Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-26T14:09:05.244Z Has data issue: false hasContentIssue false
  • English
  • Français

Schizofrenia e intervento psicosociale sulle famiglie. Indagine sulle caratteristiche dell'utenza e follow-up ad un anno

Published online by Cambridge University Press:  07 August 2014

Giuseppe Carrà ,
Massimo Clerici  and
Carlo L. Cazzullo
Giuseppe Carrà*
Affiliation:
Istituto di Clinica Psichiatrica, Università di Pavia, Pavia Associazione Ricerche sulla Schizofrenia, Milano
Massimo Clerici
Affiliation:
Associazione Ricerche sulla Schizofrenia, Milano
Carlo L. Cazzullo
Affiliation:
Associazione Ricerche sulla Schizofrenia, Milano
*
Indirizzo per la corrispondenza: Dr. G. Carrà, Istituto di Clinica Psichiatrica, Università di Pavia, Via Bassi 21, 27100 Pavia. Fax (+39) 0382-526.723.
Get access Rights & Permissions [Opens in a new window]

Summary

Aims - Evaluating socio-demographic characteristics of a sample of 102 schizophrenic patients and their relatives which got in touch with a facility with different psychoeducational treatments. Checking differential characteristics among subsamples according to the engaging to different treatment programs. Longitudinally evaluating both patient's psychosocial course and relative's perception 1 year after the end of such a treatment. Design - Assessment of patients and relatives sociodemographic characteristics, according to engaging in 2 different psychoeducative groups (informative and support) or not engaging (early drop-outs), matching Vs. an external control sample of «no-treated» families. One year follow-up study on patients and relatives both for «objective» and «subjective» conditions. Setting -A private social organization of voluntary psychiatrists, the Association for Research on Schizophrenia in Milan. Main outcome measures - Survey on characteristics of patients and relatives in different stage of treatment collected by standardized records and contrasted with those of comparison groups. Follow-up study by structured questionary. Student's two tailed t tests were used to compare some socio-demographic data. Chi-square analyses were used to compare nominal data. Mc Nemar test is used to follow significative changes. Results - Some preliminar differences in sociodemographic features, between different groups, are to be confirmed by increasing sample while there are interesting evidences for different course and outcome in a group following a particular kind of treatment (informative group) for both patient's objective performance and family subjective well-being. Conclusions - Psychoeducational family treatment shows good prospects for families interested to coping with schizophrenia and which are able to look for information and support. Longitudinal evaluation shows interesting changes in the relationship with public facilities and in the occupational status overall in the informative group. It proves its importance for «acute» schizophrenia, while a supportive treatment retains an usefulness in chronic ilnesses reducing the burden of care.

Keywords

schizophreniapsychosocial family interventiontreatment outcomeschizofreniaintervento psicosociale familiareesito del trattamento
Type
Articoli
Information
Epidemiology and Psychiatric Sciences , Volume 4 , Issue 3 , Settembre-Dicembre 1995 , pp. 212 - 226
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

BIBLIOGRAFIA

Albertini, E., Merati, O., Beltz, J., Bertrando, P. & Clerici, M. (1991). Correlazioni tra profilo EE dei familiari e livello di adesione del paziente alla terapia. Schizofrenia 1, 45–51.Google Scholar
