Attitudes of psychiatric patients and their relatives to involuntary treatment

In 1979 a Guardianship Board assumed responsibility in South Australia for the welfare of those mentally ill or handicapped people unable to look after their own health or safety, or to manage their own affairs. This study examines the attitudes to guardianship and involuntary treatment of 79 patients referred to the Board from a psychiatric hospital, all of whom were under guardianship at the time of the study. Forty-seven of their relatives took part in the project, which included measures of patients' psychiatric symptoms and relatives' punitiveness. Although almost 70% of patients objected to Guardianship in principle, they made more positive than negative statements about it. Nearly 60% rated involuntary treatment, including medication, as helpful. Patients reported a level of psychiatric symptoms less than half of that of a psychiatric outpatient sample. Relatives were strongly in favour of Guardianship, stating frequently that it allowed an improved relationship between themselves and the patient. Patients who believed that they were suffering from a mental illness were comparatively happy about being under Guardianship, and a belief that the patient was mentally ill was significantly associated with reduced extrapunitiveness in relatives.     

Burnout among relatives of psychiatric patients attending psychoeducational support groups

OBJECTIVE: The effectiveness of family interventions may be improved by concentrating on elements of objective burden that best predict subjective burden. The relationship between subjective burden and objective burden was investigated among caregivers of patients with serious mental illness in the Netherlands who were attending psychoeducational support groups. METHODS: The study used pretest data from an intervention study in which psychoeducational family support groups in the Netherlands were evaluated. A total of 164 participants from 19 psychoeducational groups organized by nine community mental health centers completed the Dutch translation of the Maslach Burnout Inventory and the Involvement Evaluation Questionnaire. Regression analyses were conducted, with elements of subjective burden as dependent variables and elements of objective burden, demographic characteristics, and characteristics of the patient's disorder as predictors. RESULTS: Burden in general and emotional exhaustion were the aspects of subjective burden best predicted by objective burden. In two regression models, objective burden together with the other predictors explained 57 percent and 54 percent of the variance in subjective burden. Two aspects of objective burden-strain on the relationship with the patient and ability to cope with the patient's behavior-were related to almost all the investigated aspects of subjective burden. CONCLUSIONS: Strong evidence was found for the relationship between objective and subjective burden and for the hypothesis that particular elements of objective burden contribute more to subjective burden than others. The findings suggest that psychoeducation should concentrate on helping relatives cope with the strain on the relationship with the patient and on improving their ability to cope with the patient's behavior.     

The role of relatives in discharge planning from psychiatric hospitals: The perspective of patients and their relatives

This study prospectively assessed the preferences and satisfaction of 98 psychiatric inpatients and 40 of their relatives with family involvement in discharge planning. Preferences questionnaires were administered during hospitalization. Satisfaction questionnaires were completed 3 months later. Preferences noted by most participants included information concerning patient health status, ways to prevent further hospitalizations, services for relatives, and signs of patient decompensation. More relatives than patients felt that post-discharge residence and activities were important areas to be involved in. Most participants were satisfied if relatives were involved in discharge planning. However, up to 89% of patients, and 84% of relatives, reported no communication between clinical staff and relatives regarding discharge. When this was the case, satisfaction rates dropped sharply, especially for relatives. The need for increased communication between clinicians and relatives regarding discharge planning remains a problem.     

A brief method for assessing expressed emotion in relatives of psychiatric patients

A measure of the attitudes and feelings that a relative expresses about a mentally ill family member, termed expressed emotion (EE), is derived from an extensive, semistructured interview, the Camberwell Family Interview (CFI). The present article describes a method for the assessment of EE attitudes that uses a variation of the 5-minute speech sample, originally developed by Gottschalk and Gleser (1969). The measure is derived from responses made by a patient's key relative when prompted to give thoughts and feelings about the patient for a 5-minute period. A coding system was developed to score behaviors analogous to those rated on the CFI, such as criticism and emotional overinvolvement. The relationship between blind EE ratings derived from the 5-minute speech samples and those from the CFI was investigated with two separate samples of relatives of schizophrenics. The relationship between the sets of ratings was very close and supports the value of the 5-minute speech sample as a brief EE screening procedure.     

