The role of family therapy in the management of schizophrenia: challenges and solutions.

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.

Typology of schizophrenic symptoms and quality of life in patients and their main caregivers in northern Chile.

BACKGROUND: Schizophrenia is a serious mental disorder characterized by the presence of both 'positive' and 'negative' symptoms that affect the essential functions through which a person gains his or her sense of individuality and capacity for independent functioning. AIMS: To describe the typology of schizophrenic symptoms and their relationship to quality of life in patients with schizophrenia and their main caregivers. METHODS: Participants were 45 patients and 45 relatives seen by the mental health services in Arica, Chile. Patients were assessed using the Positive and Negative Syndrome Scale (PANSS), the Seville Quality of Life Questionnaire (SQLQ), and the Social Functioning Scale (SFS). The latter was also administered to caregivers, along with the Zarit Burden Interview. RESULTS: Patients reported moderate levels of quality of life, there being a strong relationship with the negative syndrome and the general psychopathology of the disorder. The quality of life of main caregivers was related with the general psychopathology of patients. The results regarding social functioning and the caregivers' perceptions of patients' functional capacity showed that patients had a very limited degree of social integration. CONCLUSIONS: Negative symptoms and general psychopathology are the main predictors of quality of life in both patients and their caregivers.

Quality of life of schizophrenia patients of Aymaran ethnic background in the north of Chile.

OBJECTIVE: To describe the quality of life of patients of Aymaran descent with schizophrenia and analyse the differences with patients of non-Aymaran descent. METHOD: The study included 45 patients who attended the Mental Health Services in Arica, Chile. The Positive and Negative Syndrome Scale (PANSS) and the Seville Quality of Life Questionnaire (SQoLQ) were used. RESULTS: The patients of the study showed moderate quality of life levels, with a strong association with the negative syndrome and the general psychopathology of the disorder. No significant differences were found in the quality of life dimensions as regards ethnic background. CONCLUSIONS: The results found demonstrate that the integration of patients in the Community Health Services is positively associated as regards their quality of life. The integration of the caregivers is considered essential in the treatments administered.

[Burden of care in Aymara caregivers of patients with schizophrenia]. / Sobrecarga en cuidadores aymaras de pacientes con esquizofrenia.

INTRODUCTION: The introduction of anti-psychotic medication and the de-institutionalization have placed on the hands of their relatives the responsibility for their informal care. Many times, this role carries a high level of burden for all family members. There exist a few studies that approach this subject matter in groups of ethnic minority. The aim of this research was to describe the levels of burden in Aymaras caregivers (aborigines who are located on the highlands of Northen Chile) from Schizophrenia patients. MATERIAL AND METHODS: The sample corresponds to 45 caregivers of patients with schizophrenia that receive treatment at the Mental Health Services in the city of Arica, Chile. RESULTS: [corrected] Zarit Burden Scale classifies all Aymara relatives in the category of "Intense Burden", unlike not Aymara relatives, which classified as "Low Burden". Significant differences are observed in the subscale of incompetence where the Aymara Cargivers perceive not to feel able of taking care of the patient with the available resources. CONCLUSIONS: It is concludes that belonging to this ethnic minority would increase the psychopathological risk that caregivers of psychiatric patients experience.

Quality of life among caregivers of patients with schizophrenia: a cross-cultural comparison of Chilean and French families.

BACKGROUND: To our knowledge, no study has examined quality of life (QoL) among caregivers of individuals with schizophrenia between a developing and a developed country. The aim of this study was to assess QoL of the caregivers of individuals with schizophrenia in two countries characterized by different social, economic and cultural conditions, namely Chile and France. METHODS: Data were collected from public mental health outpatient services in Arica (Chile), and in Marseille (France). QoL was measured with the short-form health survey scale - 36 items (SF36). QoL of 41 Chilean caregivers was firstly compared with 245 French caregivers. Univariate and multivariate analyses using linear regression were then performed to determine variables potentially related to QoL scores. RESULTS: The caregivers were primarily mothers in the two groups, but Chilean caregivers were younger, and lived more frequently with the individual with schizophrenia than French caregivers. The SF36 scores were globally low in the two groups, especially on the mental QoL scores. Chilean caregivers reported lower physical SF36 scores than French caregivers. In the multivariate analysis, being mother and Chilean caregivers were the most regular features associating to a lower QoL. CONCLUSION: Despite differences between Chile and France, especially in terms of quality and quantity of mental health services and economic supports, caregivers' QoL levels remain particularly low for both countries. Future support programmes should address the specific needs of caregivers.