Anderson, C.M., Reiss, D.J. & Hogarty, G.E. (1986). Schizophrenia in the Family: a Practitioner's Guide to Psychoeducation and Management. Guilford Press: New York.Google Scholar
Balint, M. (1957). The Doctor, His Patient and the Illness. Pitman Medical Publishing: London.CrossRefGoogle Scholar
Bebbington, P. & Kuipers, L. (1994). The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychological Medicine 3, 707–718.CrossRefGoogle Scholar
Bernheim, K.F. (1982). Supportive family counseling. Schizophrenia Bulletin 8, 634–640.CrossRefGoogle ScholarPubMed
Bertrando, P., Bressi, C., Merati, O. & Clerici, M. (1988). Interventi sulla famiglia del paziente schizofrenico. Psichiatria e Medicina 2, 9–16.Google Scholar
Bertrando, P., Clerici, M., Bressi, C., Merati, O., Beltz, J. & Cazzullo, C.L. (1989a). Modelli d'intervento psicoeducativi ed informativi in familiari di pazienti schizofrenici. II. Considerazioni sulle caratteristiche e l'efficacia dei programmi. Rivista Sperimentale di Freniatria 113, 734–748.Google Scholar
Bertrando, P., Bressi, C., Clerici, M., Beltz, J., Donatini, L., Cazzullo, C.L., Pagani, C., Brambilla, F., Nahon, L., Cecchini, G., Boi, G.G., Sica, A., Corbosiero, M.L. & Perilli, M.C. (1989b). Terapia familiare sistemica ed emotività espressa nella schizofrenia cronica. Uno studio preliminare. Attraverso lo Specchio 25, 51–62.Google Scholar
Bertrando, P., Steiner, V., Beltz, J., Bressi, C. & Clerici, M. (1990). L'Emotività Espressa negli studi internazionali. Schizofrenia 3, 52–63.Google Scholar
Bertrando, P., Beltz, J., Bressi, C., Clerici, M., Farma, T., Invernizzi, G. & Cazzullo, C.L. (1992). Expressed emotion and schizophrenia in Italy. A study of an urban population. British Journal of Psychiatry 161, 223–229.CrossRefGoogle ScholarPubMed
Birchwood, M., Smith, J. & Cochrane, R. (1992). Specific and nonspecific effects of educational intervention for families living with schizophrenia. A comparison of three methods. British Journal of Psychiatry 160, 806–814.CrossRefGoogle ScholarPubMed
Bollini, P. & Mollica, R.F. (1989). Surviving with the asylum. An overview of the studies on the Italian reform movement. Journal of Nervous and Mental Disease 177, 607–615.CrossRefGoogle ScholarPubMed
Brewin, C.R., Veltro, F., Wing, J.K., MacCarthy, B. & Brugha, T.S. (1990). The assessment of psychiatric disability in the community. A comparison of clinical, staff, and family interviews. British Journal of Psychiatry 157, 671–674.CrossRefGoogle ScholarPubMed
Carrà, G. (1991). Follow-up ad Uno e Due anni nel Trattamento Multimodale di Familiari di Pazienti Schizofrenici. Tesi di Laurea. Università di Milano.Google Scholar
Cazzullo, C.L. & Clerici, M. (1991). Sistema familiare ed emotività espressa. Funzioni riabilitative. In Atti del Congresso: Schizofrenia. Cronicità. Riabilitazione, Taormina 7-10/12, 1989. Formazione Psichiatrica 4, 25–48.Google Scholar
Cazzullo, C.L., Omodeo, G., Clerici, M., Cavallari, G., Zacchetti, L., Da Ponte, C. & Bressi, C. (1985). The meeting group for schizophrenics relatives: its dinamics and operative proposals. In Schizophrenia an Integrative View (ed. Cazzullo, C.L. and Invernizzi, G.), pp. 380–383. John Libbey & C.: London.Google Scholar
Cazzullo, C.L., Bertrando, P., Clerici, M., Bressi, C., Da Ponte, C. & Albertini, E. (1989a). The efficacy of an information group intervention on relatives of schizophrenics. International Journal of Social Psychiatry 35, 313–323.CrossRefGoogle ScholarPubMed