Distress in the relatives of psychiatric patients admitted for the first time.

Seventy-three relatives of psychiatric patients aged 18-49 years admitted for the first time from a well-defined catchment area were interviewed using the Social Behaviour Assessment Schedule to determine the distress elicited by the patients' illness. The patients were interviewed with the Present State Examination, 10th edition, development version. Regardless of sex and age, frequency of contact and relation to the patient, the relatives experienced distress from symptoms, lowered social performance and the adverse effects of the illness. Informant's social class, male sex of patient and duration of illness significantly predicted distress. No differences were found in a comparison of the level of distress between non-organic psychotic disorders, mood disorders, anxiety disorders and psychoactive substance use disorders, but specific distressful areas within each disorder could be delineated.     

Cognitive and psychiatric characterization of patients with Huntington's disease and their at-risk relatives

Neurological Sciences - We examined cognitive and psychiatric disturbances in patients with Huntington's disease (HD) in comparison to at risk asymptomatic subjects. Cognitive and psychiatric...     

The burden of relatives of psychiatric patients: Comparisons between parents,spouses, and grown-up children of voluntarily and compulsorily admitted psychiatric patients

As part of an ongoing study of the quality of the mental health services in two Swedish county councils, relatives of both voluntarily and compulsorily admitted patients were interviewed with regard to family burden. The aims of this part of the study were to investigate differences in burden between subgroups of relatives, differences in family burden between 1986 and 1991, and differences between relatives of voluntarily and compulsorily admitted patients. The relatives investigated consisted of 79 spouses, 118 parents, and 31 grown-up children. The results showed that relatives of severely mentally ill persons have a considerable amount of burden, of both an external and a psychologic internal nature. Subjective burden was generally more pronounced than objective external burden. Spouses had to a greater extent external burdens. Relatives experienced more internal burden in 1986 and more external burden in 1991. There were no differences between relatives of voluntarily and compulsorily admitted patients. It is concluded that the psychiatric services in their work with relatives have to consider the specific burden of different subgroups of relatives.     

Morbidity risk of psychiatric disorders among the first degree relatives of schizophrenia patients in Taiwan

This study aimed to assess the boundaries of the schizophrenia spectrum and whether inclusion of such phenotypes increases power for linkage analysis of schizophrenia. Participants were 234 first degree relatives (FDRs) of 94 schizophrenia probands in Northern Taiwan who completed a direct interview using the Diagnostic Interview for Genetic Studies (DIGS). Based on best estimate diagnosis, the morbidity risk in the relatives for schizophrenia was 2.5 percent (Weinberg's shorter method) or 3.9 percent (Kaplan-Meier estimate). Depending on the stringency of diagnosis, lifetime prevalence was 2.6 percent to 4.7 percent for schizotypal personality disorder, 3.4 percent to 8.6 percent for paranoid personality disorder, and 1.3 percent to 3.4 percent for schizoid personality disorder. These figures are significantly higher than the corresponding figures in the general population. However, none of the recurrence risk ratio for any spectrum that included both schizophrenia and a personality disorder (3.0 to 5.9) was greater than that of schizophrenia alone (9.3 to 14.4). Thus, including schizophrenia-related personality disorders in the spectrum did not increase power for linkage analysis of schizophrenia.     

