家庭环境与精神分裂症的病因学初探

作者对４７例住院精神分裂症患者的早年残缺家庭、父母文化、职业及社会经济地位、父母教养方式与正常人进行对经研究发现，早年双亲离异、母亲低文化及无职业、早年较钞获得线痫的情感温暖、理解等家庭民精神分裂症发病关系较密切。     

影响精神分裂症患者家庭环境的多因素分析

目的　探讨精神分裂症患者家庭环境的影响因素。方法　采用家庭环境量表中文版 (FES CV)对 10 0例精神分裂症患者和 10 0例正常人进行测试 ,对影响精神分裂症患者家庭环境的各个因素分别进行逐步多元回归分析。结果　精神分裂症患者家庭表现为低亲密度、低情感表达、低成功性、低组织性以及高矛盾性和控制性差等 ;影响家庭环境的主要因素有父亲职业、母亲职业、居住地、患者受教育情况、患者年龄和婚姻。结论　精神分裂症患者家庭环境受多方面因素的影响 ,其中父母的职业、患者年龄、婚姻、居住地和受教育情况对家庭环境起重要作用。     

首发与反复发作精神分裂症患者对家庭环境评价的对照研究

目的 探讨精神分裂症患者家庭环境变化的特点。方法 应用家庭环境量表(FES)对75例复发精神分裂症患者进行测评,并与70例首发精神分裂症患者进行对照。结果 复发精神分裂症患者对家庭的亲密度、情感表达成功性、组织性的评分均较首发精神分裂症患者的评分低,而矛盾性则较高。结论 复发精神分裂症患者对家庭环境的评价较差,同时这一特征也显示不利于精神分裂症患者的康复和稳定。     

模拟家庭环境住院治疗对精神分裂症的疗效对照研究

目的 探讨模拟家庭环境住院治疗对精神分裂症的疗效、服药依从性及社会功能的影响。方法 通过模拟家庭环境住院治疗与常规住院治疗的对照，采用ＢＰＲＳ、ＳＤＳＳ对疗效及社会功能的缺陷进行评定。结果 研究组病人出院１月后的ＢＰＲＳ分、ＳＤＳＳ分明显好于对照组，服药依从性明显好于对照组。结论 模拟家庭环境住院治疗能提高病人的服药依从性，改善精神症状及社会功能。     

家庭环境和社会支持对精神分裂症复发的影响研究

目的探讨家庭环境和社会支持对精神分裂症复发的影响,为预防精神分裂症复发提供依据。方法采用家庭环境量表（FES-CV）、社会支持评定量表（SSRS）对120例正在接受康复治疗的住院精神分裂症复发患者（研究组）进行测评分析,并与120例未复发的精神分裂症患者（对照组）对照比较。结果两组家庭环境比较,研究组总体上评价差于对照组（P〈0.01）;精神分裂症复发患者的社会支持度明显低于未复发患者（P〈0.01）。结论家庭环境和社会支持是影响精神分裂症患者复发的重要因素,良好家庭环境和社会支持不仅有助于精神分裂症患者保持良好稳定的心理状态,且在预防和减少其复发方面也有重要作用。     

精神分裂症患者家庭环境、父母教养方式以及亲密度和适应性的调查分析

目的　探索精神分裂症患者的家庭环境、父母教养方式以及亲密度和适应性的特点。方法　采用家庭环境量表 (中文版 ) ) (FES -CV)、父母教养方式评价量表 (EMBU)及家庭亲密度和适应性量表 (中文版 ) (FACESII-CV)对 110例精神分裂症患者 (研究组 )进行评定 ,并与 110例正常受试者 (对照组 )加以比较。结果　①同正常对照组相比 ,患者家庭表现为低亲密度、低情感表达、低成功性、低组织性以及高矛盾性和控制性差 (P <0 0 5或P<0 0 1)。②在教养方式上 ,患者父亲表现为低情感温暖、高惩罚严厉、过分干涉和拒绝否认 (P <0 0 1) ;而母亲表现为低情感温暖、高拒绝否认、惩罚严厉和偏爱被试 (P <0 0 5和P <0 0 1)。③在亲密度和适应性方面 ,患者家庭的实际亲密度、实际适应性、理想亲密度和理想适应性均较对照组为差 (P <0 0 1)。结论　患者的家庭环境、父母教养方式以及亲密度和适应性方面均存在着诸多方面的问题 ,可能对精神分裂症的发病起重要作用。     

儿童精神分裂症与家庭环境的关系及家庭心理护理

本从临床角度入手,对儿童精神分裂症与家庭环境因素的关系进行了对照研究。结果在考察的9个项目中有6项（父、母化程度,家庭成员经常闹纠纷,家教方式不当,病前个性特征,发病诱因）等不良因素与儿童精神分裂症的关系密切。并就与疾病发生的相关因素,及儿童所特有的心理障碍如孤僻胆怯、迟钝退缩、自卑、冲动行为等,提出了相应的家庭护理对策,期望及时调整儿童的心理障碍、减少精神疾病的发生率,减轻社会各方面的负担。     