Cazzullo, C.L., Bertrando, P., Bressi, C., Clerici, M. & Maffei, C. (1989b). Schizophrenie et expression emotionnelle familiale: etude d'une population italienne. L'Encephale 15, 1–6.Google Scholar
Clausen, J.A. & Yarrow, M.R. (1955). The impact of mental illness on the family. Journal of Social Issues 11, 3–64.CrossRefGoogle Scholar
Clerici, M., Bertrando, P., Bressi, C., Albertini, E., Donatini, L. & Cazzullo, C.L. (1989). Modelli d'intervento psicoeducativi ed informativi in familiari di pazienti schizofrenici. I. Esperienze ed orientamenti attuali. Rivista Sperimentale di Freniatria 113, 719–733.Google Scholar
Clerici, M., Albertini, E., Bertrando, P., Bressi, C., Doria, S., Merati, O. & Cazzullo, C.L. (1990). Il coinvolgimento dei familiari possibilità e limiti. Schizofrenia 4, 30–41.Google Scholar
Clerici, M., Bertrando, P., Bressi, C. & Cazzullo, C.L. (1991). Qualità della vita e disabilità sociale nella famiglia dello schizofrenico cronico. In Le Psicosi Stabilizzate. Prevenzione. Trattamento Riabilitazione (ed. Bassi, M.), pp. 397–414. Patròn: Bologna.Google Scholar
Clerici, M., Carrà, G., Garavaglia, R., Mencacci, C., Pontiggia, G.F. & Cazzullo, C.L. (1993a). Oltre il modello psicoeducativo: la famiglia del paziente schizofrenico tra management e terapia. In Atti del 1 Congresso Nazionale Società Italiana per la Formazione in Psichiatria, pp. 331–342. Vita e Pensiero: Milano.Google Scholar
Clerici, M., Beltz, J., Bertrando, P. & Cazzullo, C.L. (1993b). Pattern diagnostici familiari e compliance ai trattamenti farmacologici nella schizofrenia. In La Diagnosi in Psichiatria, pp. 65–72. Borla: Roma.Google Scholar
Cooney, P. (1993). The role of carers. In Community Mental Health Care. International Perspectives on Making it Happen (ed. Dean, C. and Freeman, H.), pp. 123–124. Gaskell: London.Google Scholar
Crepet, P. (1990). A transition period in psychiatric care in Italy ten years after the reform. British Journal of Psychiatry 156, 27–36.CrossRefGoogle ScholarPubMed
Daumézon, G. (1978). Istituzione, famiglia, équipe curante: una prospettiva storica. In Istituzione, Famiglia, Équipe Curante. Pratiche e Teorie a Confronto (ed. De Martis, D. e Bezoari, M.), pp. 13–24. Feltrinelli: Milano.Google Scholar
Dean, C. & Foster, A. (1993). Measuring outcome. In Community Mental Health Care. International Perspectives on Making it Happen (ed. Dean, C. and Freeman, H.), pp. 125–127. Gaskell: London.Google Scholar
de Girolamo, G. (1989). Italian psychiatry and reform law: a review of the international literature. International Journal of Social Psychiatry 35, 21–37.CrossRefGoogle Scholar
de Jesus Mari, J. & Streiner, D.L. (1994). An overview of family interventions and relapse on schizophrenia: meta-analysis of research findings. Psychological Medicine 24, 565–578.CrossRefGoogle Scholar
De Martis, D. & Bezoari, M. (1978). Introduzione. In Istituzione, Famiglia, Équipe Curante. Pratiche e Teorie a Confronto (ed. De Martis, D. e Bezoari, M.), pp. 7–11. Feltrinelli: Milano.Google Scholar
De Martis, D. & Petrella, F. (1984). Genitori e figli nell'immaginario delle psicosi croniche. In Realtà e Fantasma nella Relazione Terapeutica (ed. De Martis, D.), pp. 143–153. Il Pensiero Scientifico Editore: Roma.Google Scholar
Faccincani, C., Mignolli, G. & Piatt, S. (1990). Service utilisation, social support and psychiatric status in a cohort of patients with schizophrenic psychoses. A 7 year follow-up study. Schizophrenia Research 3, 139–146.CrossRefGoogle Scholar
