Family Members Of Schizophrenic Patients Research Articles

Psychometric evaluation and adaptation of the stigma affiliation scale into the Indonesian language in primary family caregivers of schizophrenia patients

IntroductionThe Stigma Affiliation Scale (ASS) is an instrument to assess affiliation stigma used widely worldwide. This study aims to adapt the ASS to the Indonesian language and to evaluate the psychometric properties of the ASS among family caregivers of people with schizophrenia in Indonesia.MethodsA cross-sectional study was conducted of 94 schizophrenia patients’ family caregivers in communities, i.e., an items analysis, construct validity using the known-group method, and internal consistency reliability.ResultsThe consistency between items and overall scores using Pearson product-moment correlation shows that all the items had Pearson’s coefficient correlation ≥ 0.300, indicating good and acceptable discriminant power. The construct validity using the Mann–Whitney U test comparing the ASS scores between the primary caregivers and other family members of schizophrenic patients showed higher scores in the primary caregivers than the other family members in the three domains (p < 0.0001), indicating excellent construct validity. Cronbach’s alpha was 0.80–0.89 and above 0.90, which indicate good and excellent reliability, respectively.ConclusionThe Indonesian version of ASS shows good psychometric properties among family caregivers of people with schizophrenia in Indonesia.

Relationship between Family Burden, Stigma, Stress, Social Support, Family Acceptance, and Family’s Ability in Caregivers of Patients with Schizophrenia

The family’s ability as a caregiver for schizophrenic patients is very necessary because it can affect the success of the treatment process provided. This article aims to determine the relationship between family burden, stigma, stress, social support, family acceptance and family’s ability in caregivers of patients with schizophrenia. This study used a quantitative method with a cross-sectional study design. The study was conducted at the outpatient polyclinic at Teuku Umar General Hospital with a total sample of 98 family members of schizophrenic patients. The results of this study indicate that family burden, stress, stigma, and acceptance are related to the family’s ability to provide care to schizophrenic patients (p = 0.0001 &lt; 0.05). Only the social support variable has no relation with the family’s ability to provide care to schizophrenic patients (p = 0.145 &gt; 0.05). The lack of a relationship between the social support variable and family’s ability is consistent with the stigma variable’s results, which indicates a negative stigma from the community towards the family, so social support becomes unnecessary. This study concludes that families can better care for schizophrenic patients when their burden, stress level, and stigma are reduced or lower. The greater a family accepts schizophrenia patients, the greater their ability to care for them.

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEMAMPUAN KELUARGA DALAM PENCEGAHAN KEKAMBUHAN PASIEN SKIZOFRENIA

One problem in treating schizophrenia is recurrence. Recurrence indicates the return of symptoms of the previous disease is quite severe and disturbing daily activities and requires further treatment. Prevention of recurrence in schizophrenia can be sought by the family. This study aims to identify factors related to family abilities in preventing recurrence of schizophrenic patients. This study used a cross sectional design. The sample in the study were 82 families with family members of schizophrenic patients obtained using simple random sampling. The results of the analysis have a relationship between the age range of the family (p value 0.012), the role of respondents in the family (p value 0.032), duration of treating schizophrenic patients (p value 0.001) but there is no relationship between the ability to prevent recurrence with the sex of respondents (p value 0.835) and education level of respondents (p value 0.508). Recommendations from this study for health workers provide health education to families to provide an understanding of the ability to prevent recurrence in schizophrenic patients.&#x0D; &#x0D; Keywords: Schizophrenia, Prevention of recurrence, Family

Prevalence of depression, anxiety symptoms and related factors in family members of schizophrenic patients in a Shanghai community