精神分裂症患者直系子女早期人格特征及家庭环境的相关性研究

目的 探讨精神分裂症患者直系子女的人格特征、家庭环境模式以及家庭环境因素对其人格特征的影响.方法 采用艾森克个性问卷(幼年版)(EPQ)及家庭环境量表中文版(FES-CV)评估35例精神分裂症患者直系子女(研究组)和35例正常对照(对照组)的人格特征及家庭环境模式.结果 (1)研究组的精神质、神经质两个维度评分显著高于对照组(P ＜0.05,P＜0.01),内-外向维度评分显著低于对照组(P＜0.05).(2)研究组亲密度、成功性、娱乐性3个因子评分显著低于对照组(P＜0.01),矛盾性、独立性及控制性3个因子评分显著高于对照组(P＜0.05).(3)研究组精神质与亲密度、娱乐性呈显著负相关(P ＜0.05,P＜0.01),与矛盾性、控制性呈显著正相关(P＜0.05);内外向与亲密度、成功性、娱乐性呈显著正相关(P ＜0.05,P＜0.01);神经质与亲密度、娱乐性呈显著负相关(P＜0.05),与控制性呈显著正相关(P＜0.05).结论 家庭环境对精神分裂症患者直系子女发育早期的人格特征可能产生不利影响.     

青少年精神分裂症患者家庭因素的研究

目的:探讨青少年精神分裂症患者的发病和家庭因素的相关性.方法:采用父母养育方式评价量表(EMBU)及家庭环境量表中文版(FES-CV)对60名青少年精神分裂症患者进行测评并与60名健康青少年进行对照及相关分析.结果:青少年精神分裂症患者父母养育方式与正常组对照显示:其父亲惩罚严厉、拒绝否认因子分显著高于对照组,情感温暖、理解因子分显著低于对照组(P＜0.05或P＜0.01);其母亲过分干涉过度保护、偏爱被试因子分显著高于对照组;母亲的情感温暖理解、过度保护、偏爱被试因子分高于父亲(P＜0.05或P＜0.01).家庭环境的亲密度、情感表达、文化性、娱乐性的因子分低于对照组,矛盾性和控制性均高于对照组(P＜0.05或P＜0.01).相关分析显示:父亲过度保护与母亲拒绝否认,及母亲过度保护与父亲拒绝否认因子之间呈负相关(r≥0.8);父亲与母亲EMBU相同因子得分具有相关关系(r≥0.6).结论:不良的家庭环境和父母养育方式对青少年精神分裂症的发病起一定作用,具有相关性.     

Family environment predictors of outcome in schizophrenic patients in Spain: a nine-month follow-up study

This study investigates the effects of perceived family environment on clinical outcome among patients in Spain who suffer from schizophrenia. Forty-five consecutively admitted DSM-111-R schizophrenic patients were assessed monthly with the Brief Psychiatric Rating Scale during a 9-month period. Patients and parents rated the family environment through the Family Environment Scale (FES). FES factors were considered separately for each family member, since parents' and patient's perceptions of the family environment were weakly correlated. Stepwise multiple regression analysis showed that patients' perceptions of family control and intellectual-cultural orientation predicted rehospitalization. Patients' and mothers' ratings of family control and fathers' scores of conflict and moral religious emphasis predicted psychotic relapse. However, fathers' scores of family cohesion predicted higher negative symptoms. Prior admissions, age of onset and use of depot medication tended to predict outcome in conjunction with the family variables.     

流浪与非流浪精神分裂症患者的家庭环境比较

Background

Homelessness is an increasingly important problem for individuals with serious mental illness in China.

Aim

Identify the characteristics of families that are associated with homelessness among individuals with schizophrenia.

Methods

Participants were 1856 homeless individuals with schizophrenia (defined as those who had no place of residence or involved caregivers for 7 consecutive days) and 1728 non-homeless individuals with schizophrenia from Xiangtan, Hunan. The self-completion Family Environment Scale-Chinese Version (FES-CV) was administered to these participants after their acute psychotic symptoms resolved.

Results

Compared to individuals in the non-homeless group, those in the homeless group were older and more likely to be non-locals (i.e., from outside of Xiangtan), be residents of rural (versus urban) communities, have temporary (versus permanent) jobs, be married, and have a low level of education. After controlling for demographic differences using multivariate logistic regression models, homelessness was independently associated higher scores in the FES-CV intellectual-cultural orientation, organization, achievement orientation, and control subscales and with lower scores in the FES-CV cohesion, moralreligious emphasis, independence, and active-recreational orientation subscales.

Conclusion

After controlling for sociodemographic factors, certain aspects of the family environment areassociated with being homeless among patients with schizophrenia in China. Further work is needed to identify interventions that can reduce the risk of homelessness in high-risk individuals.     

Interaction between genetic vulnerability and family environment: the Finnish adoptive family study of schizophrenia.