Fadden, G., Bebbington, P. & Kuipers, L. (1987). Caring and its burdens. A study of the spouses of depressed patients. British Journal of Psychiatry 151, 660–67.CrossRefGoogle ScholarPubMed
Falloon, I.R.H., Boyd, J.L. & Mc Gill, C.W. (1984). Family Care for Schizophrenia: A Problem-solving Approach to Mental Illness. Guilford Press: New York.Google Scholar
Giannichedda, M.G. (1989). «A normality for us without confinement for them»: Notes on the associations of families of the mentally ill. International Journal of Social Psychiatry 35, 62–70.CrossRefGoogle ScholarPubMed
Glick, I.D. (1992). Medication and family therapy for schizophrenia and mood disorders. Psychopharmacology Bulletin 28, 237–240.Google Scholar
Glick, I.D., Spencer, J.H., Clarkin, J.F., Haas, G.L., Lewis, A.B., Peyser, J., DeMane, N., Good-Ellis, M., Harris, E. & Lestelle, V. (1990). A randomized clinical trial of inpatient family intervention. IV. Follow-up results for subjects with schizophrenia. Schizophrenia Research 3, 187–200.CrossRefGoogle ScholarPubMed
Goldstein, M.J. (1992). Psychosocial strategies for maximizing the effects of psychotropic medication for schizophrenia and mood disorders. Psychopharmacology Bulletin 28, 223–225.Google Scholar
Grad, J. & Sainsbury, P. (1968). The effects that patients have on their families in a community care and a control psychiatric service. A two year follow-up. British Journal of Psychiatry 114, 265–278.CrossRefGoogle Scholar
Hogarty, G.E., Anderson, C.M., Reiss, D.J., Kornbleth, S.J., Greenwald, D.P., Ulrich, R.F. & Carter, M. (1991). Family psychoeducation, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia. II. Two-year effects of a controlled study on relapse and adjustment. Archives of General Psychiatry 48, 340–347.CrossRefGoogle Scholar
Jackson, H.J., Smith, N. & Mc Gregory, P. (1990). Relationship between expressed emotion and family burden in psychiatric disorders: an exploratory study. Acta Psychiatrica Scandinavica 82, 243–49.CrossRefGoogle ScholarPubMed
Jones, K. & Poletti, A. (1984). The mirage of a reform. New Society, 10–11.Google Scholar
Jones, K. & Poletti, A. (1985a). Understanding the Italian experience. British Journal of Psychiatry 146, 341–347.CrossRefGoogle ScholarPubMed
Jones, K. & Poletti, A. (1985b). The Italian transformation of the asylums: a commentary and review. International Journal of Mental Health 14, 195–212.CrossRefGoogle Scholar
Jones, K. & Poletti, A. (1986a). The Italian experience reconsidered. British Journal of Psychiatry 148, 144–150.CrossRefGoogle ScholarPubMed
Jones, K. & Poletti, A. (1986b). The Italian experience in mental health care. Hospital and Community Psychiatry 37, 795–802.Google ScholarPubMed
Kavanagh, D.J. (1992). Recent developments in expressed emotion and schizophrenia. British Journal of Psychiatry 160, 601–620.CrossRefGoogle ScholarPubMed
Keefler, J. & Koretar, E. (1994). Essential elements of a family psychoeducation program in the aftercare of schizophrenia. Journal of Marital and Family Therapy 20, 369–380.CrossRefGoogle Scholar
Kreisman, D.E. & Joy, V.D. (1974). Family response to the illness of a relative: a review of the literature. Schizophrenia Bulletin 10, 34–57.CrossRefGoogle Scholar
Kuipers, L. (1993). Family burden in schizophrenia: implications for services. Social Psychiatry and Psychiatric Epidemiology 28, 207–210.CrossRefGoogle ScholarPubMed
Lam, D.H. (1991). Psychosocial family intervention in schizophrenia: a review of empirical studies. Psychological Medicine 21, 423–441.CrossRefGoogle ScholarPubMed
Leff, J.P. & Vaughn, C.E. (1985). Expressed Emotion in Families. Guilford Press: London-New York.Google Scholar