Objective To examine the prevalence of depression and anxiety symptoms, and the related factors in family members of schizophrenic patients in a Shanghai community. Methods From March to May 2017, the family members of 206 schizophrenic patients registered in Xuhui district Kangjian community of Shanghai were enrolled in this cross-sectional survey. The participants were evaluated with Patient Health Questionnaire Self-rating Depression Scale (PHQ-9) and the Anxiety Screening Scale (GAD-7). The factors related to depression and anxiety symptoms were analyzed. Results The detection rates of depressive symptoms and anxiety symptoms in the family members of schizophrenia patients were 40.3%(83/206) and 37.9%(78/206), respectively.Univariate analysis showed that the relationship with the patient, education levels were the influencing factors of depressive symptoms (χ2=17.045, 9.702; P<0.01); while age, relationship with the patient, education levels were factors related to the occurence of anxiety symptoms (χ2=11.862, 22.042, 15.060; P<0.01). Multivariate regression analysis showed that the parents of patient was more prone to depressive symptoms than spouses (OR=2.861, P<0.01); higher education was more prone to be depressive than primary education (OR=10.071, P<0.01). Age group 18-40 years were more prone to anxiety than the age group ≥66 years (OR=0.060, P<0.05); sibling relationship is more prone to anxiety than spouse relationship (OR=10.018, P<0.01), followed by parental relationship (OR=7.467, P<0.01); higher education was more prone to anxiety than primary education (OR=5.119, P<0.05). Conclusions There is high prevalence of depression and anxiety symptoms in family members of schizophrenic patients, which is related to the relationship with the patient, the education level of family members and other factors. Key words: Schizophrenia; Family members; Depression; Anxiety

Éducation thérapeutique de familles de patients schizophrènes : le modèle de l’Hôtel-Dieu de France au Liban

IntroductionSchizophrenia is a chronic illness that causes considerable functional disability. The care of a schizophrenic patient is a heavy burden which impacts negatively the patient's family. It alters the quality of life of the caregiver and creates a distress and dissatisfaction with respect to his/her role due to several factors. This negative effect on the patient's support system can also indirectly affect the prognosis of the patient's disease through the increase of relapse rate, therefore entering a vicious cycle. The therapeutic education of families of patients suffering of schizophrenia has revealed to be an efficient and positive intervention on many levels. An efficient psychoeducation program can improve the knowledge of the family members, decrease the burden of the disease and reduce the patient's relapse rate. ObjectivesGiven the frequent solicitation of the psychiatric team by the caregivers, a psychoeducation program for the family members of schizophrenic patients was implemented at the psychiatric department of Hôtel-Dieu de France, a University Hospital in Lebanon, aiming to help these families in acquiring a realistic vision of the disease, thus enabling them to actively collaborate in psychiatric care, and to tackle and discuss the common daily encountered problems in the management of such patients, finally suggesting ways to deal with these problems. DescriptionSelected family members of three schizophrenic patients attended the psychoeducation program after obtaining the consent of the patients. The intervention consisted of ten sessions, of one hour and a half each, at the pace of one session per week and it was led by a multidisciplinary team: a psychiatrist, a psychologist, a nursing manager and an occupational therapist. The psychoeducation program consisted of the presentation of the disease and of related important information, of debriefing sessions and of experience-sharing sessions between the three families. An assessment of knowledge related to schizophrenia was made before and after the implementation of the program. ContributionThe psychoeducation program enabled the families to acquire new and useful knowledge about the disease, helped in relieving their distress and in dealing with negative emotions caused by the presence of the disease in a family member. Since the family constitutes a central hub in the patient's life in Lebanese society, such therapeutic education of families of patients with schizophrenia is found to be essential in the management of the disease. Many psychoeducational approaches have been described in the literature. They differ from one another by the program's content and/or duration and the composition of the attending group. In our case, we implemented a relatively short program to a multiple-family group without the participation of the patients. ConclusionThe implementation of a psychoeducation program to the families of patients suffering of schizophrenia is important because the family members continually face particularly difficult circumstances. Such programs have several positive effects on both family members and patient. However, their long-term effects should be further evaluated and the duration of the program should be adapted accordingly. Such interventions may also be of benefit when implemented to families of patients with chronic mental disorders other than schizophrenia.

