Caregiver Criticism, Help-giving and the Burden of Schizophrenia Among Mexican American Families

Objectives—The present study tested an attribution model of help-giving in family caregivers of persons with schizophrenia as it relates to caregivers’ reported burden. We hypothesized (a) that caregivers’ attributions of their ill relatives’ responsibility for their symptoms would be associated with more negative and less positive affective reactions, (b) that affective reactions would be related to perceptions of administered support, and (c) that support would in turn predict greater burden. Methods—We examined 60 family caregivers of Mexican origin living in Southern California. Mexican Americans were chosen because of their high degree of contact with their ill relative thereby facilitating the examination of help-giving and burden. Contrary to past studies, caregivers’ attributions and affective stance were assessed independently, the former based on self-report and the latter based on codes drawn from the Camberwell Family Interview. Caregiver burden was assessed at baseline and one year later. Results—Path analyses showed partial support for the attribution model of help-giving. Specifically, attributions of responsibility negatively predicted caregiver’s warmth, which in turn predicted more administered support. Contrary to hypotheses, attributions were not associated with caregiver criticism, and criticism was positively related to administered support. In addition, caregiver support was not related to burden at either baseline or a year later. Criticism was a significant predictor of burden at follow-up through burden at baseline. Conclusion—The emotional stance of caregivers predicts burden independent of the help they provide. Caregiver criticism not only predicts negative patient outcomes but can predict negative caregiver outcomes as well

The duration of untreated psychosis among U.S. Latinxs and social and clinical correlates

PurposeThis study (a) documents the duration of untreated psychosis (DUP) and (b) examines both social and clinical correlates of DUP in a sample of U.S. Latinxs with first-episode psychosis (FEP).MethodsData were collected for a longitudinal study evaluating a community education campaign to help primarily Spanish-speaking Latinxs recognize psychotic symptoms and reduce the DUP, or the delay to first prescribed antipsychotic medication after the onset of psychotic symptoms. Social and clinical variables were assessed at first treatment presentation. A sequential hierarchical regression was conducted using √DUP to identify independent predictors of the DUP. A structural equation model was used to explore the association between DUP predictors, DUP, and clinical and social correlates.ResultsIn a sample of 122 Latinxs with FEP, the median DUP was 39 weeks (M = 137.78, SD = 220.31; IQR = 160.39–5.57). For the full sample, being an immigrant and having self-reported relatively poor English-speaking proficiency and self-reported strong Spanish-speaking proficiency were related to a longer delay to first prescribed medication after psychosis onset. For the immigrant subgroup, being older at the time of migration was related to a longer delay. Self-reported English-speaking proficiency emerged as an independent predictor of the DUP. Although the DUP was not related to symptomatology, it was associated with poorer social functioning. Low self-reported English-speaking ability is associated with poorer social functioning via the DUP.ConclusionLatinxs with limited English language skills are especially at high risk for experiencing prolonged delays to care and poor social functioning. Intervention efforts to reduce the delay in Latinx communities should pay particular attention to this subgroup

Reminder-Focused Positive Psychiatry: Suicide Prevention Among Youths With Comorbid Posttraumatic Stress Disorder and Suicidality.

ObjectiveThis study aimed to investigate the effect of brief reminder-focused positive psychiatry and suicide prevention (RFPP-S) on suicidal ideation, posttraumatic stress disorder (PTSD) symptoms, and clinical outcomes among youths with PTSD treated in psychiatric emergency rooms.MethodsThis study included youths with PTSD and suicidality who received either RFPP-S (N=50) or treatment as usual (N=150). The Columbia Suicide Severity Rating Scale (C-SSRS), Clinician-Administered PTSD Scale for children and adolescents, University of California, Los Angeles Trauma Reminder Inventory, Patient Health Questionnaire-9, Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment Scale, and positive psychiatry test batteries were administered at baseline, on day 2, and 1 week and 1 month after discharge.ResultsOn day 2, the RFPP-S group showed a greater reduction in PTSD symptoms (55%) and reactivity to trauma and loss reminders (80%) compared with the control group (10% for both) (p=0.001). A significantly greater reduction in C-SSRS score for RFPP-S (80%), compared with treatment as usual (15%), was noted (p=0.001), and RFPP-S showed more rapid stabilization (mean±SD=2.0±0.5 days) and enhanced postdischarge follow-up (100%) compared with treatment as usual (5.0±2.0 days and 50%, respectively) (p<0.05). RFPP-S, but not treatment as usual, was associated with significant increases in well-being, flexible thinking, and coping skills (p<0.05). Hospital readmission due to suicidality 1 month after discharge was 0% for the RFPP-S group and 20% for the control group.ConclusionsRFPP-S was associated with reduced PTSD symptoms, enhanced coping skills while experiencing trauma reminders, adoption of safety skills, rapid stabilization of acute crises of PTSD with suicidality, adherence to post-emergency room visits and treatment, and favorable clinical outcomes