Leff, J.P., Berkowitz, R. & Shavit Strachan, A. (1989). A trial of family therapy vs. a relatives group for schizophrenia. British Journal of Psychiatry 154, 58–66.CrossRefGoogle Scholar
Lefley, H. & Johnson, D. (ed.) (1990). Families as Allies in the Treatment of the Mentally Ill: New Directions for Mental Health Professionals. American Psychiatric Press: Washington.Google Scholar
Liberman, R.P. (1987). Psychiatric Rehabilitation of Chronic Mental Patients. American Psychiatric Association: Washington.Google Scholar
Mangen, S. (1989). The politics of reform: origins and enactment of the Italian «experience». International Journal of Social Psychiatry 35, 7–20.CrossRefGoogle ScholarPubMed
Martini, P.Cecchini, M., Corlito, G., D'Arco, A. & Nascimbeni, P. (1985). A model of a single comprehensive mental health service for a catchment area: a community alternative to hospitalization. In Focus On The Italian Psychiatric Reform (ed. Perris, C. and Kemali, D.), Acta Psychiatrica Scandinavica, Supplementum No 316, Vol. 71, pp. 95–120.Google Scholar
Martyns-Yellowe, I.S. (1992). The burden of schizophrenia on the family. A study from Nigeria. British Journal of Psychiatry 161, 779–782.CrossRefGoogle Scholar
McFarlane, W.R. (1991). Family Psychoeducational treatment. In Handbook of Family Therapy (ed Gurman, A.S. and Kniskern, D.P.), pp. 363–395. Brunner/Mazel: New York.Google Scholar
Mignolli, G., Faccincani, C. & Piatt, S. (1991). Psychopathology and social performance in a cohort of patients with schizophrenic psychoses. A seven-year follow-up study. In Community-based Psychiatry: Long-term Patterns Of Care in South Verona (ed. Tansella, M.), Psychological Medicine, Monograph Supplementum No 19, pp. 17–26, Cambridge University Press: Cambridge.Google Scholar
Mosher, L. & Burti, L. (1988). Community Mental Health. Principles and Practice. Norton: New York.Google Scholar
Mueser, K.T., Bellack, A.S., Wade, J.H., Sayers, S.L. & Rosenthal, C.K. (1992) An assessment of the educational needs of chronic psychiatric patients and their relatives. British Journal of Psychiatry 160, 806–814.CrossRefGoogle ScholarPubMed
Oldridge, M.L. & Huges, C.T. (1992). Psychological well-being in families with a member suffering from schizophrenia. An investigation into long-standing problems. British Journal of Psychiatry 161, 249–251.CrossRefGoogle ScholarPubMed
Petrella, F., Bezoari, M., Vender, S. & Weiss, G. (1978). Riflessioni su un'esperienza istituzionale con pazienti cronici: crisi dell'equipe e significato della dimissione. In Istituzione, Famiglia, Équipe Curante (ed. De Martis, D. e Bezoari, M.), pp. 51–62. Feltrinelli: Milano.Google Scholar
Randolph, E.T., Eth, S., Glynn, S.M., Paz, G.G., Leong, G.B., Shaner, A.L., Strachan, A., Van Vort, W., Escobar, J. I. & Liberman, R.P. (1994). Behavioural family management in schizophrenia. Outcome of a clinic-based intervention. British Journal of Psychiatry 164, 501–506.CrossRefGoogle ScholarPubMed
Ray, L., Parmanaud, K. & Ajit, A. (1991). Social burden of positive and negative schizophrenia. International Journal of Social Psychiatry 37, 242–250.Google Scholar
Ruggeri, M. & Dall'Agnola, R. (1993). The development and use of the Verona Expectations for Care Scale (VECS) and the Verona Satisfaction Service Scale (VSSS) for measuring expectations and satisfaction with community-based psychiatric services in patients, relatives and professionals. Psychological Medicine 23, 511–523.CrossRefGoogle ScholarPubMed
