W05-01 Development of aculturally informed therapy for schizophrenia

This speaker will serve as chair ofthis workshop. Background informationabout schizophrenia will be presented, including how cultural variables impactvarious aspects of the illness. Ofparticular interest is the fact that patients from more traditional societiesappear to have a vastly better course of illness (World Health Organization, 1960, 1992). The speaker will present results fromnumerous studies, both from her own research and from colleagues, demonstratingthe possible reasons why patients from these cultures have better prognoses. Main ideas include attributions for thecause/controllability of the illness, use of religion/spirituality, greaterfamily cohesion, and less critical/hostile emotional climate of the family(commonly referred to as Expressed Emotion). Dr. Weisman de Mamani will describe how these studies have shaped a newfamily therapy for schizophrenia, titled Culturally Informed Therapy forSchizophrenia (CIT-S). This new therapyis being pilot tested at the University of Miami and incorporates elements frompreviously-established therapies as well as new, culturally-informedtechniques. CIT-S consists of 15sessions broken into five modules: Family Collectivism, Education, SpiritualCoping, Problem-Solving, and Communication Training. CIT-S is offered in English and in Spanish

The Mediating Effect of Family Cohesion in Reducing Patient Symptoms and Family Distress in a Culturally Informed Family Therapy for Schizophrenia: A Parallel-Process Latent-Growth Model

Objective: Although both patients with schizophrenia and their caregivers report elevated levels of depression, anxiety, and stress (DASS), affective symptoms in patients and family members seldom constitute a primary treatment focus. The present study tested whether a culturally informed family therapy for schizophrenia (CIT-S) outperformed standard family psychoeducation (PSY-ED) not only in decreasing patient schizophrenia symptoms, but also in decreasing individual DASS. Because CIT-S fostered family cohesion throughout treatment, we predicted that increases in family cohesion would mediate treatment effects. Method: Participants included 266 patients and family members nested within 115 families, randomized to the CIT-S or PSY-ED conditions. We specified a series of multilevel latent growth and latent change models to examine direct effects of CIT-S on patient schizophrenia symptoms, individual DASS, and family cohesion over time. Next, we used parallel-process growth models to test the indirect effect of CIT-S on decreasing patient and caregiver psychopathology over time via changes in family cohesion. Results: The CIT-S treatment significantly reduced patient schizophrenia symptoms from baseline to follow-up (γ = −1.72, 95% confidence interval [CI] [−2.83, −0.60]), as well as individual DASS (γ = −4.39, 95% CI [−6.44, −2.34]) from baseline to termination. In line with treatment goals, CIT-S increased family cohesion from baseline to midpoint (γ = 0.93, 95% CI [0.06, 1.80]). The CIT-S-related change in cohesion mediated changes in DASS (γ = −0.87, 95% CI [−1.47, −0.27]), but not patient symptoms. Conclusion: By integrating the family's cultural context into treatment, clinicians may foster family dynamics that enhance treatment outcomes and promote broad improvements in mental health. What is the public health significance of this article? This study found that a culturally informed family therapy for schizophrenia (CIT-S) had a lasting impact on reducing patient symptoms. In addition, by increasing family cohesion, CIT-S decreased patient and caregiver depression, anxiety, and stress. For a family seeking treatment for 1 member with schizophrenia, therapists may enhance patient gains by incorporating relevant cultural variables into treatment

Risk and Protective Factors, Perceptions of Family Environment, Ethnicity, and Schizophrenia Symptoms

The family environment can either play a detrimental or a protective role in symptom severity for people with schizophrenia. The current study examined both patient and caregiver perspectives of the family environment in an ethnically diverse sample of 221 patients with schizophrenia. We hypothesized that environments characterized by high levels of perceived caregiver criticism, low perceived caregiver warmth, and low family cohesion (from both the patient and caregiver perspective) would predict greater symptom severity. As expected, results demonstrated that lower patient ratings of family cohesion and caregiver warmth were associated with greater symptom severity. However, once put into a hierarchical regression analysis, only patient ratings of family cohesion remained significant. Ethnic patterns were also examined and revealed that family cohesion may be particularly protective for ethnic minorities. Study implications are discussed

A Comparison of Psychiatric Symptom Severity in Individuals Assessed in Their Mother Tongue Versus an Acquired Language: A Two-Sample Study of Individuals With Schizophrenia and a Normative Population

Case studies published over 40 years ago suggest that seriously mentally ill patients appear to report more severe psychotic symptoms when assessed in their mother tongue as opposed to a later acquired language. We aimed to test this hypothesis empirically in both a clinical sample of 222 patients with schizophrenia/schizoaffective disorder (Study 1) and a nonclinical sample of 414 undergraduates (Study 2), focusing on positive and disorganized symptoms (clinical and subclinical, respectively), which have been indicated as most influenced by sociocultural factors. In Study 1, participants interviewed in their mother tongue endorsed significantly greater symptom severity than those interviewed in a later-acquired language on the Thought Disturbance subscale of the Brief Psychiatric Rating Scale, but no differences on the Disorganization subscale. In Study 2, participants who were assessed in their mother tongue reported significantly greater Unusual Experiences and Cognitive Disorganization on the Oxford-Liverpool Inventory of Feelings and Experiences than those responding in an acquired language. Results supported the hypothesis that evaluations conducted in an individual's mother tongue reveal greater psychopathology than those conducted in a later acquired language. Clinical implications regarding language use in assessment are discussed

Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: a review of the literature

The aim of this article is to critically review the literature on expressed emotion (EE), communication deviance (CD), and culture in families of patients with schizophrenia. There is growing evidence that EE and CD are highly linked. Yet the two constructs together predict the development of schizophrenia and the associated symptoms better than either construct alone. In this article, the authors review data indicating that both the expression and the levels of high EE and CD vary by ethnicity. It may be especially difficult for family members to communicate coherently and in a less critical manner when focusing on patients' inability to sustain particular cultural norms and values that are endorsed by their family and ethnic background. The authors propose that more attention to the role of culture in EE and CD and greater focus on the proper assessment of these variables would further enhance our understanding of these constructs