Study of olfactory identification and EEG in a sample of schizophrenic patients and their first-degree relatives as an endophenotype for schizophrenia

Objective Investigations of the genetic basis for mental disorders have recently focused on Endophenotypes as alternative phenotypes reflecting internal phenomena of organisms that define elements of mental disorders proximal to effects of genes. Olfactory deficits and abnormal resting state electroencephalogram (EEG) are among endophenotypes that have been reported in patients with schizophrenia. This study assessed olfactory function and resting state EEG abnormalities in patients (first episode and chronic schizophrenic patients) and again in the healthy first degree family members of schizophrenic patients to determine genetic liability for the disorder. Method The University Of Pennsylvania Smell Identification Test (UPSIT) was administered birhinally to three groups of subjects aged less than 65 years: 30 schizophrenic patients, 30 healthy first degree family members and 30 age- and sex-matched healthy volunteers. Resting EEG data were also collected from the study groups. Result A high percentage of schizophrenic patients (both first episodes and chronic patients) were microsmic compared with control subject (P = 0,000*). However there was no significant statistical difference between first episode patients and family group (P = 0.915). The family group showed significantly statistical difference in UPSIT score compared to control subjects (P = 0,001*).These group differences could not be accounted for by age, sex, medication exposure, education or smoking habit. Schizophrenic patients had no significantly statistical difference (on the augmented low frequency-delta component than did normal control subjects P = 0.167), and there was no significant difference in scores on the delta component between first episode and chronic schizophrenic patients (P = 713). In the family group no significant difference on the augmented low frequency-delta component than did normal control subjects (P = 176). Conclusions Impairment in olfactory identification ability was present from the onset of psychotic illness which suggests central causes. Olfactory identification deficit aggregates in healthy first-degree family members which may serve as a strong endophenotypic vulnerability marker. The findings of Resting state EEG collected from the study groups suggest that there is EEG abnormalities in schizophrenia patients and their first degree healthy family members, but because small sample size the data wasn't' conclusive and needs to be repeated on larger sample size.

A study of the family burden of 150 family members of schizophrenic patients

Purpose. – Investigation into the family burden (FB) of schizophrenic patients has recently risen sharply. Nevertheless, to date there has been little consensus as to what factors influence the FB. The purpose of this study is to acquire a greater insight into the variables that influence the FB. Subjects/methods. – The FB was measured with the interview for the family burden (Kluiter H, Kramer JJAM, Wiersma D, et al. Interview voor de belasting van de familie 1997 [Interview for the burden on the family]. Department Sociale Psychiatrie. Groningen: Rijksuniversiteit). One hundred and fifty family members (parents/partners) of schizophrenic patients participated in the study. Results. – The results of our study show (1) that family members experience burden both on a practical and an emotional level, (2) a highly significant correlation between the amount of symptomatic behaviour of the patient and FB, (3) that parents had taken on more tasks, had contributed more financially and had experienced a tenser atmosphere at home than partners did and (4) that family members of patients who have been treated for less than 1 year worry more about the other members of their family than family members of patients who have been receiving treatment for more than 1 year. Conclusions. – Family members of schizophrenic patients experience burden on a practical, financial and emotional level and the extent of the burden is closely linked to the amount of symptomatic behaviour of the patient.

31P-MR spectroscopy in children and adolescents with a familial risk of schizophrenia.

Based on a previous report [9] on alterations of membrane phosphorus metabolism in asymptomatic family members of schizophrenic patients, the aim of the present study was to extend and improve the evaluation and data processing of (31)P spectroscopic data obtained from a larger study population by including an analysis of the broad spectral component (BC) of membrane phospholipids (PL). Eighteen children and siblings of patients with schizophrenia and a gender- and age-matched control group of 18 healthy subjects without familial schizophrenia were investigated with phosphorus magnetic resonance spectroscopy ((31)P-MRS) by using image selected in vivo spectroscopy (ISIS) in the dorsolateral prefrontal regions (DLPFR) of the brain. Spectral analysis was performed by using both the full and truncated FID to estimate metabolic peak ratios of different (31)P metabolites and the intensity and linewidth of the broad component. A significantly higher PDE level (p<0.01) and increased linewidth of the PDE components were observed for the high-risk group compared with the control group (p=0.02). No significant differences were observed for PME as well as for other (31)P-metabolites. No differences were observed between the left and right hemispheres for different normalised (31)P-metabolic levels. Decreased intensities (p=0.03) and smaller linewidths (p=0.01) were obtained for the broad component in the high-risk group. Impairments of membrane metabolism that are typical for schizophrenic patients are partially observed in adolescent asymptomatic family members of schizophrenics, including increased levels of low molecular PDE compounds indicating increased membrane degradation processes, no changes for PME, and decreased intensities and linewidths of the BC indicating changes in the composition and fluidity of membrane phospholipids. Despite limitations to completely suppress fast-relaxing components by dismissing initial FID data points, the spectroscopic results indicate additional changes in the membrane metabolism of high-risk subjects beyond changes of synthesis and degradation.