Schene, A.H., Tessler, R.C. & Gamache, G.M. (1994). Instruments measuring family or caregiver burden in severe mental illness. Social Psychiatry and Psychiatric Epidemiology 29, 228–240.CrossRefGoogle ScholarPubMed
Strayhorn, M.J. (1987). Control group for psychosocial intervention outcome studies. American Journal of Psychiatry 144, 3–9.Google ScholarPubMed
Tansella, M. (1985). Misunderstanding the Italian experience. British Journal of Psychiatry 147, 450–451.CrossRefGoogle Scholar
Tansella, M. (1991). Community care without mental hospitals: ten years' experience. In Community-based Psychiatry: Long-term Patterns of Care in South-Verona (ed. Tansella, M.), Psychological Medicine, Monograph Supplementum No. 19, pp. 47–49. Cambridge University Press: Cambridge.Google Scholar
Tansella, M. (1993). The Research Unit of the Servizio di Psicologia Medica at the Institute of Psychiatry of the University of Verona, 1980-1991. Psychological Medicine 23, 239–247.CrossRefGoogle Scholar
Tansella, M. & Williams, P. (1987). The Italian experience and its implications. Psychological Medicine 17, 283–289.CrossRefGoogle ScholarPubMed
Tansella, M., De Salvia, D. & Williams, P. (1987). The Italian psychiatric reform: some quantitative evidence. Social Psychiatry 22, 37–48.CrossRefGoogle ScholarPubMed
Tarrier, N. (1991). Some aspects of family interventions in schizophrenia. 1: Adherence to interventions programmes. British Journal of Psychiatry 159, 475–480.CrossRefGoogle Scholar
Tarrier, N., Lowson, K. & Barrowclough, C. (1991). Some aspects of family interventions in schizophrenia. 2: Financial considerations. British Journal of Psychiatry 159, 481–484.CrossRefGoogle Scholar
Tarrier, N., Barrowclough, C., Porceddu, K. & Fitzpatrick, E. (1994). The Salford Family Intervention Project: relapse rate of schizophrenia at five and eight years. British Journal of Psychiatry 165, 829–832.CrossRefGoogle Scholar
Thornicroft, G., Bisoffi, G., De Salvia, D. & Tansella, M. (1993). Urban-rural differences in the association between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case register study in Northen Italy. Psychological Medicine 23, 487–496.CrossRefGoogle Scholar
Vaughn, C.E. & Leff, J.P. (1976a). The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry 129, 125–137.CrossRefGoogle ScholarPubMed
Vaughn, C.E. & Leff, J.P. (1976b). The measurement of Expressed Emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology 15, 157–165.CrossRefGoogle ScholarPubMed
Veltro, F. (1993). L'approccio psicosociale alla valutazione dell'esito della schizofrenia. Epidemiologia e Psichiatria Sociale 2, 11–13.CrossRefGoogle Scholar
Veltro, F., Magliano, L., Lobrace, S., Morosini, P. & Maj, M. (1993). Valutazione del carico familiare in un campione di parenti di pazienti con diagnosi di schizofrenia paranoide: risultati preliminari. Epidemiologia e Psichiatria Sociale 2, 35–46.CrossRefGoogle Scholar
World Health Organization (1992): Schizophrenia: Information for Families. World Health Organization: Geneva. Trad. it. Schizofrenia. Informazioni per le Famiglie (a cura di G. Dell'Acqua, D. Vidoni e E. Compiutti). Edizioni Biblioteca dell'Immagine: Pordenone, 1994.Google Scholar
Xiang, M., Ran, M. & Li, S. (1994). A controlled evaluation of psychoeducational family intervention in a rural Chinese community. British Journal of Psychiatry 165, 544–548.CrossRefGoogle Scholar
Xiong, W., Hu, X., Wang, R., Dai, Q., Kleinman, J. & Kleinman, A. (1994). Family based intervention for schizophrenic patients in China. A randomised controlled trial. British Journal of Psychiatry 165, 239–247.CrossRefGoogle Scholar