A nationwide Finnish sample of schizophrenics' offspring given up for adoption was compared blindly with matched controls, that is, adopted-away offspring of nonschizophrenic biologic parents. The adoptive families were investigated thoroughly by joint and individual interviews and psychologic tests. Biologic parents were also interviewed and tested. Among the 144 index and 178 control offspring, the percentage of both psychoses and other severe diagnoses (borderline syndrome and severe personality disorder) was significantly higher in the index adoptees than in the matched control adoptees. Of the 15 psychotic adoptees in the total sample to date, 13 are offspring of schizophrenics and 2 are control offspring. Both global clinical ratings and test data for the adoptive, rearing parents also correlate with the symptomatic status of the adoptees. A prospective, longitudinal study of adoptees at risk is being undertaken to explore the direction of effects between adoptees and adoptive parents.     

Family attributions and coping in the prediction of emotional adjustment in family members of patients with first-episode schizophrenia

OBJECTIVE: This study used a stress and coping framework to examine family members' emotional adjustment to caring for a patient with a first episode of schizophrenia. METHOD: One family member providing primary assistance to each of 63 patients with a first episode of schizophrenia or schizoaffective disorder was interviewed shortly after patient hospitalization. RESULTS: Overall, family members showed evidence of reasonably good emotional adjustment. Select indices of poorer emotional adjustment by family members were linked to (i) attributions in which the patient's psychiatric problems were viewed as a result of the patient's moral failings or psychological problems from earlier life, (ii) coping that was avoidant and (iii) patient management strategies that involved conflict avoidance and authoritarianism/reasoning. CONCLUSION: These findings are consistent with psychoeducational interventions that educate family members about psychiatric illness and assist them in their efforts to cope with and manage patient problems at home.     

Family interventions in schizophrenia: an analysis of non-adherence.

OBJECTIVE: The aim of this study was to identify baseline factors which may make it possible to predict non-adherence to prescribed treatment. METHOD: A total of 87 schizophrenic patients in a catchment area of Valencia (Spain) were randomly assigned to two family strategies. The characteristics associated with lack of adherence to the programmes were analysed in both the patients and their families. RESULTS: Older patients, those with a higher number of previous hospital admissions, those living in small households and those having relatives with little knowledge of schizophrenia at the time of the initial assessment were the main factors associated with a higher risk of dropping out of the interventions. CONCLUSIONS: The findings of this study offer some guidance on suggesting intervention strategies that might reduce drop-out rates in these types of programmes.     

Family stigma and care burden of schizophrenia patients: Comparison between Japan and Korea

Introduction: In the present study, we compared the care burden and stigma experienced by families of patients with schizophrenia in Japan (Niigata) and Korea (Seoul and Daegu) to elucidate similarities and differences in the sociocultural factors that affect the care experience of families in East Asia. Methods: Factors such as care burden (evaluated using the eight‐item short version of the Zarit Caregiver Burden Interview [ZBI‐8]), stigma, and social distance were evaluated in members of support groups for families of mentally ill individuals in Japan (n=47) and Korea (n=92) using an interview questionnaire. Interviewees reported their personal attitudes (personal stigma and social distance) and perceptions of the attitudes of others in the community (perceived stigma) with respect to a case vignette. These vignettes described a person with chronic schizophrenia. Results: The data analysis revealed the following: (i) feelings of care burden (according to ZBI‐8), perceived stigma, and social distance were significantly stronger in Japan compared to Korea, and (ii) feelings of personal stigma were significantly stronger in Korea than in Japan. Discussion: The care burden and stigma experienced by families of patients with schizophrenia differed between Japan and Korea. The present findings suggest that to provide effective support for reducing family stigma and care burden, the necessity of such support must be emphasized in both countries.     

Family interventions for schizophrenia in Italy: randomized controlled trial

Objective To evaluate the effectiveness of multiple group family treatment for Schizophrenia. Method Relatives were randomly provided with an informative programme (n = 50), or allocated to receive an additional support programme (n = 26). Patients did not attend the programme to overcome cultural and organizational implementation barriers. The 12 and 24 months clinical and family outcomes were assessed. Results Patients’ compliance with standard care was greater at 12 months in the more intensive behavioural management group over a control group receiving treatment as usual (TAU) (n = 25). A reduction in levels of expressed emotion (EE), significantly more frequent in those receiving the additional support programme than just the informative, occurred after treatment completion. Other clinical and family outcomes did not differ. However, treatment benefits declined at 24 months, when baseline high EE was again predictive of patient’s admission and relatives were more vulnerable to objective burden. Baseline illness severity variables predicted a number of medium and long-term poor clinical outcomes. Conclusions Although family psychoeducation has been tested in a wide range of Anglo-Saxon settings, there remains need to assess outcomes more internationally. Effective family interventions for people with schizophrenia probably require continued administration of key-elements or ongoing informal support to deal with the vicissitudes of illnesses.     

精神分裂症长期住院患者躯体疾病调查

目的：分析精神分裂症长期住院患者躯体疾病情况。方法：对精神分裂症长期住院患者215例进行心电图、血糖、血常规、血钾、血压等检验，并与一般人群进行比较。结果：伴有冠心病、糖尿病和肺结核均以精神分裂症长期住院患者显著较一般人群为多（P均〈0．01），高血压病显著较少（P〈0．05）。结论：应注意长期住院精神分裂症患者用药情况和躯体情况。