Psychoeducation for patients with schizophrenia and their families

In this review, the current evidence for the efficacy of psychoeducation, a nonpharmacological treatment strategy in the treatment of patients with schizophrenia and their families, is assessed by summarizing meta-analyses/reviews and important single studies published after the recent meta-analyses. It was found that psychoeducation for patients with schizophrenia and their families can reduce the relapse rates of these patients; long-term family interventions (i.e., with durations of more than 3 months) are particularly helpful. However, there are still unsolved questions in this area. Therefore, future research needs are a further focus of this review; for example, on the questions of how to adapt programs for stable outpatients and their families, and the minimum effective dose of psychoeducation. Finally, new approaches in the area of psychoeducation, such as including quality-of-life issues, offering psychoeducation formats for combined diagnoses, family and patient peer-to-peer programs, and focusing on gender aspects are discussed.     

住院精神分裂症患者家属自测健康状况调查研究

目的探讨住院精神分裂症患者家属的自测健康状况,为改善患者的家庭支持系统提供依据。方法采用分层随机取样法,抽取2012年9月-12月在广东省河源市源城区精神卫生防治所住院的精神分裂症患者的家属(家属组)和一般人群(对照组)各100例,进行自测健康评定量表(SRHMS)调查,并采用简易应对方式量表(SCSQ)调查家属组的应对方式特点。结果家属组SRHMS的健康总体自测维度得分和社会健康子量表得分均低于对照组[(28.39±8.95)分vs.(32.51±3.65)分,(75.47±25.52)分vs.(88.66±11.94)分],差异有统计学意义(t=3.015、3.311,P0.01);家属组的积极应对方式和消极应对方式得分与常模比较差异有统计学意义(t=2.056、4.494,P0.05或0.01);家属组SRHMS各维度与积极因子正相关(r=0.728~0.299,P0.05或0.01);除维度1、5、8、9及社会健康子量表分、健康量表总分外,其余各维度与消极因子负相关(r=-0.416~-0.304,P0.05或0.01)。结论精神分裂症患者家属的健康水平偏低,可能与消极应对方式有关。     

缓解期精神分裂症患者的病耻感及住院态度

目的 通过对缓解期精神分裂症患者病耻感及对住院态度的调查,分析缓解期精神分裂症的病耻感特点,不同治疗方式和环境对精神分裂症病耻感的影响,为减轻病耻感,提高治疗效果提供依据.方法 对浙江同德医院门诊或住院治疗的缓解期精神分裂症患者120例进行人口学特征、BPRS、CGI-SI、SSMI-C、TESS和自制的对住院态度问卷进行测量和评估,分析比较门诊或住院患者缓解期病耻感特点.结果 调查发现缓解期精神分裂症患者普遍存在被歧视、自我感觉的病耻感及对疾病的掩饰性,其中与门诊组患者比较,住院组患者的歧视因子较高,积极效应因子评分较低,两组比较差异有统计学意义（P＜0.01）;住院组患者对被欺骗、强行住院、强行治疗和被搜身等抵抗态度的发生率明显高于门诊组,两组比较差异有统计学意义（P＜0.05）.结论 门诊治疗对患者产生病耻感的影响较小,对积极效应影响小.住院患者被强制住院、强制治疗、限制自由均加重患者对住院治疗的抵抗和病耻感,采取积极有效的治疗模式或改善住院环境可能对减轻病耻感、提高生活质量有积极作用.     

The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy

OBJECTIVE: (a) To explore burden related to caregiving and support received from professionals and social network in relatives of patients with schizophrenia in Northern, Central and Southern Italy; and (b) to test whether a higher level of family burden is associated with a lower level of professional and social network support. METHOD: Seven hundred and nine patients with schizophrenia and their key-relatives were consecutively recruited in 30 Italian mental health departments. Data were collected on: (a) patients' clinical status and levels of disability; (b) relatives' burden, social and professional support; (c) interventions received by patients and their families. RESULTS: Family burden was found lower in Northern Italy. However, after controlling for psychosocial interventions, differences in family burden among the three geographical areas disappeared. Family burden was associated with patients' levels of disability and manic/hostility symptoms, and with professional and social network support received by the family. CONCLUSION: Professional and social network support represent crucial resources to reduce family burden in schizophrenia.     