Psychiatric rehabilitation for schizophrenia

La esquizofrenia es un trastorno neurobiológico relacionado con el estrés, que se caracteriza por alteraciones en la forma y el contenido del pensamiento y los procesos perceptivos del individuo, afectando sus conductas social e instrumental. El impacto penetrante de la esquizofrenia sobre los campos perceptivo, cognitivo, emocional y de conducta, al igual que la heterogeneidad dentro de estos ámbitos requiere un abordaje multimodal y comprehensivo en el tratamiento y la rehabilitación que involucre al individuo y su medio ambiente. Lo preferible es que los tipos de intervención utilizados para tratar y rehabilitar a las personas con esquizofrenia se guien por un modelo multidimensional e interactivo que incluya al estrés, a la vulnerabilidad y a los factores protectores. La significación práctica del modelo estrés-vulnerabilidad-factores protectores de la esquizofrenia está en la guia que ofrece a los clínicos. Los medicamentos amortiguan la vulnerabilidad psicobiológica y el trastorno bioquímico subyacente; el entrenamiento en la resolución de problemas y en habilidades sociales y de vida independiente promueve el desarrollo de la competencia personal y, de esa manera, fortalece la protección del individuo contra el estrés y la vulnerabilidad; los servicios de sostén (p. ej.: el manejo de caso, la vivienda, los derechos a servicios sociales, el empleo protegido) compensan los síntomas residuales y los déficits en el funcionamiento independiente. Se ha documentado que un tratamiento de abordaje integrado que incluya la detección y el tratamiento precoces de los síntomas esquizofrénicos, la colaboración entre pacientes y cuidadores en el manejo del tratamiento, los soportes familiar y social y el entrenamiento en habilidades sociales e instrumentales mejoran el curso y el pronóstico de la esquizofrenia, en cuanto a la recurrencia de síntomas, el funcionamiento social y la calidad de vida

Psychiatric rehabilitation for schizophrenia

La esquizofrenia es un trastorno neurobiológico relacionado con el estrés, que se caracteriza por alteraciones en la forma y el contenido del pensamiento y los procesos perceptivos del individuo, afectando sus conductas social e instrumental. El impacto penetrante de la esquizofrenia sobre los campos perceptivo, cognitivo, emocional y de conducta, al igual que la heterogeneidad dentro de estos ámbitos requiere un abordaje multimodal y comprehensivo en el tratamiento y la rehabilitación que involucre al individuo y su medio ambiente. Lo preferible es que los tipos de intervención utilizados para tratar y rehabilitar a las personas con esquizofrenia se guien por un modelo multidimensional e interactivo que incluya al estrés, a la vulnerabilidad y a los factores protectores. La significación práctica del modelo estrés-vulnerabilidad-factores protectores de la esquizofrenia está en la guia que ofrece a los clínicos. Los medicamentos amortiguan la vulnerabilidad psicobiológica y el trastorno bioquímico subyacente; el entrenamiento en la resolución de problemas y en habilidades sociales y de vida independiente promueve el desarrollo de la competencia personal y, de esa manera, fortalece la protección del individuo contra el estrés y la vulnerabilidad; los servicios de sostén (p. ej.: el manejo de caso, la vivienda, los derechos a servicios sociales, el empleo protegido) compensan los síntomas residuales y los déficits en el funcionamiento independiente. Se ha documentado que un tratamiento de abordaje integrado que incluya la detección y el tratamiento precoces de los síntomas esquizofrénicos, la colaboración entre pacientes y cuidadores en el manejo del tratamiento, los soportes familiar y social y el entrenamiento en habilidades sociales e instrumentales mejoran el curso y el pronóstico de la esquizofrenia, en cuanto a la recurrencia de síntomas, el funcionamiento social y la calidad de vida

Perceptions of efficacy, expressed emotion, and the course of schizophrenia: the case of emotional overinvolvement.

Although it is clear that expressed emotion (EE) is associated with the course of schizophrenia, proposed models for this association have struggled to account for the relationship between the EE index of emotional overinvolvement (EOI) and relapse. To expand our understanding of the EOI-relapse association, we first attempted to replicate the finding that the EOI-relapse association is curvilinear among 55 Mexican-Americans with schizophrenia and their caregiving relatives. Second, we evaluated whether the caregivers perception of their ill relatives efficacy may account for the EOI-relapse association. Our results comport with past findings with regard to the curvilinear nature of the EOI-relapse association among Mexican-Americans and suggest that EOI may only seem to be a risk factor of relapse because of its strong association with a true risk factor for relapse (i.e., caregivers perception of their ill relatives efficacy)

Recent Advances in Social Skills Training for Schizophrenia

Social skills training consists of learning activities utilizing behavioral techniques that enable persons with schizophrenia and other disabling mental disorders to acquire interpersonal disease management and independent living skills for improved functioning in their communities. A large and growing body of research supports the efficacy and effectiveness of social skills training for schizophrenia. When the type and frequency of training is linked to the phase of the disorder, patients can learn and retain a wide variety of social and independent living skills. Generalization of the skills for use in everyday life occurs when patients are provided with opportunities, encouragement, and reinforcement for practicing the skills in relevant situations. Recent advances in skills training include special adaptations and applications for improved generalization of training into the community, short-term stays in psychiatric inpatient units, dually diagnosed substance abusing mentally ill, minority groups, amplifying supported employment, treatment refractory schizophrenia, older adults, overcoming cognitive deficits, and negative symptoms as well as the inclusion of social skills training as part of multidimensional treatment and rehabilitation programs

Perceptions of efficacy, expressed emotion, and the course of schizophrenia: the case of emotional overinvolvement.

Although it is clear that expressed emotion (EE) is associated with the course of schizophrenia, proposed models for this association have struggled to account for the relationship between the EE index of emotional overinvolvement (EOI) and relapse. To expand our understanding of the EOI-relapse association, we first attempted to replicate the finding that the EOI-relapse association is curvilinear among 55 Mexican-Americans with schizophrenia and their caregiving relatives. Second, we evaluated whether the caregivers' perception of their ill relative's efficacy may account for the EOI-relapse association. Our results comport with past findings with regard to the curvilinear nature of the EOI-relapse association among Mexican-Americans and suggest that EOI may only seem to be a risk factor of relapse because of its strong association with a true risk factor for relapse (i.e., caregivers' perception of their ill relative's efficacy)