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Ferentinos P, Douki S, Kourkouni E, Dragoumi D, Smyrnis N, Douzenis A. Differential correlates of criticism versus emotional overinvolvement towards patients with schizophrenia living in halfway houses or with their families. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02609-7. [PMID: 38296844 DOI: 10.1007/s00127-023-02609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE This study systematically searched for differential correlates of criticism vs. emotional overinvolvement (EOI) towards patients with schizophrenia in families and halfway houses, which have only incidentally been reported in previous research. Identified patterns were compared across settings. METHODS We included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the expressed emotion (EE) of 22 psychiatric nurses or 56 parents, respectively, through Five Minutes Speech Samples. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses. Each outpatient was rated by one or both parents. As EE ratings had a multilevel structure, weighted Spearman correlations of criticism and EOI with various patient- and caregiver-related characteristics were calculated and compared with Meng's z-test. RESULTS Criticism was weakly negatively correlated with EOI in nurses but negligibly in parents. Distinct patterns of significant differential correlates arose across settings. Outpatients' aggressive behavior and parents' related burden were mainly associated with higher criticism. Inpatients' symptoms (agitation/aggression, negative and other psychotic symptoms) and nurses' burnout (Depersonalization) were mainly associated with lower EOI. Inpatients' perceived criticism and outpatients' previous suicide attempts were equally associated with higher criticism and lower EOI (mirror correlations). Finally, various inpatient attributes (older age, chronicity, unemployment and smoking) triggered higher EOI only. Inpatients' age, psychopathology (esp. agitation/aggression and negative symptoms) and perceived criticism survived adjustment for multiple comparisons. CONCLUSION Our findings suggest setting-specific pathogenetic pathways of criticism and EOI and might help customize psychoeducational interventions to staff and families.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece.
| | - Stamatina Douki
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Dimitra Dragoumi
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Athanassios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
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Broadbent E, Wilkes C, Koschwanez H, Weinman J, Norton S, Petrie KJ. A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychol Health 2015; 30:1361-85. [DOI: 10.1080/08870446.2015.1070851] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Price O, Baker J, Bee P, Lovell K. Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression. Br J Psychiatry 2015; 206:447-55. [PMID: 26034178 DOI: 10.1192/bjp.bp.114.144576] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND De-escalation techniques are a recommended non-physical intervention for the management of violence and aggression in mental health. Although taught as part of mandatory training for all National Health Service (NHS) mental health staff, there remains a lack of clarity around training effectiveness. AIMS To conduct a systematic review of the learning, performance and clinical safety outcomes of de-escalation techniques training. METHOD The review process involved a systematic literature search of 20 electronic databases, eligibility screening of results, data extraction, quality appraisal and data synthesis. RESULTS A total of 38 relevant studies were identified. The strongest impact of training appears to be on de-escalation-related knowledge, confidence to manage aggression and deescalation performance (although limited to artificial training scenarios). No strong conclusions could be drawn about the impact of training on assaults, injuries, containment and organisational outcomes owing to the low quality of evidence and conflicting results. CONCLUSIONS It is assumed that de-escalation techniques training will improve staff's ability to de-escalate violent and aggressive behaviour and improve safety in practice. There is currently limited evidence that this training has these effects.
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Affiliation(s)
- Owen Price
- Owen Price, MSc, RMN, NIHR Trainees Coordinating Centre, London; John Baker, PhD, Penny Bee, PhD, Karina Lovell, PhD, The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester M13 9PL, UK
| | - John Baker
- Owen Price, MSc, RMN, NIHR Trainees Coordinating Centre, London; John Baker, PhD, Penny Bee, PhD, Karina Lovell, PhD, The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester M13 9PL, UK
| | - Penny Bee
- Owen Price, MSc, RMN, NIHR Trainees Coordinating Centre, London; John Baker, PhD, Penny Bee, PhD, Karina Lovell, PhD, The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester M13 9PL, UK
| | - Karina Lovell
- Owen Price, MSc, RMN, NIHR Trainees Coordinating Centre, London; John Baker, PhD, Penny Bee, PhD, Karina Lovell, PhD, The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester M13 9PL, UK
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Caqueo-Urízar A, Rus-Calafell M, Urzúa A, Escudero J, Gutiérrez-Maldonado J. The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatr Dis Treat 2015; 11:145-51. [PMID: 25609970 PMCID: PMC4298308 DOI: 10.2147/ndt.s51331] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Family interventions for schizophrenia have been amply demonstrated to be effective and are recommended by most of the international clinical guidelines. However, their implementation in the clinical setting as well as in treatment protocols of patients with psychosis has not been fully achieved yet. With the increasing deinstitutionalization of patients, family has begun to assume the role of care performed by psychiatric hospitals, with a high emotional cost for caregivers as well as the recognition of burden experiences. Families have been the substitute in the face of the scarcity of therapeutic, occupational, and residential resources. For this reason, the viability of patients' care by their families has become a challenge. This article aims to discuss the most important aspects of family interventions, their impact on families, and the most important challenges that need to be overcome in order to achieve well-being and recovery in both patients and caregivers.
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Affiliation(s)
| | - Mar Rus-Calafell
- Department of Social Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Alfonso Urzúa
- Alfonso Urzúa Morales, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Jorge Escudero
- Departamento de Filosofía y Psicología, Universidad de Tarapacá, Arica, Chile
| | - José Gutiérrez-Maldonado
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Barcelona, Barcelona, Spain
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