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Órgano Oficial del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz

2003, Number 1

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Salud Mental 2003; 26 (1)

Intervenciones familiares en la esquizofrenia. Cambios en la sintomatología y el ajuste social

Espina A, González P

Language: Spanish
References: 47
Page: 51-58
PDF size: 371.62 Kb.


ABSTRACT

Gender, socialization, depression, alcoholism, neurosis.This article describes an essay of family interventions in schizophrenic patients developed at the University of the Basque Country.
The aims of the essay were to determine and contrast, in schizophrenic patients who had a pharmacological treatment, the therapeutic effect of three kinds of interventions: Family Therapy (FT), Support Group for Parents plus Group Therapy for the patients (SGP + GT), and Psychopedagogic Therapy (PT), compared among them and with a control group, to improve the symptomatology and the social adjustment and to prevent the relapse.
The interventions went on for 12 months. The design was a quasi-experimental one of comparison pretest-postest with a control group (n = 15), and three experimental ones: Family Therapy (n = 13), Support Group for Parents + Group Therapy for Patients (n = 10), and Psychopedagogic Therapy (n = 17). In this work we can see the results on symptomatology and social adjustment. The results of other variables (Expressed Emotion, contact hours, anxiety and depression in fathers and mothers) and the follow-up a year after finishing the interventions will be published in another work.
The patients were rated by means of the Brief Psychiatric Rating Scale – Expanded (BPRS-E) (Lukoff, Nuechterlein & Ventura, 1986), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS) (Andreasen, 1984) and the Social Adjustment Scale - Self Report (SAS-SR) (Weissman, Bothwell, 1976). Other instruments used will be described in another work.
The patients of the groups of Family Therapy and Support Group for Parents + Group Therapy for the Patients showed statistically significant improvements on symptomatology and social adjustment, while the other groups (Psychopedagogic Therapy and Control) did not show these changes. With regard to the relapse rate, patients from the Support Group for Parents relapsed significantly less than those from the Control Group in the period between the pre- and the post-test.
Our results allow us to suggest that the Family Therapy and the Support Group for Parents plus Group Therapy for Patients are effective interventions to reduce the symptomatology and improve the social adjustment of schizophrenic patients. They also reduce the use of neuroleptic medication, but they should be longer in time, and complemented with other psychosocial interventions. It is also important to consider the regular intake of medication and the consumption of alcohol and drugs by the patients.


REFERENCES

  1. AMERICAN PSYCHIATRIC ASSOCIATION: Diagnostic and Statistical Manual of Mental Disorders. Cuarta edición. DSMIV. Washington, 1994

  2. ANDERSON CM, REISS DJ, HOGARTY GE: Schizophrenia and the Family. A Practitioner’s Guide to Psychoeducation and Management. The Guilford Press, Nueva York, 1986.

  3. ANDREASEN NC: Scale for the Assessment of Negative and Positive Symptoms. The University of Iowa, Iowa, 1984.

  4. ATWOOD N: Parents support group in schizophrenia. En: McFarlane WR (ed). Family Therapy in Schizophrenia. The Guilford Press, Nueva York, 1983.

  5. BROWN GW, RUTTER M: The measurement of family activities and relationships: A methodological study. Human Relat, 19:241-263, 1966

  6. BROWN GW, BIRLEY JL, WING JK: Influence of family life on the course of schizophrenic disorders: A replication. Brit J Psychiatry, 121:241-258, 1972.

  7. DIAZ-MARTINEZ L, MUROW E, ORTEGA H, VALENCIA M, RASCON ML, RAMÍREZ I: El manejo integral del paciente esquizofrénico. Un modelo del Instituto Mexicano de Psiquiatría. Salud Mental, 19(4):1-7. 1996.

  8. DIAZ-MARTINEZ L, RASCON ML, VALENCIA M, UNIKEL C, MUROW E, RASCON D, LEAÑOS C, ORTEGA H: El programa de rehabilitación integral del paciente esquizofrénicos del Instituto Mexicano de Psiquiatría. Seguimiento a dos años. Salud Mental (Número especial):104-113, 1999.

  9. DIXON L, CURTIS A, LUCKSTED A: Update on psychoeduction for schizophrenia. Schiz Bull 26(1):5-20, 2000.

  10. ESPINA A: Terapia familiar en la esquizofrenia. Revista Psicoterapia, II(8):13-33, 1991

  11. FALLOON IRH, BOYD JL, MCGILL CW, WILLIAMSON M, RAZANI J, MOSS HB, GILDERMAN AM, SIMPSON GM: Family management in the prevention of morbidity of schizophrenia. Clinical outcome of a two-year longitudinal study. Arch Gen Psychiatry, 42:887-896, 1985.