Hypofrontality — a risk-marker related to schizophrenia?

In order to better understand whether cortical hypoactivation and hypofrontality is a possible risk marker for schizophrenia, we investigated resting EEG activity in 39 unmedicated schizophrenics and 21 persons with schizotypal personality. Compared to a normal control group, we found an increased, frontally pronounced delta activity in schizophrenic patients, a result that is in accordance with other studies. Subjects with schizotypal personality, who are believed to have an increased risk for schizophrenia, did not show an increase of delta activity. From this result, we concluded that cortical hypoactivation and hypofrontality — defined as an increase of frontally pronounced delta activity during resting EEG — cannot be interpreted as a risk factor for schizophrenia. However, since it is controversial whether subjects with schizotypal personality are at increased risk for schizophrenia, further studies in unaffected family members of schizophrenic patients are needed.

The low prevalence of high levels of expressed emotion in Bali

The present study contrasts the expressed emotion (EE) status in family members of schizophrenic patients between Bali (Indonesia) and Tokyo (Japan), the former being a non-industrialized society and the latter an industrialized society in Asia. The EE ratings of each key relative for 62 consecutively hospitalized schizophrenic patients at the Bangli State Mental Hospital (Bali) and 33 consecutively admitted schizophrenics at Komagino Hospital (Tokyo) were obtained using the Five Minute Speech Sample (FMSS) method. A significantly lower prevalence of high EE (12.9%) was observed in Bali compared with Tokyo (36.4%) ( P<0.01). This result may explain the better social adjustment of schizophrenics in Bali. In addition, in Bali, to clarify the EE effect in this non-industrialized society, we examined the relationship between each key relative’s EE and the patient’s psychotic symptoms at admission, as assessed by the Brief Psychiatric Rating Scale (BPRS) and the Scales for the Assessment of Negative Symptoms (SANS). Moreover, the association between each family member’s EE and a patient’s rate of re-admission over the 1-year period following discharge was evaluated. The EE value was significantly related to the anxious–depression factor score in the BPRS, but not to either of the other factor scores in the BPRS or SANS subscales. Furthermore, EE status was not a reliable predictor of patient re-admission over the 1-year period following discharge in Bali.

Expressed emotion, attributions, and schizophrenia symptom dimensions.

Using a sample of 40 Anglo American family members of schizophrenic patients, the present study replicates and lends cross-cultural support for an attribution-affect model of expressed emotion (EE). Consistent with attribution theory, the authors found that highly critical relatives (high-EE) viewed the illness and associated symptoms as residing more within the patient's personal control as compared with less critical relatives (low-EE). A content analysis classified the types of behaviors and symptoms most frequently criticized by relatives. Symptoms reflecting behavioral deficits (e.g., poor hygiene) were found to be criticized more often than symptoms reflecting behavioral excesses (e.g., hallucinations). In line with an attribution-affect framework, relatives may be less tolerant of behavioral deficits because they are viewed as intentional, whereas behavioral excesses are easily recognized as core symptoms of mental illness.

Eye movements in spectrum personality disorders: comparison of community subjects and relatives of schizophrenic patients