Cognitive deficits in the families of patients with schizophrenia

PURPOSE OF REVIEW: Studies of first-degree relatives of patients with schizophrenia over the past 25 years have reported a number of cognitive deficits, primarily in the domains of memory and executive function. Nevertheless, due to a number of methodological issues, such as including different types of relatives and not controlling for possible psychopathology, it is not yet clear that these findings can fully support a conclusion of heritability of cognitive dysfunction associated with a schizophrenia genotype. RECENT FINDINGS: Several recent meta-analyses have shown that the most consistent deficit shown by relatives is impaired performance on 'maintenance plus' frontal-lobe tasks requiring increased effort and higher central executive processing. Studies of multiplex families (multiple diagnoses in one family) also report that family members tend to have more difficulty on executive function tasks. Another interesting trend is research on subgroups of patients and relatives displaying distinct cognitive syndromes, particularly a subgroup with a generalized cognitive deficit. SUMMARY: As methodological designs improve, this field of study holds promise not only for understanding the neurobiological mechanisms of schizophrenia and the associated cognitive deficits, but also for possibly describing endophenotypes that may lead to identifying at-risk patients and relatives.     

Stigma and public health policy for schizophrenia.

Few families seem to be preparing adequately for the future with respect to financial planning or caregiving responsibilities. The consequences of schizophrenia on siblings and sibling relationships can be significant. Exploring how the chaos and confusion that typically accompanies the onset of the illness may have adversely affected family members and family relationships can offer an opportunity to build proactive partnerships toward future planning for continuity of care for the mentally ill. The Schizophrenia Society of Saskatchewan facilitates family involvement in fostering a sibling support strategy focused on the specific issues faced by siblings of people with schizophrenia. Support groups and the provision of concrete family financial and caregiving planning are tangible ways siblings can prepare better for the future. Strengthening lobbying capacities is also important to advocate partnerships between integrative community-based, client-centered services and family members of the severely mentally ill.     

Smooth pursuit performance in families with multiple occurrence of schizophrenia and nonpsychotic families.

BACKGROUND: Eye tracking dysfunction (ETD) has been put forward as a trait marker for biological susceptibility to schizophrenia with the hope of identifying a link to specific cerebral lesions. METHODS: Eye movements were recorded using infrared oculography in 8 families (67 members) showing multiple occurrence of schizophrenia and in 9 nonpsychotic families (80 members). Triangle wave stimuli at 15 degrees/s and 30 degrees/s were used and gains (eye velocity/target velocity), rates and amplitudes of different saccade categories (catch-up, back-up, anticipatory saccades, and squarewave-jerks) were determined. RESULTS: In the relatives, the same deficit in maintenance of smooth pursuit performance was found as was seen in the schizophrenic patients. This deficit, which was not observed in the nonpsychotic families, consisted of lower gains for leftward as compared to rightward pursuit. This was emphasized most clearly at 30 degrees/s and was associated with an excess of catch-up saccades in the schizophrenic patients, whereas in the relatives a tendency to exhibit more and larger anticipatory saccades was observed. CONCLUSIONS: The results confirm the hypothesis that eye-tracking dysfunction is a phenotypic marker for genetic liability to schizophrenia. Neurophysiologically, a cerebral dysfunction which includes one or more of the oculomotor centers can be assumed in subjects who carry a genetic susceptibility to schizophrenia.     

Burden of care and general health in families of patients with schizophrenia

BACKGROUND: De-institutionalization of psychiatric patients has led to a greater emphasis on family management in the community, and family members are often overwhelmed by the demands that caring for a patient with schizophrenia involves. Most studies of family burden in schizophrenia have taken place in developed countries. The current study examined family burden and its correlates in a regional area of a medium income country in South America. METHOD: Sixty-five relatives of patients with schizophrenia who were attending a public mental health out-patient service in the province of Arica, Chile, were assessed on Spanish versions of the Zarit Caregiver Burden Scale and SF-36 Health Survey (SF-36). RESULTS: Average levels of burden were very high, particularly for mothers, carers with less education, carers of younger patients and carers of patients with more hospitalisations in the previous 3 years. Kinship and number of recent hospitalisations retained unique predictive variance in a multiple regression. Burden was the strongest predictor of SF-36 subscales, and the prediction from burden remained significant after entry of other potential predictors. CONCLUSIONS: In common with families in developed countries, family members of schizophrenia patients in regional Chile reported high levels of burden and related functional and health impact. The study highlighted the support needs of carers in contexts with high rates of poverty and limited health and community resources.     

心理干预对改善精神分裂症患者家属心理状况的效果分析

目的 探讨心理干预对改善精神分裂症患者家属心理状况的效果.方法 采用症状自评量表(SCL-90)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对229名精神分裂症患者家属进行调查,并对其进行为期4周的心理干预.结果 精神分裂症患者家属的SCL-90各因子、SAS和SDS的评分均显著高于全国常模(P<0.05),心理干预后,患者家属的SCL-90各因子、SAS和SDS的评分较干预前有显著性降低(P<0.05).结论 精神分裂症患者家属的心理问题状况较为严重,而心理干预可有效改善患者家属的心理状况.     

