Family intervention in psychosis: who needs it? (original) (raw)
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Family Process, 1989
This study focused on the development of and changes in the interaction within a family after the onset of schizophrenia in a family member. Special attention is given to the possible effects of various treatments on the interaction. Our method was a circular interview of all family members in a joint session 8 years after the onset of schizophrenia. We observed that changes in family interaction usually had taken place during the first year of the illness. Thereafter, family conditions and interactions seem to have remained relatively unchanged. On the other hand, in addition to actual family-centered therapy, all other treatment modesindividual therapy, medication, hospitalizationseemed to have acted as systemic interventions on the family level. Our observation that family interactions and models of therapy often had a surprisingly strong resemblance led us to consider the idea of their coevolution over the years and the possible significance of this. This article aims at calling the reader's attention to the manifold influences that the onset of schizophrenia and its various treatments seem to have had on family systems. The opportunity to study family interaction several years after the onset of schizophrenia in a family member came about when the decision was made to continue the study of Alanen and his colleagues (2, 3) in the Mental Health District of Turku on 100 successive cases of schizophrenic psychoses in 1976-77. The patients had undergone a thorough examination that included their registration, a followup of various symptoms, study and followup of their life situation, work situation, and relationships within their family and with significant others. The patients had been studied at the onset of their psychosis and at 2-and 5-year followups. The patient sample included 53 men and 47 women. The diagnostic spectrum was relatively broad: 56 typical schizophrenia, 10 schizophreniform psychoses, 14 schizoaffective psychoses, and 20 borderline schizophrenia (3). From the beginning, the treatment was psychotherapeutic, with an emphasis mostly on individual therapy, although family therapy and a therapeutic ward milieu were also available (3). The 2-and 5-year followup studies had been family-oriented only to the extent that attempts were made to meet with all family members separately; previously, no conjoint interviews had been arranged. In our own study, we chose to interview family members as a unit because we wanted to evaluate family interaction, including changes and the factors responsible for the changes (see 6). Prior to our study, neither of us had met these patients or families; we had not participated in the first study nor in the 2-and 5-year followups. We had, however, access to all the material from the previous studies. Our starting point was the idea of the family as a system whose members have a circular interaction with and influence on each other. The changes both inside and outside the system are variously reflected in all interactional relationships within the system (4). One such change is, of course, the mental illness of a family member. We therefore hypothesized that the illness and the treatments affected not only the life and relationships of the patient but also the life and relationships of the whole family.
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.
Abstract: A family is an exclusive group of people who share a close relationship —a unit typically composed of a matedcouple and their dependent children in co-residence. Families create generations—each of which gain in maturity and self-sufficiency such as to create and provide for subsequent generations. The word ‘family’ came from the Latin word familiare. Family is a group of people who have tied by kinship. Family has been the society's primaryagency in satisfying common needs for survival, sense of loving and belonging, status andself-esteem, and self-realization since the very onset of human civilization. The family provides for the child's biological needs andsimultaneously directs its development towards becoming an integrated person capableof living in society and maintaining and transmitting culture. Specific to mental health, family plays a very significant role in development of positive mental health and making a person psychologically resourceful and socially organizedFamily factors in conjunction with biological and genetic factors could play instrumental role in causing psychological problems. Chances of occurring of psychological problems could be lessened if family climate is maintained as healthy and supportive to family members- soothing family atmosphere could work as a buffering agent against stress and limit the deleterious effect of stress on one’s psyche. Keywords: Dysfunctional Family, Family, and Mental Illness.
The positive effects of family therapy in state psychosis: The Ian R. H. Falloon model
The latest developments in the treatment of mental disorders include systematic education of patients and their families on mental disorders and treatment. Psychoeducation is considered an integral part of modern and integrated treatment for mental disorder. It is the principal intervention in the application of the theory of psychosocial rehabilitation in practice. It is a model adapted to the needs of the chronically ill patient family. Purpose: The purpose of this paper is to highlight the active involvement of the family members throughout the course of the disease, mainly due to the long-term interaction and patient care. Results: All family psychoeducational models in studies of intervention compared with usual supportive intervention of the individual patient, always in combination with drug therapy proved highly effective not only in reducing relapses and reduce tension and stress in the family, reducing the expression of negative emotions as well as relieve the family from feeling the burden, but also to change the attitudes and behaviors of the family towards the patient, and finally improve the family atmosphere. Conclusions: The intervention psychoeducational is an important link in the treatment of mental illness particularly on the part of the family. Both the teacher and the supportive role of psychoeducational intervention is invaluable therapeutic value.