The purpose of the current study was to test the specificity of an association between eye tracking abnormality and schizophrenia spectrum personality symptoms in the family members of schizophrenic patients. The studies of biological markers for genetic vulnerability to schizophrenia, which test an association between a biological measure and schizophrenia spectrum personality symptoms, are constrained, since these personality symptoms may lack the specificity for a schizophrenic phenotype. An association between a behavioral measure and these personality symptoms in general can easily be false (i.e., not related to schizophrenic vulnerability). In contrast, a strong deviant finding in the relatives of schizophrenic patients with spectrum personality symptoms, in the presence of a relatively normal finding in spectrum subjects without a known history of schizophrenia, makes the biobehavioral measure an interesting candidate for such investigations. Seventy-five subjects recruited from the community who did not have a family history of psychosis completed the study (24 of the 75 had significant schizophrenia spectrum personality symptoms). Thirty-two first-degree relatives of schizophrenic patients (13 with spectrum symptoms) completed the study. Subjects were 18-45 years old and had no DSM-III-R axis I diagnosis. Qualitative smooth pursuit eye movement score was significantly worse in relatives with the spectrum symptoms than in spectrum subjects without a family history of schizophrenia and the nonspectrum relatives. Schizotypal and schizoid symptoms explained a significant amount of the variance in the eye tracking measure in the relatives (31% and 20%, respectively) but not in the community subjects (less than 2%). Relatives of schizophrenic patients with and without the spectrum symptoms had significantly longer antisaccade latency, in spite of comparable latency for visually guided saccades, than the community subjects. Smooth pursuit abnormality in subjects with schizophrenia spectrum personality disorders is specifically associated with a family history of schizophrenia.

Hopelessness in first-episode schizophrenia

The authors evaluated the extent of overlap between DSM-III-R schizophrenia spectrum personality diagnoses (SSPD) and the Psychosis Proneness Scales of Chapman and his associates. The subjects were recruited from the family members of schizophrenic patients (“familial” subjects; n = 45) and members of the community with negative family histories for schizophrenia (“nonfamilial” subjects; n = 60). Clinical interviews were performed to obtain DSM-III-R Axis I and II diagnoses. In 105 individuals with no Axis I diagnosis, the five Chapman Scales were administered. The results suggest that the nonfamilial subjects with diagnoses of SSPD (n = 24) scored significantly higher on the Chapman Scales of Magical Ideation, Perceptual Aberration, and Impulsive Nonconformity compared with the familial SSPD subjects and the other non-SSPD groups. The familial SSPD subjects (n = 17) scored significantly higher than the nonfamilial, non-SSPD groups on the Physical Anhedonia Scale. Scores on the Social Anhedonia Scale were highest in the SSPD subjects, but only scores for the nonfamilial SSPD subjects were statistically different from those for the other non-SSPD groups. The data were reanalyzed by first dividing the scores from the Chapman Scales into high and low scores based on different cutoff points. Sensitivities, specificities, and predictive powers of the “high” Chapman scores for SSPD diagnoses were then calculated. These were done because the Chapman Scales are often used to identify individuals with schizophrenia-related personality disorders on the basis of scores that exceed arbitrary cutoff points. The results suggest that the Chapman Scales (other than the Physical Anhedonia Scale) and DSM-III-R criteria identified mostly the same subjects, when only nonfamilial subjects were considered (with sensitivities and specifities of about 0.70). However, the overlap between these two constructs was poor when only schizophrenia spectrum subjects recruited from the family members of schizophrenic patients were considered.

An attributional analysis of expressed emotion in Mexican-American families with schizophrenia.

In this study we tested an attributional model of expressed emotion (EE) among Mexican-American families. A sample of 46 key family members of schizophrenic patients were measured on three dimensions: affect toward patient, controllability attributions, and level of EE. Consistent with an attributional model, we found that high EE families (defined on the basis of critical comments) viewed the illness and associated symptoms as residing within the patient's personal control, more so than did low EE families. We also found that attributions held by family members are related to their affective reactions. Specifically, family members who perceived the patient as having control over the symptoms of schizophrenia tended to express greater negative emotions such as anger and annoyance toward the patient than did family members who viewed the symptoms as beyond the patient's personal control. An examination of the types of affects found and their relationship to EE status is discussed, along with implications for this research.

