Beliefs of psychiatric nurses about schizophrenia: a comparison with patients' relatives and psychiatrists

BACKGROUND: What patients' relatives and health professionals think about causes, treatments and psychosocial consequences of schizophrenia can influence its detection and outcome. AIMS: To compare the beliefs about schizophrenia in 190 nurses, 110 psychiatrists and 709 relatives of patients with this mental disorder, recruited in 30 randomly selected mental health centres. METHODS: In each centre, the key-relatives of the first consecutive 25 subjects with schizophrenia, and the nurses and psychiatrists who had been working in the service for at least one year, were asked to complete the Questionnaire on the Opinions about Mental Illness (QO). RESULTS: The factors most frequently mentioned by psychiatrists and nurses among the causes of schizophrenia were heredity, stress and family conflicts, while those most frequently mentioned by relatives were stress, traumas and love breakdown. Nurses had opinions: (a) similar to those expressed by psychiatrists concerning patients' ability to work equally as other people, and patients' punishability in case of illegal acts; (b) similar to those expressed by relatives about patients' unpredictability and political rights; (c) significantly different from the other two samples as concerns recognition of patients' affective rights. CONCLUSIONS: Family psychoeducational interventions and nurses' training should address not only clinical aspects but also disability and psychosocial consequences of schizophrenia.     

精神分裂症患者亲属应对方式、心理健康状况及健康教育需求的研究

目的探讨精神分裂症患者亲属应对方式、心理健康状况及其相关性以及健康教育需求情况。方法应用特质应对方式问卷、症状自评量表(SCL-90)、自制健康知识知晓情况及健康教育需求情况调查表对100名精神分裂症患者亲属进行调查。结果精神分裂症患者亲属积极应对因子分低于常模,消极应对因子分高于常模,其SCL-90总分及各因子分均高于常模,差异有显著性(P<0.05或0.01),相关分析表明,精神分裂症患者亲属SCL-90躯体化、敌对因子分与积极应对分呈显著负相关(P<0.05),SCL-90总分、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性因子分与消极应对分呈显著正相关。97%的患者亲属知道疾病的诊断,但缺乏护理知识与技能,94%的患者亲属希望医务人员传授健康知识,对健康知识的需求侧重于安全护理、疾病症状、沟通方法、用药指导、疾病预防及康复知识、日常生活护理指导等。92%的亲属希望提供个别指导,83%的亲属选择提供科普手册。出院后健康教育方式调查发现,78%的亲属选择护士家访,63%选择电话咨询。结论精神分裂症患者亲属多采用消极应对的方式,而较少采用积极应对的方式,其心理健康状况较差,且与应对方式密切相关。     

A family study of DSM-III-R schizoaffective disorder, depressive type, compared with schizophrenia and psychotic and nonpsychotic major depression

OBJECTIVE: To assess the validity of DSM-III-R schizoaffective disorder, the authors explored the morbid risks for schizophrenia and major affective disorders in the first-degree relatives of patients with schizoaffective disorder and relevant other diagnoses. METHOD: In addition to patients with DSM-III-R schizoaffective disorder, depressive type (N = 21), the probands included patients with mood-incongruent psychotic depression (N = 22), mood-congruent psychotic depression (N = 19), nonpsychotic depression (N = 27), or schizophrenia (N = 28) and normal subjects (N = 18). The patients were consecutively recruited from the outpatient facilities of a university psychiatry department; the normal subjects were students and nurses. All probands were directly interviewed, with the Schedule for Affective Disorders and Schizophrenia--Lifetime Version (SADS-L), by a psychiatrist blind to information about relatives. Consenting relatives were directly interviewed, with the SADS-L, by two psychiatrists blind to the probands' diagnoses. The direct interview was supplemented--or replaced, when an interview was not possible (24%)--by family history data from all available sources. Morbid risks in relatives were calculated according to the Weinberg method. RESULTS: The relatives of the schizoaffective patients had almost the same risk for schizophrenia as the relatives of the schizophrenic patients. In the relatives of the patients mood-incongruent psychotic depression, the morbid risk for major affective disorders was about one-half that of the relatives of the patients with mood-congruent psychotic depression and one-third that of the relatives of the patients with nonpsychotic depression, but these differences did not reach statistical significance. CONCLUSIONS: These results suggest that DSM-III-R schizoaffective disorder is close to schizophrenia and largely corresponds to mainly schizophrenic schizoaffective disorder in the Research Diagnostic Criteria, whereas DSM-III-R mood-incongruent psychotic depression is probably quite heterogeneous and should be studied further.     