Coping strategies in Aymara caregivers of patients with schizophrenia.

Deinstitutionalization has forced families of patients with schizophrenia to take responsibility of informal care, without having the tools to exert their role properly. The aim of this study was to evaluate the coping strategies of caregivers of patients with schizophrenia, belonging to the Aymara ethnic group, (aborigines who are located on the highlands of Northern Chile). The studied sample comprised 45 caregivers of patients with schizophrenia users of the Mental Health Service of Arica, Chile. The results from the Family Coping Questionnaire (FCQ) show that both, Aymara and non-Aymara caregivers use the same coping strategies except for spiritual help which is more likely to be used by Aymara. This strategy might be related with the worldview they possess, thus the relation with the deities has a meaningful importance in the way of explaining and coping with different phenomena.

Attitudes and burden in relatives of patients with schizophrenia in a middle income country.

ABSTRACT: BACKGROUND: Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. METHODS: We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. RESULTS: Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). CONCLUSIONS: Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context.

Associations between sociocultural pressures to be thin, body distress, and eating disorder symptomatology among Chilean adolescent girls.

This study explored the relationships between perceived sociocultural pressure to fulfill the thin beauty ideal, body distress, and the presence of eating disorder symptoms. Participants were 437 Chilean adolescent girls from Arica, northern Chile, aged 13-18. Results showed significant associations between perceived pressure from social agents to be thin and the presence of disrupted eating attitudes and behavior. The perceived influence of advertising, verbal messages and social situations related to eating and dieting emerged as the strongest predictors of eating disorders symptoms. Influence of advertising was also the strongest predictor of body image distress. Age differences emerged in perceived sociocultural pressure to be thin, with older participants reporting higher sociocultural pressure to fulfill the slender beauty ideal. This paper provides information about body distress and associated disturbances, a phenomenon which has seldom been studied in non-Western countries, but which has important health implications.

Quality of life in caregivers of patients with schizophrenia: a literature review.

BACKGROUND: A couple of decades ago, hospitals or psychiatric institutions were in charge of caring for patients with schizophrenia; however, nowadays this role is performed by one or more patient's relatives. Evidence shows that informal caregivers experience negative changes in their quality of life (QOL). The aim of this study is to review the main factors associated with the QOL of caregivers of people with schizophrenia. METHODS: A search through databases from journals published last decade between 1998 and 2008 was performed. In accordance with the inclusion criteria, titles and abstracts of citations obtained from the search were examined independently by two authors and irrelevant articles discarded. The full text of those studies considered relevant by either reviewer were obtained and assessed independently. Where differences of opinion rose they were resolved by discussion. Out of the 258 references, 37 were included in the review. Studies which assessed factors associated with caregivers of people with schizophrenia's quality of life were included and the information summarized. RESULTS: Evidence suggest that physical, emotional and economic distress affect negatively caregiver's QOL as a result of a number of unfulfilled needs such as, restoration of patient functioning in family and social roles, economic burden, lack of spare time, among other factors. CONCLUSION: Decreased QOL may be associated with caregivers' burden, lack of social support, course of the disease and family relationships problems. In addition, in developing countries, QOL is affected by caregivers' economic burden. High quality research is needed in order to identify factors associated with QOL over time and testing the efficacy of interventions aiming to improve QOL in caregivers of patients with schizophrenia.

Satisfaction with mental health services in a Latin American community of carers of patients with schizophrenia.

The aim of this study is to compare levels of satisfaction with Mental Health Services in a sample of 41 relatives of patients with schizophrenia, users of the Mental Health Public Service in the city of Arica, Chile. Of this sample, 18 participated in a group family intervention and 23 did not. Overall, the total sample of relatives expressed satisfaction with the Mental Health Service. However, in the compound satisfaction measure (patient's evolution and satisfaction with the mental health service), there were significant differences between caregivers who participated in the psycho-educative multifamily intervention and those who did not. The control group was more satisfied with the care provided by mental health services. The experimental group reported greater satisfaction in the area of patient's evolution. This result is of special interest since it indicates that psycho-educational programs increase relatives' satisfaction with the patient's evolution and also has positive consequences for the relationship between patients and their relatives.

Effects of a psychoeducational intervention program on the attitudes and health perceptions of relatives of patients with schizophrenia.

