Creating a new whole: helping families of people with schizophrenia

Collaboration between psychiatric nurses and family members is considered an important part of caring for people with schizophrenia either in hospital or at home after discharge. Studies have demonstrated family involvement in terms of caring for patients who have been discharged early from hospital. An extensive review of the literature and related studies regarding nursing interventions have been done, but there have been limited studies on what psychiatric nurses actually do when working with the families of people with schizophrenia in Thailand. The purpose of the present study was to explore relationships between Thai psychiatric nurses and families in terms of administering nursing care to patients. Grounded theory methodology was used to examine the processes through which psychiatric nurses work with families. Data were collected by 16 psychiatric nurses through in-depth interviews, observations, and field notes. Data were analyzed using constant and comparative methods of other studies, which revealed the process by which nurses can create a new whole between families, patients, and Thai psychiatric nurses. The process consists of four major stages: establishing trust, strengthening connections, promoting readiness to care, and supporting family.     

首发与复发精神分裂症患者家属健康教育需求差异分析与对策

目的了解首发和复发精神分裂症患者家属对健康教育知识、方法及出院后健康教育方式需求的特点。方法采用自行设计健康教育需求情况调查表,对88例首发入院与122例复发入院的精神分裂症患者家属进行调查。结果两组患者家属对健康教育知识的需求中疾病的病因及症状、检查指导、疾病预后、饮食禁忌、诱发因素与预防、心理调节方法与技巧、康复指导和病情复发处理差异均具有统计学意义(P0.01或P0.05);对健康教育方法的需求中病友间经验交流、健康教育录像、工休讨论会,出院后健康教育方式的选择中参加健康教育课堂、医护家访差异均具有统计学意义(P0.01或P0.05)。结论根据首发与复发精神分裂症患者家属需求的不同,有针对性地开展健康教育,确保健康教育工作的效果,控制患者疾病的复发。     

家庭关系对精神分裂症病人康复的影响

目的探讨家庭关系对精神分裂症病人康复的影响.方法对具有不同家庭关系背景的405例精神分裂症病人进行为期3年的随访对照研究,并用BPRS、SDSS量表对病人的精神症状及社会功能进行评定.结果在3年的随访期间家庭关系不同的3组病人复发恶化率及BPRS、SDSS量表评分无明显差异;多因素分析结果表明,本次病程是影响精神分裂症康复的最主要因素,家庭关系是主要影响因素之一.结论精神分裂症病人的康复受综合因素的影响,良好的家庭关系有助于病人的康复.     

Schizophrenia and genetics: a review and critique for the psychiatric nurse

Nursing authors such as McCrone and Gournay persist in the orthodox view that the genetic heritability of schizophrenia is an established scientific fact. In this article I take issue with the view they propound by way of an examination of the literature pertaining to schizophrenia and genetics. My reading of the literature suggests that the certainty they seek is not to be found in any of the scientific evidence so far put forward in support of the genetic hypothesis. Much of the early work in this field is fatally flawed and can no longer be used to support the genetic argument. More recent work tends to give increasing support to a greater role for environmental factors than is compatible with a hereditarian argument. Fifty years of research in this field has consistently failed to provide reliable scientific evidence in support of any of the genetic hypotheses relating to schizophrenia. Nurses, it is argued, should not be dispensing advice to patients on the basis of a genetic model that is at best mere hypothesis.     