A Better Understanding of the Concept “A Good Death”: How Do Healthcare Providers Define a Good Death?

Objective

The goal of palliative care is to improve quality of life when recovery is no longer possible. The study's objective was to widen our vision of potential (unspoken) needs at the end of life with patients, close relatives, nurses, and general practitioners to aim at more versatile but personal care. The question asked was how important patients, close relatives, and healthcare providers considered the 11 core themes in defining a good death, as described in the 2016 article “Defining a good death” by Meier et al.

Patterns of contact of patients' families with mental health professionals and attitudes toward professionals.

Previous studies have shown that many relatives of mentally ill persons are dissatisfied with their relationships with mental health professionals. In this study, 274 relatives or close friends of 168 recently discharged mental patients reported on 1,198 separate contacts with mental health professionals during the course of the patient's illness. Primary kin, such as parents and spouses, were most likely to be in contact with professionals. Different types of professionals were more likely to be in contact with relatives at different points in the patient's illness. Relatives' satisfaction varied significantly for the different types of professionals. Depending on the reason for the contact, 53 to 73 percent of the relatives reported being very satisfied or satisfied with the outcome. Respondents were most satisfied with their contacts with psychologists, followed by nurses, case managers, social workers, and psychiatrists.     

Knowledge of stroke among stroke patients and their relatives in Northwest India

BACKGROUND: The knowledge of warning symptoms and risk factors for stroke has not been studied among patients with stroke in developing countries. AIMS: We aimed to assess the knowledge of stroke among patients with stroke and their relatives. SETTINGS AND DESIGN: Prospective tertiary referral hospital-based study in Northwest India. MATERIALS AND METHODS: Trained nurses and medical interns interviewed patients with stroke and transient ischemic attack and their relatives about their knowledge of stroke symptoms and risk factors. STATISTICAL ANALYSIS: Univariable and multivariable logistic regression were used. RESULTS: Of the 147 subjects interviewed, 102 (69%) were patients and 45 (31%) were relatives. There were 99 (67%) men and 48 (33%) women and the mean age was 59.7+/-14.1 years. Sixty-two percent of respondents recognized paralysis of one side as a warning symptom and 54% recognized hypertension as a risk factor for stroke. In the multivariable logistic regression analysis, higher education was associated with the knowledge of correct organ involvement in stroke (OR 2.6, CI 1.1- 6.1, P =0.02), whereas younger age (OR 2.7, CI 1.1-7.0, P =0.04) and higher education (OR 4.1, CI 1.5-10.9, P =0.005) correlated with a better knowledge regarding warning symptoms of stroke. CONCLUSIONS: In this study cohort, in general, there is lack of awareness of major warning symptoms, risk factors, organ involvement and self-recognition of stroke. However younger age and education status were associated with better knowledge. There is an urgent need for awareness programs about stroke in this study cohort.     

The effect of intensive case management on the relatives of patients with severe mental illness

OBJECTIVE: Relatives play a vital role in caring for patients with severe mental illness but receive inadequate support from psychiatric services. Evidence suggests that although intensive case management is directed primarily at patients, relatives may benefit as well. This study examined whether relatives of patients who were receiving intensive case management had more contact with mental health professionals than relatives of patients who were receiving standard case management. It also examined whether relatives of patients receiving intensive case management appraised caregiving less negatively and experienced less psychological distress than relatives of patients receiving standard case management. METHODS: The sample was drawn from the pool of patients participating in the UK700 randomized controlled trial of intensive case management. Prospective data on contact between case managers and the relatives of 146 patients were collected over a two-year period. At a two-year follow-up assessment, relatives of 116 patients were interviewed with the Experience of Caregiving Inventory and the 12-item General Health Questionnaire. RESULTS: Considerably more relatives of patients receiving intensive case management had contact with a case manager during the study period than relatives of patients receiving standard case management (70 percent compared with 45 percent). However, relatives of patients receiving intensive case management did not appraise caregiving less negatively or experience less psychological distress than relatives of patients who were receiving standard case management. CONCLUSIONS: Reducing case managers' caseloads alone will not guarantee adequate support for relatives. Instead, providing more support will need to be an explicit aim, and staff will require specific additional training to achieve it.     