  12. GOLDSTEIN MJ, RODNICK EH, EVANS JR, MAY RPA, STEINBERG MR: Drug and family therapy in the aftercare of acute schizophrenics. Arch Gen Psychiatry. 35:1169-1177,1978.

  13. HALEY J: Leaving Home: The Therapy of Disturbed Young People. McGraw-Hill, Nueva York, 1980.

  14. HERZ MI, LAMBERTI JS, MINTZ J, SCOTT R, O‘DELL SP, MCCARTAN L, NIX G: A program for relapse prevention in schizophrenia. A controlled study. Arch Gen Psychiatry, 57:277-283, 2000.

  15. HUXLEY NA, RENDALL M, SEDERER L: Psychosocial treatments in schizophrenia: a review of the past 20 years. J Nerv Ment Dis, 188(4):187-201, 2000.

  16. KUIPERS E, FOWLER D, GARETY P, CHISHOLM D, FREEMAN, D, DUNN G, BEBBINGTON P, HADLEY E: London-east Anglia randomized controlled trial of cognitivebehavioral therapy for psychosis. III: follow-up and economic evaluation at 18 months. Brit J Psychiatry, 173:61-68, 1998.

  17. LAM DH: Psychosocial family intervention in schizophrenia: a review of empirical studies. Psychol Med, 21:423-441, 1991.

  18. LEFF J, KUIPERS L, BERKOWITZ R, STURGEON D: A controlled trial of social intervention in the families of schizophrenic patients: Two year follow-up. Brit J Psychiatry, 146:549-600, 1985.

  19. LEFF J, VAUGHN C: Expressed Emotion in Families: Its Significance for Mental Illness. The Guilford Press, Londres, 1985.

  20. LEFF JP, BERKOWITZ R, SHAVIT N, STRACHAN A, GLASS VAUGHN C: A trial of family therapy versus a relatives’ group for schizophrenia: two-year follow-up. Brit J Psychiatry, 157:571-577, 1990.

  21. LEVENE JE, NEWMAN F, JEFFRIES JJ: Focal family therapy outcome study I: Patient and family functioning. Can J Psychiatry, 34:641-647, 1989.

  22. LIBERMAN RP, WALLACE CJ, FALLOON IRH, VAUGHN CE: Interpersonal problem-solving therapy for schizophrenics and their families. Compr Psychiatry, 22:627-629, 1981.

  23. LINSZEN DH, DINGEMANS PM, NUGTER MA, VAN DER DOES AJW, SCHOLTE WF, LENIOR MA: Patient attributes and expressed emotion as risk factors for psychotic relapse. Schiz Bull, 23(1):119-130, 1997.

  24. LINSZEN DH, LENIOR MA, DE-HAAN L, DINGEMANS PM, GERSONS B: Early intervention, untreated psychosis and the course of early schizophrenia. Brit J Psychiatry. 172(33):84-89, 1998.

  25. LUKOFF D, NUECHTERLEIN KH, VENTURA J: Appendix A: Manual for the Expanded Brief Psychiatric Rating Scale (BPRS). Schiz Bull, 12:594-602, 1986.

  26. MCFARLANE WR, LUKENS E, LINK B, DUSHAY R, DEAKINS SA, NEWMARK M. DUNNE EJ, HOREN B, TORAN J: Multiple-family groups and psychoeducation in the treatment of schizophrenia. Arch Gen Psychiatry, 52:679-687, 1995.

  27. MERINDER LB, VIUFF AG, LAUGESEN HD, CLEMMENSEN K, MISFELT S, ESPENSEN B: Patient and relative education in community psychiatry: a randomized controlled trial regarding its effectiveness. Soc Psychiatry Psychiat Epidemiol, 34(6):287-294, 1999.

  28. MINUCHIN S: Families and Family Therapy. Harvard University Press, Cambridge, 1974.

  29. MONTERO IM, ASENSIO A, HERNADEZ I, MASANET M, LACRUZ M, BELLVER F, IBORRA M, RUIZ I: Tow strategies for family intervention in schizophrenia: a randomized trial in a Mediterranean environment. Schiz Bull, 27(4):661-670, 2001.