The therapy of families of patients suffering from schizophrenia

The development of pharmacotherapy, social psychiatry and the new patterns of comprehensive treatment of patients suffering from schizophrenia make most of psychiatrists believe that hospitalisations should be reduced to minimum. There has been a change in the roles and tasks of parents and spouses of the patients during their ambulatory therapy. Apart from outpatient clinics, daily wards, and hostels, there is a significant role of the therapy of families of the patients in the posthospital treatment. The patterns of schizophrenia as a disease and the relating indications concerning basic therapeutic management are of significant importance. The work presented here discusses two basic therapies of the families of patients suffering from schizophrenia, namely psychoeducation and systemic family therapy. The work draws attention to aims, forms and concepts of these therapies. However, an appropriate pharmacotherapy of patients suffering from schizophrenia is necessary regardless of their positive response to the families.     

Burden on the families of patients with schizophrenia: results of the BIOMED I study

The burden, the coping strategies and the social network of a sample of 236 relatives of patients with schizophrenia, living in five European countries, were explored by well-validated assessment instruments. In all centres, relatives experienced higher levels of burden when they had poor coping resources and reduced social support. Relatives in Mediterranean centres, who reported lower levels of social support, were more resigned, and more often used spiritual help as a coping strategy. These data indicate that family burden and coping strategies can be influenced by cultural factors, and suggest that family interventions should have also a social focus, aiming to increase the family social network and to reduce stigma. Accepted: 31 December 1997     

Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies

Purpose

The aim of this review is to identify consistent themes among the qualitative literature on stigma as experienced by patients with schizophrenia receiving community mental health care. With the treatment focus of schizophrenia nowadays shifting more and more towards community-based mental health care, professionals need to be aware of the increased vulnerability of their clients in their social environment as a result of stigma towards their disease. In-depth knowledge on stigma is critical in order to offer a dignifying community mental health care.

Methods

A systematic search of the qualitative literature in Web of Science, PubMed, PsycINFO and Francis was performed to review the subjective experiences and ideas on stigma in outpatients with schizophrenia.

Results

Three major themes were identified in 18 studies and need to be taken into consideration when implementing an adequate community mental health care: (i) the continuing existence of stigma inherent in the health care setting, (ii) the importance of relational aspects of stigma encounters in daily life and (iii) the significance of the behavioural aspects related to previous stigma experiences and beliefs among patients.

Conclusions

Despite much effort in community treatment, patients still experience stigma and discrimination. Community mental health care professionals should not only be aware of structural problems in mental health care, but should also pay considerable attention towards the relational and behavioural aspects in their clients’ life concerning stigma. Furthermore, they have the crucial role in the community to raise awareness about stigma in order to increase their clients’ acceptance in society.     

One-year follow-up of a multiple-family-group intervention for Chinese families of patients with schizophrenia

OBJECTIVES: This study tested the effectiveness of a mutual support multiple-family-group intervention for schizophrenia in terms of improvements in patients' psychosocial functioning, use of mental health services, and rehospitalization compared with a psychoeducation intervention and standard care. METHODS: A controlled trial was conducted in a sample of 96 Chinese families who were caring for a relative with schizophrenia in Hong Kong. The families were randomly assigned to one of three groups: mutual support (N=32), psychoeducation (N=33), and standard care (N=31). The interventions were delivered at two psychiatric outpatient clinics over a six-month period. The mutual support and psychoeducation interventions consisted of 12 group sessions every two weeks, each lasting about two hours. The mutual support group was a peer-led group designed to provide information, emotional support, and coping skills for caregiving in stages. The psychoeducation group was a professional-led group designed to educate families about the biological basis of schizophrenia and treatment and to improve illness management and coping skills. The standard care group and the other two groups received routine psychiatric outpatient care during the intervention. Data analyses of multiple outcomes over one-year follow-up were conducted on an intention-to-treat basis. RESULTS: Multivariate analyses of variance showed that the mutual support intervention was associated with consistently greater improvements in patients' functioning and rehospitalization and stable use of mental health services over the follow-up period compared with the other two interventions. CONCLUSIONS: The study provides evidence that mutual support groups can be an effective family intervention for Chinese persons with mental illness in terms of improving patients' functioning and hospitalization without increasing their use of mental health services.     

Implementing psychoeducational interventions in Italy for patients with schizophrenia and their families

OBJECTIVE: This study explored the feasibility of providing psychoeducational interventions for persons with schizophrenia and their families. METHODS: The study was carried out in 23 Italian mental health centers. Two professionals from each center attended three monthly training sessions on psychoeducational interventions. After the training, each professional provided informative sessions on schizophrenia to five families of service users with schizophrenia, which consisted of three meetings with each family on clinical aspects of schizophrenia, drug treatments, and detection of early signs of relapse. Each professional then provided the intervention to families for six months. RESULTS: Thirty-eight of the 46 participants completed the training course, and 34 provided the intervention to 71 families. Twenty-nine of the 34 provided the entire intervention to the families and five of the 34 held only informative sessions on schizophrenia. Ninety-one percent of the participants who completed the study reported difficulties in integrating the intervention with their other work responsibilities, and 96 percent acknowledged the positive effect that the intervention had on the center's relationship with patients with schizophrenia and their families. CONCLUSIONS: These results support the idea that it is possible to introduce psychoeducational interventions in mental health services after a relatively brief period of training and supervision.     