Risk of dementia in first-degree relatives of patients with Alzheimer's disease and related disorders

First-degree relatives of patients with Alzheimer's disease (AD) are at greater risk for dementia when compared with the relatives of their healthy peers, but not when compared with the relatives of patients with Parkinson's disease. This may indicate that the risk of dementia in these relatives is not specific to AD or that these studies are biased. We obtained a family history and vital status information on each first-degree relative of patients attending a clinic and in a group of recruited healthy elderly subjects. Patients formed two groups: probable AD and other forms of dementia or cognitive disorders without dementia. The odds of dementia in first-degree relatives did not differ between patient groups. The odds of dementia in relatives of patients with probable AD or other forms of dementia was six times that in the relatives of the healthy elderly subjects. The cumulative incidence of dementia increased with age in the first-degree relatives of all subjects. Approximately 50% of the first-degree relatives of patients with AD were demented by age 91 years, but almost the same number of the other patient group's relatives were demented as well. That figure was never reached in the healthy elderly subject's relatives. Because the risk of dementia in first-degree relatives of patients with AD was similar to that for patients with other disorders, we cannot exclude the possibility that this is the result of selection and information biases. Our investigation implies that the increased risk of dementia may not be specific to relatives of patients with AD; the risk may also be increased in first-degree relatives of patients with other neurologic disorders.     

A controlled family study of chronic psychoses. Schizophrenia and schizoaffective disorder

Two hundred thirty-seven relatives of 48 patients with chronic psychosis, diagnosed as either schizophrenia or schizoaffective disorder, along with 380 relatives of psychiatrically normal controls, were studied using systematic diagnostic interviews, information from relatives, and review of medical records where appropriate. A variety of nonbipolar psychotic disorders was found in the relatives of the patients. Comparing relatives of patients with schizophrenia with relatives of patients with schizoaffective disorder, there was no tendency for schizoaffective diagnosis or acute psychoses to aggregate separately from schizophrenia. Increased incidence of bipolar disorder was found in relatives of patients with schizoaffective disorder but not in relatives of patients with schizophrenia. Incidence of major affective disorder (bipolar and unipolar) was increased in relatives of probands with both types of psychoses. If we subdivide the ill probands according to whether or not they had a history of substance abuse, relatives of probands with substance abuse had greater frequency of affective disorder and substance abuse, but there were not significant differences in the number of relatives with nonbipolar psychoses.     

A new type of epidemiological study: questionnaire administered by medical personnel.

Doctors, nurses, and medical and nursing students administered a questionnaire on memory disturbances, tremor and clumsiness in their first-degree relatives who live or lived near them. We obtained data on 1,479 relatives, of whom 805 were alive and 674 had died. Of those alive and older than 65, 8.69% had severe memory disturbances, 1.11% a parkinsonian syndrome and 5.59% essential tremor. Of those who had died, 10.68% had suffered from severe memory disturbances before they died. The results of both groups are similar and in accordance with the data in the literature. In our opinion this new type of epidemiological study can be very useful in diseases which are easily detected by nonspecialists and in areas with hospitals and medical schools.     

Informed consent in trials for neurological emergencies: the example of subarachnoid haemorrhage

BACKGROUND: In patients with acute life threatening diseases, and in their relatives, the ability to make a balanced decision on participation in a clinical trial may be impaired. OBJECTIVES: To assess what relevant information could be recalled by patients who were living independently after a subarachnoid haemorrhage, and by their relatives; and to determine how these patients and relatives had reacted to the informed consent encounter. METHODS: Twenty months (range 7 to 31) after treatment for subarachnoid haemorrhage, 49 patients and 47 relatives who had participated in one of two randomised trials on medical management were interviewed. The interview consisted of items on: spontaneous recall and knowledge of trial design; understanding of the trial design and the informed consent procedure; the amount and clarity of the information given; and reasons for participating. Finally patients and relatives were asked whether they would participate again in similar circumstances. RESULTS: One third of the patients recalled having participated in a clinical trial. Thirteen per cent of the patients and 20% of the relatives felt that the information supplied had not been sufficient. Nine per cent of the patients and half the relatives had read the written information. None of the patients and one relative thought that participation had been obligatory. Twenty eight per cent of the patients and 94% of the relatives felt in retrospect that they had been capable of making an adequate decision. Virtually all patients and relatives would participate again in similar circumstances. CONCLUSIONS: Many patients and their relatives have little recall of the informed consent procedure and the essentials of acute subarachnoid haemorrhage trials. However, most were satisfied with the overall procedure and would participate again.     