精神分裂症患者服药依从性与家庭环境的相关性研究

目的：分析精神分裂症患者服药依从性与家庭环境的相关性。方法：对495名精神分裂症患者进行问卷调查。调查工具包括一般资料问卷、家庭环境量表中文版（FES-CV）和精神分裂症患者服药依从性问卷。结果：单因素分析结果显示,年龄、病程、住院次数、就诊方便程度、家庭经济状况、医疗费用情况和家人是否参加过健康教育是精神分裂症患者服药依从性的影响因素（P〈0.05）;精神分裂症患者家庭环境量表各维度得分与国内常模相比均有统计学差异（P〈0.05）;精神分裂症患者服药依从性量表各维度得分与家庭环境量表各维度得分相关（P〈0.05）;分层回归分析显示,亲密度、病程、就诊方便程度和住院次数均为精神分裂症患者服药依从性的影响因素。结论：精神分裂症患者服药依从性与其家庭环境密切相关,应加强对患者家庭的护理干预,以提高患者的服药依从性。     

Genetic and environmental factors in the aetiology of simple goiter

The aetiology of simple goitre, affecting up to 5% of a population in iodine-sufficient areas and over 10% in endemic areas, is incompletely understood. It is generally believed that the development of simple goitre, whether endemic or sporadic, depends on complex interactions between genetic, environmental and endogenous factors. The importance of genetic factors is evident from the clustering of simple goitre within families and from a higher concordance rate for goitre in monozygotic than in dizygotic twins. Recently, studies assessing the role of specific candidate genes or genetic markers in the aetiology of simple goitre have given conflicting data in various families. However, there may well be single genes playing a major role within certain families, eg the thyroglobulin (Tg) gene, the thyroid-stimulating hormone receptor (TSHR) gene, the Na⁺/I^- symporter (NIS) gene, and the multinodular goitre marker 1 (MNG1) on chromosome 14, but the genes will vary from family to family. In addition, family and twin studies also indicate a modest to major role for environmental factors in the aetiology of simple goitre. Clearly, iodine deficiency and cigarette smoking are the most important environmental risk factors associated with the genesis of simple goitre. Other suggested risk factors include naturally occurring goitrogens, emotional stress and certain drugs and infections. Ongoing studies focus on whole-genome screening in multiplex families as well as on large population-based case-control studies. However, the possibility that simple goitre is a heterogeneous disease without a single well-defined genotype and phenotype should be left open.     

对精神分裂症康复期患者家庭干预的指导及效果观察

目的 探讨在医护人员指导下实施家庭干预对预防精神分裂症复发的影响。方法 80例女性精神分裂症患者,分为家庭干预组40例,传统随防组40例。对家庭干预组家属进行定期康复指导,传统随访组不进行特殊指导,比较两组出院后0.5年、1年、1.5年复发率。结果 两组3个时段内的复发例数,经X~2检验均存在显著性差异(P<0.05或P<0.01),且传统随防组在1.5年与0.5年自身比较复发数有显著性差异(P<0.05)。结论 家庭干预对防止精神分裂症复发具有积极意义。     

Effectiveness of family interventions for patients with schizophrenia: A systematic review and meta-analysis

The family is the primary caregiver for most patients with schizophrenia, and their roles are essential in patients' illness trajectories and outcomes. Due to this, various family interventions for schizophrenia have been developed and applied to the relatives who take care of their family members with schizophrenia. This study examined the effectiveness of existing family interventions for schizophrenia in achieving their target outcomes at both the family and patient levels by utilizing a systematic review and meta-analysis. Combinations of terms were used to search for relevant studies from the databases. Thirty-seven randomized controlled trials that met the inclusion criteria were included in the analysis. Based on the pooled result of the included studies, the programmes significantly improved the targeted outcomes with large effect size. The programmes' impacts on family-related outcomes were higher than those on patients. Among the targeted outcomes, patients' treatment satisfaction and adherence and family caregivers' mental health were the most remarkable outcomes that had improved from the included programmes. Conversely, outcomes related to family relationships, caregiving experiences, perceived social support of family caregivers, and patients' medication use did not see significant improvements. The programmes delivered to individual family units and only to the family caregivers were more effective than those delivered to groups of caregivers and caregivers and patients together, respectively. Programme-focused interventions were more effective than emotion-focused ones. Based on these findings, an in-home visiting nurse programme or advanced technology is suggested when applying family interventions for schizophrenia in practice.     

