Problem behaviours encountered by families living with a schizophrenic member

Long-Term Mental Health Disability: Going to the Consumers to Assess Need in the Community

This research paper demonstrates the steps involved in setting up and carrying out a small descriptive survey of families where there is a person with a long-term mental health problem. The aim was to assess clients' needs for occupation and accommodation and to compare their responses with those of their carers. The results showed that clients themselves most frequently expressed a need for more social contact with others and that there was a significant measure of agreement with their carers in this area. Most carers but not clients, however, also expressed a need for clients to find new interests and a place of refuge when things get difficult at home.

Predictors of changes in caregiving burden in people with schizophrenia: a 3-year follow-up study in a community mental health service

OBJECTIVE

The aims of this study were to measure changes over 3-years in caregiving burden and emotional distress in relatives of people with schizophrenia and to identify factors predicting the levels of caregiving burden.

METHOD

A cohort of 51 caregivers of patients with schizophrenia attending the South-Verona Community Mental Health Service was assessed over 3-years with the Involvement Evaluation Questionnaire, European Version. Predictors of caregiving burden included both caregivers' and patients' characteristics and patterns of carer-patient interaction.

RESULTS

Baseline levels of family burden were high in worrying and urging domains. Fifty-one per cent of caregivers experienced significant emotional distress. Both overall burden and emotional distress improved. Higher patients' psychopathology, higher numbers of patient-rated needs, patients' lower global functioning and patients' poorer quality of life were found to be related to the severity of family burden. The only significant predictor of caregivers' burden at follow-up was the baseline level of caregivers' burden itself.

CONCLUSION

A policy addressing the caring burden of informal caregivers beyond patients' symptoms reduction should be considered.

The impact of caregivers' characteristics, patients' conditions and regional differences on family burden in schizophrenia: a longitudinal analysis

OBJECTIVE

Impact of caregiver characteristics, patient variables, and regional differences on family burden.

METHOD

Two hundred and eighteen schizophrenia patients and key-relatives of an urban and a rural area were examined five times over 30 months. Patients' psychopathology, service utilization; relatives' burden, coping abilities and contact duration with the patients were recorded. Effects of interpersonal differences and intrapersonal changes over time were analyzed with regression models.

RESULTS

Interpersonal differences (patients' positive and negative symptoms, relatives' coping abilities, and patient contact) and intrapersonal changes (relatives' coping abilities, patients' negative symptoms and utilization of community care) predicted family burden.

CONCLUSION

Family education programs should help caregivers to improve their coping strategies. Therapy solutions must address negative symptoms just as much as positive symptoms, as these especially impact caregivers. Intensified community-based care can reduce burden, but provision alone is not sufficient. Psychiatrists and caregivers should motivate patients to take advantage of such offers.

Caregiver burden in recent-onset schizophrenia and spectrum disorders: the influence of symptoms and personality traits

Earlier studies that used two symptom dimensions indicate that the caregiver burden for patients with schizophrenia is significantly determined by their negative symptoms. The purpose of this study is to examine the relationship between symptom severity in recent-onset schizophrenia and caregiver burden in a more differentiated way (i.e., five-symptom dimensions). Based on previous research, which shows that patients' personality traits influence the course of schizophrenia, we theorize that personality traits could also influence caregiver burden. So far, this hypothesis has never been studied. Therefore, the second purpose of this study is to examine whether patients' personality traits would contribute to caregiver burden. The results of this study showed that the disorganization symptom component was the predicting variable of the subscales supervision, tension, urging, distress, and the overall amount of caregiver burden in a linear regression analysis. Personality traits of patients played no substantial role in caregiver burden. These findings suggest that psychoeducational programs should address the severity of disorganization symptoms to reduce caregiver burden in the early phase of schizophrenia.

Instruments measuring behavioral disturbance in relatives with schizophrenia

This article presents a review of 16 instruments measuring behavioral disturbance of persons with schizophrenia as perceived by their family members. Information about the domain, the types of rating scales, and the psychometric properties of these instruments are provided. Future directions in the study of behavioral disturbance are proposed.

The caregiver's perception of behavioral disturbance in relatives with schizophrenia: a stress-coping approach

This article suggests some theoretical orientations in studying behavioral disturbance from a stress-coping perspective. First, an overview of Lazarus and Folkman's cognitive theory of stress is presented. Secondly, some linkages are proposed between the rating scales used to measure behavioral disturbance and the concepts of this theory. Future research directions are then suggested to further explore the affective, cognitive and behavioral responses related to the management of disturbing behaviors.

Well Siblings Living With Schizophrenia

As a result of the ongoing hallucinations and delusions, life at home became "anxious and chaotic" with "lots of stress." Because there was no on-site crisis intervention by professionals, well siblings were sometimes called upon to control the violent behavior and were vigilant and fearful regarding the potential for abuse. Negative symptoms were the most disturbing to well siblings. Siblings need help to understand that social isolation and lack of motivation are symptoms of the illness--not due to "laziness."