The relationship of paranoid states to schizophrenia

The author interviewed relatives of 32 paranoid patients, 32 matched depressed patients, and 15 schizophrenic patients regarding family history. Two (1.3%) of the relatives of paranoid patients and one (0.6%) of the relatives of depressed patients had possible paranoid states. Significantly more relatives of schizophrenic patients than relatives of paranoid or depressed patients had schizophrenia, but the rates were similar among relatives of paranoid and depressed patients. The author concludes that there is little evidence of familial occurrence of paranoid states and no evidence that paranoid states are familially related to schizophrenia.     

Lack of familial aggregation of Parkinson disease and Alzheimer disease

OBJECTIVE: To investigate the risk of Alzheimer disease (AD) in first-degree relatives of patients with Parkinson disease (PD) compared with first-degree relatives of controls. DESIGN: Case-control study, family history method, and reconstructed cohort approach. METHODS: Probands with PD without dementia and control probands, matched by age strata, sex, and ethnicity, were examined in person and enrolled without knowledge of family history of PD and other neurological disorders. Disease status in first-degree relatives of probands with PD and control probands was ascertained through a structured family history interview administered to the proband and a second informant (self-report or another informant). Cox proportional hazards models with double-censoring techniques for missing information on age of onset of AD were used to analyze the risk of AD in first-degree relatives of patients with PD compared with first-degree relatives of controls. RESULTS: Four hundred eighty-seven probands with PD and 409 control probands provided family history information on 4819 first-degree relatives older than 30 years (2534 relatives of probands with PD and 2285 relatives of control probands). One hundred thirteen first-degree relatives (2.3%; 61 relatives [2.4%] of patients with PD and 52 relatives [2.3%] of controls) were diagnosed with AD. The risk of AD was not increased in relatives of patients with PD compared with relatives of controls (hazard ratio, 1.1; 95% confidence interval, 0.7-1.6; P =.65). Similarly, no significantly increased risk of AD was observed when comparing relatives of patients with early-onset (< or =50 years) and late-onset (>50 years) PD with relatives of controls. CONCLUSION: The lack of familial aggregation of PD and AD does not support the hypothesis of major shared genetic contributions to the etiology of the 2 most common neurodegenerative disorders.     

A controlled family history study of Tourette's syndrome, III: Affective and other disorders

In a family history study, the frequency of affective disorders was significantly higher for all relatives of Gilles de la Tourette's syndrome (TS) patients than for all relatives of controls. Among the relatives of TS patients, the presence of any behavior disorder was significantly more frequent for first-, second-, and third-degree relatives and total relatives. Among all relatives, 30.6% of the relatives of TS patients versus 6.1% of control relatives (p less than .0001) had some behavior disorder. Studies of first-degree relatives suggest that among those individuals expressing the Gts gene as some type of behavioral problem, about half have tics and half do not. These observations suggest that in addition to tics that Gts gene(s) can be expressed as a spectrum of behavioral disorders.     

Schizotypal symptoms in the relatives of schizophrenia patients: an empirical analysis of the factor structure

This study examined the nature of schizotypal symptoms in the relatives of schizophrenia patients and investigated phenomenological differences in symptomatology manifested by a familial sample and a clinical sample of personality disorder patients. Confirmatory factor analyses were used to test models of DSM-III-R schizotypal symptoms in the first degree relatives (n = 172) of schizophrenia patients. A multisample analysis was conducted to determine whether the same model adequately described the schizotypal symptoms rated in the relatives of schizophrenia patients and in clinically selected personality disorder patients. The results indicated that a three-factor model consisting of cognitive/perceptual, interpersonal, and disorganization factors yielded the best fit to the data from the relatives of schizophrenia patients, but that this model did not adequately describe both the relatives of schizophrenia patients and personality disorder patients. These findings indicate that the structure of schizotypal symptoms in the relatives of schizophrenia patients is similar to the three-factor model of schizophrenia symptoms often reported, but not the same as the structure of schizotypal symptoms in clinically selected personality disorder patients.     

