The concept of “psychic handicap” has appeared recently in the French context. This article outlines some of the challenges this new categorization. The concept of “psychic handicap” is analysed as a way less pejorative than “madness” and “illness” to designate the mental troubles. It opens to a better consideration of the social needs of people with mental illness. However, the concept of disability bears his own stigma.     

Differences in adaptive functioning among people with autism or mental retardation

This report describes differences in motoric and instrumental activity of daily living skills (MADLs and IADLs) between 1,442 people with autism and 24,048 people with mental retardation, using data from an adaptive behavior measure. Comparisons were made using groups defined by age (5–12, 13–21, and 21–35 years) and intellectual level. Diagnoses of record were confirmed through group analyses of rates of problem behaviors consistent with autism and comparison to an independent data base. Findings suggest that at ages 5–12 the skills of children with autism are more developed than those of children with mental retardation matched by age and intellectual level. However, in the older groups these differences diminish, and with increasing age (21–35 years) more developed instrumental skills are observed for people with mental retardation.