Psychosis proneness scales in schizophrenia spectrum personality disorders: Familial vs. nonfamilial samples

The authors evaluated the extent of overlap between DSM-III-R schizophrenia spectrum personality diagnoses (SSPD) and the Psychosis Proneness Scales of Chapman and his associates. The subjects were recruited from the family members of schizophrenic patients (“familial” subjects; n = 45) and members of the community with negative family histories for schizophrenia (“nonfamilial” subjects; n = 60). Clinical interviews were performed to obtain DSM-III-R Axis I and II diagnoses. In 105 individuals with no Axis I diagnosis, the five Chapman Scales were administered. The results suggest that the nonfamilial subjects with diagnoses of SSPD ( n = 24) scored significantly higher on the Chapman Scales of Magical Ideation, Perceptual Aberration, and Impulsive Nonconformity compared with the familial SSPD subjects and the other non-SSPD groups. The familial SSPD subjects ( n = 17) scored significantly higher than the nonfamilial, non-SSPD groups on the Physical Anhedonia Scale. Scores on the Social Anhedonia Scale were highest in the SSPD subjects, but only scores for the nonfamilial SSPD subjects were statistically different from those for the other non-SSPD groups. The data were reanalyzed by first dividing the scores from the Chapman Scales into high and low scores based on different cutoff points. Sensitivities, specificities, and predictive powers of the “high” Chapman scores for SSPD diagnoses were then calculated. These were done because the Chapman Scales are often used to identify individuals with schizophrenia-related personality disorders on the basis of scores that exceed arbitrary cutoff points. The results suggest that the Chapman Scales (other than the Physical Anhedonia Scale) and DSM-III-R criteria identified mostly the same subjects, when only nonfamilial subjects were considered (with sensitivities and specifities of about 0.70). However, the overlap between these two constructs was poor when only schizophrenia spectrum subjects recruited from the family members of schizophrenic patients were considered.

An attributional analysis of expressed emotion in Mexican-American families with schizophrenia.

In this study we tested an attributional model of expressed emotion (EE) among Mexican-American families. A sample of 46 key family members of schizophrenic patients were measured on three dimensions: affect toward patient, controllability attributions, and level of EE. Consistent with an attributional model, we found that high EE families (defined on the basis of critical comments) viewed the illness and associated symptoms as residing within the patient's personal control, more so than did low EE families. We also found that attributions held by family members are related to their affective reactions. Specifically, family members who perceived the patient as having control over the symptoms of schizophrenia tended to express greater negative emotions such as anger and annoyance toward the patient than did family members who viewed the symptoms as beyond the patient's personal control. An examination of the types of affects found and their relationship to EE status is discussed, along with implications for this research.

A psychoeducational intervention for schizophrenic patients

Most psychoeducational programs have been designed for family members of schizophrenic patients rather than for the patients themselves. This program was constructed to systematically educate inpatients/outpatients about their disorder and address their concerns and misperceptions in order to increase compliance with medical regimen and improve patients' self-management. This didactic-experiential intervention educates patients about the nature of schizophrenia, its course, causes, prevalence, drug treatments, common misperceptions about medication, non-drug treatments, stress factors, legal advocay issues, and community resources. The program's rationale, goals, format, instructional aids, pre/post intervention assessment tools, and content material are presented.

Teaching mental health trainees to work with families of the chronic mentally ill.

Torrey (10) has accused many of us of contributing to "iatrogenic anguish" by blaming family members of schizophrenic patients. Many more of us have been guilty of ignoring, avoiding, and alienating families, perhaps out of a well-meaning sense of loyalty to the patient, perhaps out of lack of time, perhaps out of discomfort with our own competence. While we can, and should, work to rectify these deficiencies in current psychiatric practice, we must also attend to what we are teaching the future generation of mental health professionals. Perhaps we can teach them to do a better job than we have done.

Communication in lower class families of schizophrenics. I. Methodological problems.

REPORTS in the psychiatric literature of recent years have indicated the existence of severe disturbances in the interaction and communication within families of schizophrenic patients. Earlier studies by Lidz^1,2emphasize certain pathological marital relationships, while Bateson and Jackson³note particular interactional patterns such as the "double bind" in families of schizophrenics. More recently Wynne,^{4 ,5}in examining family transactional process, has been able to differentiate blindly between families of schizophrenics and both neurotic and normal families on the basis of samples of their communications. These analyses of interaction and communication among family members of schizophrenic patients have usually examined intact families, and have generally omitted "broken homes" and physically disintegrated families from investigation. In addition, the families "available" for study were those who could afford the time in the doctor's office and who were sufficiently motivated