BACKGROUND: In recent years there has been increased interest in the role played by families in the treatment of patients with schizophrenia. Some family interventions may significantly reduce clinical difficulties and may have a positive impact, both emotionally and economically. The aim of this study is to assess the efficacy of a family psychoeducational program in changing attitude and health perceptions in relatives of patients with schizophrenia. SAMPLE: 45 relatives, key caregivers of patients with schizophrenia seen at a public mental health outpatient centre in Arica (Chile). INSTRUMENTS: Attitudes of Relatives toward Schizophrenia Questionnaire and General Health Questionnaire SF-36. PROCEDURE: The sample was randomly divided into a control group, in which caregivers received the usual treatment (a monthly interview with a psychiatric nurse), and an experimental group, which participated in a family psychoeducational intervention program in addition to the usual treatment. Medication of patients remained unchanged in both groups. RESULTS: The psychoeducational program was effective in modifying caregivers' attitudes. However, it had no effect on their health perceptions. CONCLUSIONS: This family psychoeducational treatment program modifies the negative attitudes of relatives towards schizophrenia. However, programs of this kind may not improve health problems; alternatively, their effects may only be seen in the long term.

Effectiveness of a psycho-educational intervention for reducing burden in Latin American families of patients with schizophrenia.

OBJECTIVES: To explore the effectiveness of a psycho-educational family intervention program for reducing burden in caregivers of patients with schizophrenia in a developing country. METHOD: Forty-five caregivers participated, 22 in a psycho-educational family intervention group and 23 in a control group. The family program was held once a week for 5 months. In the control group the caregivers received standard intervention, comprising periodical meetings with the staff to monitor the effects of the medication. Burden was measured before and after the intervention: relatives in the psycho-educational group were evaluated at inclusion and at the end of the program; controls were evaluated at inclusion and 5 months later. RESULTS: Burden decreased significantly in the psycho-educational group; mean scores on the Zarit Caregiver Burden Scale fell from 85.06 pre-intervention to 52.44 post-intervention, while scores fell only slightly in the control group, from 87.65 to 87.22. Treatment was especially effective in mothers and caregivers with lower educational levels. CONCLUSION: This intervention program for reducing caregiver burden in developing Latin American countries was effective. Future investigations should focus on obtaining more precise estimates of the contributions of specific components of these programs to reducing burden.

Burden of care in families of patients with schizophrenia.

BACKGROUND: Family caregivers of persons with schizophrenia and other disorders experience high levels of burden. Most studies of family burden in schizophrenia have taken place in developed countries. The current study examined family burden and its correlates in a medium income country in South America. METHOD: Forty-one relatives of patients with schizophrenia who were attending a public mental health outpatient service in the province of Arica, Chile, were assessed on Spanish versions of the Zarit Caregiver Burden Scale. RESULTS: All caregivers show a very high degree of burden, especially mothers, older, with low educational level, without an employment and who are taking care of younger patients. CONCLUSIONS: As developing country, Chile has a few national social welfare and community rehabilitation programs for relatives of psychiatric patients, especially in this part of the country. This significantly influences the high level of burden experienced by these caregivers. These results suggest a close monitoring of carer's mental health and the provision of a family intervention and psycho-social support.

Temperamento y personalidad en deficientes mentales / Temperament and personality in mental deficients

Se revisan los estudos sobre el temperamento y la personalidad de los deficientes mentales, se discute la hipótesis del déficit de inhibición y se estudia la aplicación de las dimensiones temperamentales básicas de extraversión y neuroticismo. Se concluye que no puede hablarse de un temperamento propio de los deficientes, puesto que se encuentra tanta variabilidad en el temperamento de los deficientes mentales como entre la población general; y que la consideración conjunta del temperamento, por un lado, y de la historia personal y la situación actual, por otro, permite dar cuenta, como en la población general, de las deficiencias individuales en los rasgos de personalidad de los deficientes mentales.

Temperamento y personalidad en deficientes mentales / Temperament and personality in mental deficients

Se revisan los estudos sobre el temperamento y la personalidad de los deficientes mentales, se discute la hipótesis del déficit de inhibición y se estudia la aplicación de las dimensiones temperamentales básicas de extraversión y neuroticismo. Se concluye que no puede hablarse de un temperamento propio de los deficientes, puesto que se encuentra tanta variabilidad en el temperamento de los deficientes mentales como entre la población general; y que la consideración conjunta del temperamento, por un lado, y de la historia personal y la situación actual, por otro, permite dar cuenta, como en la población general, de las deficiencias individuales en los rasgos de personalidad de los deficientes mentales. (AU)