精神分裂症患者亲属心理健康状况分析

目的研究精神分裂症患者亲属的心理健康状况。方法采用SDS、SAS量表及自编一般项目调查表对71例精神分裂症患者亲属进行测评。结果 71例亲属SDS、SAS评分均显著高于国内常模（P〈0.01）,无职业者焦虑评分显著高于有职业者（P〈0.05）。结论精神分裂症患者亲属焦虑、抑郁症状突出,应对其进行心理卫生干预。     

Neuropsychological performance and spectrum personality traits in the relatives of patients with schizophrenia and affective psychosis

Neuropsychological deficits are found in both schizophrenic patients and their relatives, and some studies have shown similar, but less severe, deficits in affective psychotic patients and their relatives. We set out to establish: (a) whether schizophrenia spectrum personality traits are more common in the relatives of schizophrenic patients than, in the relatives of affective psychotic patients; and (b) what the relation is between spectrum personality traits and neuropsychological deficits in these relatives. Relatives were interviewed using the International Personality Disorder Examination (IPDE), and also completed the National Adult Reading Test (NART), the Trail Making Test (TMT; Parts A and B) and Thurstone's Verbal Fluency Test (TVFT). Spectrum personality traits were equally common in 129 relatives of schizophrenic patients and 106 relatives of affective psychotic patients, but the performance of the former group was inferior to that of the latter on the NART and the TVFT. Relatives with high paranoid traits had lower NART scores than relatives without such personality traits; similarly, those with high schizoid traits took longer to complete the TMT, part B, than those without such traits; and relatives with high schizotypal traits generated significantly fewer words on the TVFT than those without such traits. We conclude that relatives of schizophrenic and affective psychotic patients share a propensity to schizophrenia spectrum traits, but relatives of the former have poorer neuropsychological performance. Furthermore, there exists an association between neuropsychological deficits and spectrum traits in both groups of relatives; in particular those with high paranoid traits have lower IQ scores than their less paranoid counterparts.     

Hard neurologic signs and psychopathology in relatives of schizophrenic patients.

Previous research found more hard neurologic signs (i.e., signs that have localizing significance and exclude likely artifacts) in the nonschizophrenic relatives of schizophrenic patients than in control subjects, and in the psychiatrically normal relatives of schizophrenic patients compared with their ill relatives. Using interview-based DSM-III-R diagnoses and standard clinical neurological examinations on new samples, we found a trend to more hard signs in the 52 nonschizophrenic relatives of schizophrenic patients than in 20 control subjects, and significantly more signs in psychiatrically normal relatives than in ill ones. When pooled with previous data, signs were significantly higher in (1) relatives vs. controls and (2) normal vs. ill relatives, suggesting neurologic signs reflect an etiologic factor that often runs in families of schizophrenic patients.     

精神分裂症患者亲属心理健康状况分析

目的 研究精神分裂症患者亲属的心理健康状况。方法 采用SDS、SAS量表及自编一般项目调查表对71例精神分裂症患者亲属进行测评。结果 71例亲属SDS、SAS评分均显著高于国内常模(P<0.01),无职业者焦虑评分显著高于有职业者(P<0.05)。结论 精神分裂症患者亲属焦虑、抑郁症状突出,应对其进行心理卫生干预。     

Risk of cognitive impairment or dementia in relatives of patients with Parkinson disease

BACKGROUND: The evidence for increased risk of dementia in relatives of patients with Parkinson disease (PD) remains conflicting. OBJECTIVE: To study the risk of cognitive impairment or dementia in first-degree relatives of patients with PD. Design, Setting, and PARTICIPANTS: We conducted a historical cohort study of 1019 first-degree relatives of 162 patients with PD and of 858 relatives of 147 matched controls representative of the population of Olmsted County, Minnesota. In addition, we studied 2716 first-degree relatives of 411 patients with PD referred to Mayo Clinic. MAIN OUTCOME MEASURES: We administered via telephone a cognitive test directly to relatives or a dementia questionnaire to proxies. For relatives reported by proxies to have dementia, we obtained copies of their medical records to confirm the diagnosis. We also obtained dementia information from a medical records-linkage system. RESULTS: In the overall population-based sample, the risk of cognitive impairment or dementia was increased in relatives of patients with PD compared with relatives of controls (hazard ratio, 1.37; 95% confidence interval, 1.03-1.81; P = .03) and was particularly increased in relatives of patients with onset of PD at age 66 years or younger (youngest tertile; hazard ratio, 1.73; 95% confidence interval, 1.21-2.46; P = .003). The findings were consistent in several sensitivity analyses. In the referral-based sample, the risk of cognitive impairment or dementia in relatives increased with younger age at onset of PD but did not vary by other clinical characteristics. CONCLUSION: Cognitive impairment or dementia may share familial susceptibility factors with PD (genetic or nongenetic).