Positive and negative symptom behaviors and caregiver burden in the relatives of persons with schizophrenia

OBJECTIVE

The relationships of perceived severity and responsibility attribution for positive and negative symptom behaviors to caregiver burden were investigated. Two types of burden were studied: objective burden (i.e., negative consequences such as physical problems, financial difficulties, and household tension), and subjective burden (i.e., emotional distress about disturbing behaviors).

METHOD

Self-report measures were completed by 70 primary caregivers of persons with schizophrenia.

RESULTS

Subjective burden was related to both the severity of positive and negative symptom behaviors, whereas objective burden was related only to the severity of negative symptom behaviors. Responsibility attribution for negative symptom behaviors was related only to objective burden. Caregivers who perceived patients as being less responsible for their negative symptom behaviors reported higher levels of objective burden. The relationship between responsibility attribution for negative symptom behaviors and objective burden remained significant, even after controlling for the severity of negative symptom behaviors. Caregivers' perceptions of patients' responsibility for positive symptom behaviors were not related to objective burden.

CONCLUSIONS

As expected, perceived severity of negative symptom behaviors was related to objective caregiver burden, whereas severity of positive symptom behaviors was not. These findings suggest that negative symptoms may have a greater impact on role functioning that positive symptoms, leading to greater burden. However, contrary to expectations, less responsibility attribution for negative symptom behaviors was related to higher levels of objective caregiver burden. Caregivers who perceive patients as incapable of altering their negative symptom behaviors and meeting certain role obligations may assume extra responsibilities, leading to higher levels of objective burden. The results indicate that there may be disadvantages for caregivers associated with assuming that patients have no control over their negative symptom behaviors.

Objective burden among primary caregivers of persons with chronic schizophrenia

A better understanding of the burden on the family has become increasingly important because many families assume a major role in the care of their relatives who have schizophrenia. The purpose of this study was to provide descriptive information about the negative consequences on the family (e.g. physical problems, restrictions in social life, tense relationships in the family) reported by the primary caregivers of persons with schizophrenia. Two types of objective burden were studied: general and attributable objective burden. The former refers to the general consequences on the family while the latter corresponds to those consequences specifically attributed to the presence of mental illness. Seventy primary caregivers completed a self-report instrument. The general negative consequences identified most frequently were tense relationships in the household, and the physical and emotional problems of the primary caregiver. The most common negative consequences directly related to the ill relative were the primary caregiver's emotional problems, the disturbance in the primary caregiver's performance of work, and the disruption in the lives of other adults in the household. The clinical implications and future directions of research are discussed.

Consistency of Behavior: Expect the Unexpected

Clinicians and lay people mistakenly expect behavior to be consistent across time and situations. However, the presence of a psychological disorder can cause large and seemingly inexplicable fluctuations in patient behavior. These fluctuations intrinsically are aversive, and increase the burden on family members. This article outlines the clinical implications of inconsistency in patient behavior. A practical set of guidelines for the mental health worked is issued.

Family interactions of schizophrenic and schizoaffective patients: determinants of relatives' negativity

Videotaped family problem-solving interactions of 57 schizophrenic or schizoaffective patients and their relatives were examined for predictors of negativity of their communication behavior. Ratings of patients' behaviors and independent assessments of patients' symptomatology were used to predict the negativity of relatives in the videotaped interaction. The results indicated that severity of symptomatology was not related to relatives' negativity. Patients' social skill, as independently assessed by a role-play test, also was not associated with relatives' negativity. The regression results suggest that with both members of a patient-relative dyad, the quality of communication in a discussion is related to the other participant's level of negativity.

Burden of mental illness on the family: a critical review

The burden that a family experiences as a result of one of its members having a chronic mental illness has been the subject of research since the mid-1950s. A review of the findings in the research literature, an examination of the conceptual and operational definitions of burden, and an evaluation of methodological issues are provided. Finally, based on this critical review, suggestions are offered for future research.

Family care and schizophrenia: the effects of a supportive educational program on relatives' personal and social adjustment

In the aftermath of deinstitutionalisation and the move to community management of schizophrenia, relatives play an increasing role in the management of the illness. Families often complain of being misinformed and ill equipped to aid in the treatment. A supportive/educational intervention for relatives is described and evaluated. Seven parents with a schizophrenic offspring participated in a descriptive pilot study employing a pre-post-treatment design. To test the hypotheses that treatment would impact on participants' distress, burden, family conflict, isolation and knowledge of schizophrenia, before and after measures were taken on self-report indices utilising these features. Generalisation effects on family coping were assessed via tri-weekly telephone interviews for the duration of the study. The intervention included information and sharing sessions. There was a substantial reduction in distress symptoms, anxiety, depression, burden and the amount of family conflict; there was an increase in the duration of home visits, out of home excursions and knowledge of schizophrenia. Most of the subjects' needs were met by the intervention. These gains were achieved with a high level of consumer acceptance. It was concluded that this kind of education has an important role in psychosocial intervention with relatives of the mentally ill.