Interinformant reliability of family history information on psychiatric disorders in relatives

Knowledge on the reliability of family history information is essential for every family study. However, systematic analyses of interinformant reliability of family history information on individual relatives have not yet been published. Consequently, family history information on 1306 first-degree relatives and spouses of patients and of control subjects was collected from at least two other family members using questionnaires. Interinformant reliability was acceptable for dementia [Kappa = 0.58, 95% confidence interval (CI) = 0.48–0.68], but less so for alcoholism (Kappa = 0.41, CI = 0.23–0.59), depression (Kappa = 0.26, CI = 0.14–0.38) and anxiety disorders (Kappa = 0.19, CI = 0.05–0.43). Demographic variables of subjects and informants and their familial relationship did not influence diagnostic agreement on the diagnosis of dementia. Diagnostic agreement on depression was significantly reduced when information from siblings of index subjects was compared with information from spouses of index subjects. The interinformant agreement for the diagnosis of depression was higher in younger than in older subjects (relative risk for disagreement 1.08/additional year, CI = 1.02–1.15). Siblings of index subjects seem to provide different, but not necessarily less relevant, family history information in comparison with other relatives. Researchers should be aware of the problem that depression in the elderly can be easily missed by family history. It seems more important for the diagnosis of depression than for a diagnosis of dementia to get information from multiple informants. Received: 20 May 1997 / Accepted: 12 December 1997     

Inter-rater reliability of family history information on psychiatric disorders in relatives

The family history method in psychiatric family studies is an important and necessary way of obtaining information on family members who are not available for personal interview. Studies on the validity of this method have shown that family history information on psychiatric disorders in relatives is neither accurate nor sensitive but highly specific. However, its inter-rater reliability has rarely been assessed, even though this is a prerequisite for adequate validity. In the present investigation we examined the inter-rater reliability of family history information obtained with a semi-structured and symptom-oriented interview. Forty informants were interviewed twice by two different raters within 3 and 20 days. The inter-rater reliability was found to be good for dementia (kappa=0.82, 95 % CI=0.61–1.00), alcohol related disorders (kappa=0.93, 95 % CI=0.80–1.00), for depressive disorders (kappa=0.72, 95 % CI=0.42–1.00), anxiety disorders (kappa=0.75, 95 % CI=0.41–1.00) and any psychiatric disorder (kappa=0.79, 95 % CI=0.66–0.91). We concluded that the family history interview is a useful family study instrument that can be applied reliably by different raters for frequent psychiatric disorders. Received: 13 September 2001 / Accepted: 28 September 2001     

Neurologic abnormalities in schizophrenic patients and their families. II. Neurologic and psychiatric findings in relatives

Neurologic abnormalities in 21 nonschizophrenic siblings and parents of schizophrenics, 24 DSM-III schizophrenics, and 24 normal "control" subjects were assessed by experienced neurologists blind to the subjects' psychiatric status. Medication artifacts and other neurologic signs likely to be etiologically irrelevant to psychiatric illness were excluded. Psychiatric diagnostic assessments of subjects were made blind to neurologic results. The prevalence of neurologic abnormalities in relatives was significantly greater than in controls, but similar to that among the schizophrenics. Relatives and controls differed even more markedly on signs involving motor system abnormalities of localizing significance. Finally, the relatives showed a suggestive dissociation of psychopathology and neurologic signs. The results appear most consistent with the hypothesis that overt schizophrenia may often result from the combined operation of two independent familial factors--one "psychopathologic," the other "neurologic".     

Educating relatives of schizophrenic patients

Summary An education programme given to relatives of schizophrenic patients in the context of other social interventions is described. The findings show that although relatives remember relatively little one month after receiving the education, it is an important intervention. Several reasons are suggested, one of which is that education is a somewhat neutral but engaging beginning to the therapeutic relationship. At the later nine months follow up several positive changes in relatives' attitude were shown.     

Families' perceptions of psychiatric hospitalization of relatives with a severe mental illness

This paper reports the experience with psychiatric inpatient care of families with mentally ill relatives. Most families report great dissatisfaction with their involvement with the staff and treatment at psychiatric hospitals. Recommended methods of reducing the family burden and improving a productive alliance are engaging the family at admission, inclusion in the treatment process, family education, proactive engagement and training which addresses the family perspective.     

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.