Schizophrenia: group support for relatives

Family expectation, social adjustment and gender differences in a sample of schizophrenic patients

A case series to study factors related to family expectation regarding schizophrenic patients was conducted in an out-patient setting in the city of S. Paulo, Brazil. Patients diagnosed as presenting schizophrenia by the ICD 9th Edition and having had the disease for more than four years were included in the study. Family Expectation was measured by the difference between the Katz Adjustment Scale (R2 and R3) scores based on the relative's expectation and the socially expected activities of the patient (Discrepancy Score), and social adjustment was given by the DSM-III-R Global Assessment Scale (GAS). Outcome assessments were made independently, and 44 patients comprised the sample (25 males and 19 females). The Discrepancy mean score was twice as high for males as for females (p < 0.02), and there was an inverse relationship between the discrepancy score and social adjustment (r = -0.46, p < 0.001). Moreover, sex and social adjustment exerted independent effects on the discrepancy score when age, age at onset and number of psychiatric admissions were controlled by means of a multiple regression technique. There was an interaction between sex and social adjustment, the inverse relationship between social adjustment and discrepancy score being more pronounced for males. These findings are discussed in the light of the potential association between the family environment, gender and social adjustment of schizophrenic patients, and the need for further research, i.e. ethnographic accounts of interactions between patient and relatives sharing households particularly in less developed countries.

Families of psychiatric patients: a critical review and future research directions

It is generally acknowledged that mental illness creates burdens for family caregivers. Since the 1950s, medical literature has identified the type and extent of those burdens, especially for families of patients with schizophrenia. Whereas the imperative to identify interventions for these families is clear, there has been a lack of systematic research of families' responses to and management of mental illness, resulting in significant gaps in knowledge. The rapidly changing health-care environment suggests that our understanding of families' responses to mental illness need to be reexamined for current relevance and new insights. This article critically examines the research to date and identifies gaps in knowledge related to family experience of mental illness. It argues the need to continue studies of caregiver burden and the stress resulting from that burden. Future directions for research are suggested.

Running groups for parents with schizophrenic adolescents: initial experiences and plans for the future

Six-session educational and support groups were held for two sets of parents (32 in all) who had an adolescent schizophrenic child. Results indicate no significant increases in knowledge about the disorder following the group (probably due to the relatively high scores obtained at the outset) but gains seem to have been made in ability to handle the teenage patient at home. All parents commented on how they had benefited from the supportive aspect of the group. Future developments of these groups are discussed.

Family therapy and schizophrenia: recent developments

A review of recent studies of family interaction as a causal factor in the development of schizophrenia suggests a paucity of evidence supporting this point of view. However, research has suggested family variables may influence the course and outcome of schizophrenia. The impact of schizophrenia on the family has recently received more attention. Some research has identified differences between families of schizophrenics and the families of other diagnostic groups and controls. Whether these studies are beginning to influence the theory and practice of family therapy is discussed. Recent studies suggest the combination of long-acting medication and 'psychosocial' interventions may reduce the relapse rate of schizophrenia in the short term. This research suggests that family therapists must re-evaluate their role in the management of schizophrenia.

Group Support for the Families of Psychiatric Patients

The use of such a group model would seem to be useful for all families of psychiatric patients, and most particularly, for families experiencing an initial hospitalization episode. The benefit of mutual support, it is concluded, is a powerful and effective means of meeting the needs of families during the hospitalization phase of the patient's illness.

Problem behaviours encountered by families living with a schizophrenic member

Attention is focused on the problem behaviours encountered by relatives of schizophrenic patients. Seventy families, members of the "Friends of Schizophrenics" association completed a questionnaire aimed at eliciting specific problem behaviours from the perspective of the relative. By far, the most frequent problems were concerned with the 'negative' symptoms of schizophrenia while the problems found most difficult to manage included those to do with insight compliance and 'positive' symptoms.

Co-therapy in a clinic for schizophrenia

In the outpatient treatment of schizophrenia, the routine practice of providing each patient with two co-therapists results in several benefits: reduced dependency, increased expertise, objective monitoring, added support and morale for the therapists, more obvious and therefore more reversible countertransference, more obvious and therefore more treatable "splitting" and "projecting." Despite these benefits, problems arise in the two-therapist arrangement. They are discussed under the following headings: loyalty conflicts; limit setting; crisis management; family work. The authors report on techniques of co-therapy problem prevention and problem resolution. Though not always successful, co-therapy continues to be a useful model of service delivery to schizophrenic outpatients.