Lack of association between schizophrenia and polymorphisms in dopamine metabolism and transport genes

We investigated the relationship between several functional polymorphisms in genes coding for dopamine metabolism and transport enzymes (MAO‐A VNTR; MAO‐A 941T>G; DAT VNTR; DAT ‐67A/T; CYP2D6*3; CYP2D6*4; CYP2D6*5; CYP2D6*6) and the frequency of schizophrenia. Participants in the study were 242 subjects diagnosed with schizophrenia and related disorders and 290 hospital‐based controls. Genomic DNA was isolated from whole blood and genotyped by several methods. However, there was no association between schizophrenia and the alleles, genotypes or diplotypes that were studied or their interactions. Polymorphisms in genes coding for dopamine metabolism and transport enzymes did not predispose to or protect from schizophrenia and related disorders.     

精神分裂症患者维持治疗中依从性的研究

目的采用心理教育性家庭干预和认知领悟疗法,观察对精神分裂症患者维持治疗中依从性的影响。方法将2002-06/2001-03本院118例精神分裂症按就诊顺序编号随机分成2组,干预组用药物+心理教育性家庭干预和认知领悟治疗,对照组用药物+普通心理治疗,出院后随访1年。采用简明精神病评定量表(BPRS)、社会功能缺陷筛查表(SDSS)、副反应量表(TESS)评价疗效、依从性、复发率、病残率。结果干预组完全依从48%、不依从9%、治愈率65%、复发率35%、病残率13%;对照组分别为26%,24%,44%,65%,26%。结论心理教育性家庭干预和认知领悟治疗能提高精神分裂症患者维持治疗中依从性。     

家庭干预对农村慢性精神分裂症患者作用的随访研究

目的探讨家庭干预对农村慢性精神分裂症患者的康复作用和其经济效益。方法将 90例慢性精神分裂症患者随机分为干预组和对照组各 45例 ;对干预组定期进行以心理教育为主的家庭干预 1年。在入组时、入组第 6个月和第 12个月用SDSS、SAPS、SANS、MRSS对两组患者进行评估 ,且比较两组 1年的经济收入和支出情况。结果在家庭干预的第 6个月和 12个月时 ,干预组SDSS、SAPS、SANS、MRSS的均值 ,及间接医疗费用均低于对照组 ,复工收入高于对照组 (均为P <0 .0 0 1)。结论对农村慢性精神分裂症患者实施家庭干预治疗 ,既有利于控制其病情和提高其社会功能 ,又可减轻患者家庭的经济负担     

家庭干预对精神分裂症病人生活质量影响的研究

[目的]探讨家庭干预对精神分裂症病人生活质量影响。[方法]将精神分裂症病人57例,随机分成干预组及对照组,干预组采用定期随访的方式进行家庭护理干预,于干预前和干预后3个月进行家庭功能评定量表(FAD)和精神分裂症病人生活质量量表(SQLS)评定,对照组不给予家庭干预。[结果]干预组精神分裂症病人生活质量有明显的改善,与对照组比较差异有统计学意义(P<0.01)。[结论]家庭干预有利于提高病人生活质量。     

A study of three measures of expressed emotion in a sample of Chinese families of a person with schizophrenia

Emotional climate or expressed emotion (EE) has been examined in families of white descent who have a family member with schizophrenia but few studies have been conducted in Asian or Chinese families. This study tested the utility of the five-minute interview (FMI), adjective checklist (ACL) and family attitude scale (FAS) in a sample of Chinese family members in Beijing, in an attempt to introduce useful measures of EE into practice. A sample of 51 family members were interviewed and administered the three instruments. A total of 29.4% of families were found to be high-EE critical and 13.7% high-EE emotional over involvement using the FMI. The FAS and ACL prove internally consistent and were significantly correlated but not with the FMI. Cultural explanations for the discrepancies are offered. The measures have applicability in terms of understanding family relationships but further research and replication is necessary to deepen our understanding of EE in Chinese families.