Stigma and state hospital patients.

This study set out to measure the degree of social stigma experienced by discharged mental hospital patients and the extent to which these patients were viewed as a burden by family and friends. Predictors of stigma included social class and demographic factors, posthospital situation, emotional functioning, and use of aftercare facilities. However, available measures were able to account for little of the variance in stigma, and further research is suggested to establish more reliable predictors of mental patient stigmatization.     

Psychiatric morbidity in Gotlandic families with schizophrenia

To work as a psychiatrist on the island of Gotland is in much to work in an epidemiological laboratory situation.

Since 1976 the author has been fascinated by the epidemiological and social-psychiatric experiences done in daily work on the island, especially regarding the interaction between psychiatric biological heredity and socio-cultural influences.

The following article was presented at the $III World Congress of Biological Psychiatry, in Stockholm June 1981 as part of a work outgoing from a group of 27 schizophrenic families on Gotland.     

Study of anticipation in Chinese families with schizophrenia

The anticipation phenomenon is an important aspect in several genetic disorders in which the age at onset (AAO) decreases and the severity of illness increases in successive generations. This phenomenon has been reported in several schizophrenic family studies, and expanded repeat mutations are implicated. In the present study, we investigate the anticipation phenomenon in Chinese schizophrenic families. We compare the AAO between two generations of 38 unilinear schizophrenic families. Intergenerational comparisons show that the AAO was significantly earlier in the offspring generation (mean AAO, 22.2 years) than that in the parental generation (mean AAO, 31.0 years) (P < 0.001). When only including the offspring generation who married, the AAO difference between the two generations was not significant (28.4 years vs 31.0 years, P = 0.151). Our findings suggest that a selection bias in the parental group might greatly impact the study of anticipation in schizophrenia. Other unavoidable biases associated with these analyses are discussed in the text.     

Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families

Psychoeducation was originally conceived as a composite of numerous therapeutic elements within a complex family therapy intervention. Patients and their relatives were, by means of preliminary briefing concerning the illness, supposed to develop a fundamental understanding of the therapy and further be convinced to commit to more long-term involvement. Since the mid 1980s, psychoeducation in German-speaking countries has evolved into an independent therapeutic program with a focus on the didactically skillful communication of key information within the framework of a cognitive-behavioral approach. Through this, patients and their relatives should be empowered to understand and accept the illness and cope with it in a successful manner. Achievement of this basic-level competency is considered to constitute an "obligatory-exercise" program upon which additional "voluntary-exercise" programs such as individual behavioral therapy, self-assertiveness training, problem-solving training, communication training, and further family therapy interventions can be built. Psychoeducation looks to combine the factor of empowerment of the affected with scientifically founded treatment expertise in as efficient a manner as possible. A randomized multicenter study based in Munich showed that within a 2-year period such a program was related to a significant reduction in rehospitalization rates from 58% to 41% and also a shortening of intermittent days spent in hospital from 78 to 39 days. Psychoeducation, in the form of an obligatory-exercise program, should be made available to all patients suffering from a schizophrenic disorder and their families.     

Stigma and discrimination towards people with schizophrenia and their family members

Background  

There is a scarcity of data regarding the actual stigma and discrimination experienced by schizophrenic patients and their relatives. Those experiences can vary significantly depending on the specific social group involved. We have explored such phenomena in our culture with a qualitative technique.     

The impact of work-related rehabilitation on the quality of life of patients with schizophrenia

In a cross-sectional study of 60 outpatients with schizophrenia (mean age 36.3 ± 11.1) the effect of a work-related rehabilitation programme on the patients' quality of life was investigated. A group of patients with the same diagnosis, but without rehabilitation, served as controls. Patients of the rehabilitation group had been attending the programme for a mean duration of 15.0 months. The programme focuses on occupational and everyday skills and also involves social aspects. The patients' quality of life was assessed using two self-administered questionnaires: the Munich List of Life Dimensions (MLDL, Heinisch et al. 1991) and the Everyday Life Questionnaire (Bullinger et al. 1993). Life satisfaction as well as functional quality of life were higher in the rehabilitation group in the majority of domains assessed. Difference between groups was highest for satisfaction with work, followed by leisure-time activities, independence and friendships/acquaintances. Results indicate that the rehabilitation programme acts like a “lever” which, applied to one point (work, day structuring), subsequently affects most domains of daily living. Accepted: 26 February 1998