  30. MUELA JA, GODOY J: Programa de intervención familiar en esquizofrenia. Dos años de seguimiento del estudio de Andalucía. Apuntes Psicología, 19(3):421-430, 2001.

  31. MUROW E, UNIKEl C: La musicoterapia y la terapia de expresión corporal en la rehabilitación del paciente con esquizofrenia crónica. Salud Mental, 20(3):35-40, 1997.

  32. NUGTER A, DINGEMANS P, VAN DER DOES JW, LINSZEN D, GERSONS B: Family Treatment, expressed emotion and relapse in recent onset schizophrenia. Psychiatry Res, 72:23-31, 1997.

  33. OTERO V: Evaluación de un programa de rehabilitación psiquiátrica. Psiquis, 13(3):135-142, 1992.

  34. PITSCHEL-WALTZ G, LEUTCH S, BÄUML J, KISSLING W, ENGEL RR: The effect of family interventions on relapse and rehospitalisation in schizophrenia. A meta-analysis. Schiz Bull, 27(1):73-92, 2001.

  35. RANDOLPH ET, SPENCER E, GLYNN SM, PAZ GG, LEONG GB, SHANER AL, STRACHAN A, VAN VORT W, ESCOBAR JL, LIBERMAN RP: Behavioral family management in schizophrenia: Outcome of a clinic-based intervention. Brit J Psychiatry, 164:501-506, 1994.

  36. SHIMODERA S, INOUE S, MINO Y, TANAKA S, KII M, MOTOKI Y: Expressed Emotion and Psychoeducational intervention for relatives of patients with schizophrenia: a randomized controlled study in Japan. Psychiatry Res, 96:141- 148, 2000.

  37. SZMUKLER GI, HERRMAN H, COLUSA S, BENSON A, BLOCH S: A controlled trial of a counseling intervention for caregivers of relatives with schizophrenia. Soc Psychiatry Psychiat Epidemiol, 31:149-155, 1996.

  38. TARRIER N, BARROWCLOUGH C, VAUGHN C, BAMRAH JS, PORCEDDU K, WATTS S, FREEMAN H: The community management of schizophrenia: A controlled trial of a behavioral intervention with families to reduce relapse. Brit J Psychiatry, 153:532-542, 1988.

  39. TOMARAS V, MAVREAS V, ECONOMOU M, IOANNOVICH E, KARYDI V, STEFANIS C: The effect of family intervention on chronic schizophrenics under individual psychosocial treatment: A 3-year study. Soc Psychiatry Psychiatr Epidemiol, 35(11):487-493, 2000.

  40. VALENCIA M: Tratamiento psicosocial en pacientes esquizofrénicos del Instituto Mexicano de Psiquiatría. Salud Mental, 22(2):31-40, 1999.

  41. VALENCIA M: Programa de intervención psicosocial para pacientes esquizofrénicos. Salud Mental (número Especial): 128-137, 1999.

  42. VAUGHAN K, DOYLE M, MCCONAGHY N, BLASZCZYNSKI A, FOX A, TARRIER N: The Sydney interventiontrial. A controlled trial of relatives’ counseling to reduce schizophrenic relapse. Soc Psychiatry Psychiatr Epidemiol, 27:16- 21, 1992.

  43. WEISSMAN MM, BOTHWELL: Assessment of social adjustment by patient self-report. Arch Gen Psychiatry. 33(9): 1111-1115, 1976.

  44. WIEDEMANN G, HAHLWEG K, MUELLER U, FEINSTEIN E, HANK JG, DOSE M: Effectiveness of targeted intervention and maintenance pharmacotherapy in conjunction with family interventions in schizophrenia. Eur Arch Psychiatry Clin Neuroscience, 251(2):72-84, 2001.

  45. XIANG M, RAN M, LI S: A controlled evaluation of psychoeducational family intervention in a rural Chinese community. Brit J Psychiatry, 165:544-548, 1994.

  46. XIONG W, PHILLIPS MR, HU X, RUIWEN W, DAI Q, KLEINMAN J, KLEINMAN A: Family-based intervention for schizophrenic patients in China: a randomized controlled trial. Brit J Psychiatry, 165:239-247, 1994.

  47. ZASTOWNY TR, LEHMAN AF, COLE RE, KANE C: Family management of schizophrenia: a comparison of behavioral and supportive family treatment. Psychiatry Quarterly, 63:159-186, 1992.




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