The role of family therapy in the management of schizophrenia: challenges and solutions
Neuropsychiatric disease and treatment, 2015
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.
Psychiatry research, 2014
The present study aimed to investigate possible differences in family environment among patients experiencing their First Episode of Psychosis (FEP), chronic patients and controls. Family cohesion and flexibility (FACES-IV) and psychological distress (GHQ-28) were evaluated in families of 50 FEP and 50 chronic patients, as well as 50 controls, whereas expressed emotion (FQ) and family burden (FBS) were assessed in families of FEP and chronic patients. Multivariable linear regression analysis, adjusted for confounders, indicated impaired cohesion and flexibility for families of FEP patients compared to controls, and lower scores for families of chronic patients compared to those of FEP patients. Caregivers of chronic patients scored significantly higher in criticism, and reported higher burden and psychological distress than those of FEP patients. Our findings suggest that unbalanced levels of cohesion and flexibility, high criticism and burden appeared to be the outcome of psychosis...
Social psychiatry and psychiatric epidemiology, 1994
This paper presents the results of a study carried on an urban population in Belgrade investigating the connections between relapse in schizophrenia and the expressed emotion (EE) status of families where at least one of the patient's parents was a member of the household. The overall rate of high EE was just under 50%, in the middle of the range of values reported in studies carried out elsewhere. Relapse was found to be 10 times more frequent in patients whose families were rated high in EE. The sample consisted of 30 patients with hebephrenic schizophrenia and 30 with paranoid schizophrenia. The results suggested that these subtypes may be associated with different attributes of EE. Criticism was more frequent in families of patients with paranoid schizophrenia, while emotional overinvolvement was more frequent in families having a hebephrenic offspring. The different components of EE, suitably combined, may differentiate between the two subtypes of schizophrenia in terms of ...
Family functioning in the families of psychiatric patients a comparison with nonclinical families
To examine family functioning in the families of psychiatric patients. Material and Method: Families of psychiatric patients and nonclinical families were compared. There were 60 families in each group. The instrument included a semistructured interview of family functioning and the Chulalongkorn Family Inventory (CFI), a self-report questionnaire designed to assess the perception of one's family. Results: From the assessment by semistructured interview, 83.3% of psychiatric families and 45.0% of nonclinical families were found to be dysfunctional in at least one dimension. The difference was statistically significant (p < 0.001). The average number of dysfunctional dimensions in the psychiatric families was significantly higher than in the nonclinical control group, 3.5 + 1.9 and 0.98 + 1.5 respectively, p < 0.0001. The CFI scores of the psychiatric families were significantly lower than the control group, reflecting poor family functioning. The dysfunctions were mostly in the following dimensions: problem-solving, communication, affective responsiveness, affective involvement, and behavior control. Psychiatric families faced more psychosocial stressors and the average number of stressors was higher than the control families, 88.3% vs 56.7% and 4.2 + 2.7 vs 1.3 + 1.47 stressors respectively, p < 0.0001. Conclusion: Family functioning of psychiatric patients was less healthy than the nonclinical control. The present study underlined the significance of family assessment and family intervention in the comprehensive care of psychiatric patients.
Family therapy as predictor of wellbeing and recovery among patients with schizophrenia
International Journal of Health Sciences (IJHS), 2022
The study investigated family therapy as a predictor of well-being among Schizophrenic patients. Family therapy is a therapeutic approach used to help people with schizophrenia deepen their family connections to get through stressful times. The study adopted a descriptive survey design. Two hundred and ninety-seven (297) schizophrenic patients participated in the study. An adapted and validated questionnaire with a reliability coefficient of r = 0.77 was used for data collection. Four (4) trained research assistants helped in data collection. Frequency count, simple percentages, Pearson Product Moment Correlation (PPMC) and Regression Analysis were used as statistical tools. Hypotheses were tested at 0.05 alpha level. The study established a significant relationship between family therapy and the health of schizophrenics (r = .605, n = 297, p < 0.05). A significant relationship also exists between family therapy and the emotional stability of schizophrenics (r = .527, n = 297, p < 0.05). In the same vein, there is a significant relationship between family therapy and the recovery of schizophrenics (r = .606, n = 297, p < 0.05). It was established that family therapy jointly predicts the well-being and recovery of schizophrenics. This implies that family therapy had a significant relationship with the health, emotional stability and recovery among schizophrenics. It was concluded that early detection and intervention by the families and medical team would improve the clinical condition of the schizophrenics. It was 5796 recommended that family bonding should be encouraged. Consistent interactive communications could improve the social functioning of schizophrenics.