Claudio Malangone

Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study

Background: To date, only few data are available on how family burden in schizophrenia changes over time. In addition, no study has explored how such factors as coping styles and social support influence burden over time. This paper presents the 1-year follow-up data from the BIOMED I study on family burden and coping strategies in schizophrenia. Methods: A sample of 159 relatives of patients with schizophrenia living in five European countries was followed up prospectively for 1 year with regard to burden and coping strategies, using validated questionnaires. Results: In the sample as a whole, the burden was stable. A reduction of family burden over time was found among relatives who adopted less emotion-focused coping strategies and received more practical support from their social network. In addition, family burden decreased in relation to the improvement of patients social functioning. Conclusions: When relatives of patients with schizophrenia are able to improve their coping strategies, it is possible for burden to be reduced even after several years. This points to the necessity to provide families of chronic psychotic patients with psychoeducational interventions emphasising the adoption of an effective coping style.

The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy

Objective:  (a) To explore burden related to caregiving and support received from professionals and social network in relatives of patients with schizophrenia in Northern, Central and Southern Italy; and (b) to test whether a higher level of family burden is associated with a lower level of professional and social network support.

Family burden and coping strategies in schizophrenia: are key relatives really different to other relatives?

Subjective and objective burden, psychiatric symptoms and coping strategies in a sample of 90 key relatives and other relatives of patients with schizophrenia. living in two European countries, were explored by means of well‐validated questionnaires. The levels of burden on key relatives did not differ significantly from those on other relatives. Moreover, the risk of developing psychiatric symptoms was similar in the two subject groups at both centres. Significant correlations were found between key relatives and other relatives concerning the adoption of emotion‐focused coping strategies. These data contrast with the current belief that family burden in schizophrenia is mainly a burden of key relatives, and they emphasize the need to provide supportive interventions for as many relatives as possible.

Beliefs of Psychiatric Nurses about Schizophrenia: A Comparison with Patients’ Relatives and Psychiatrists

Background: What patients’ relatives and health professionals think about causes, treatments and psychosocial consequences of schizophrenia can influence its detection and outcome. Aims: To compare the beliefs about schizophrenia in 190 nurses, 110 psychiatrists and 709 relatives of patients with this mental disorder, recruited in 30 randomly selected mental health centres. Methods: In each centre, the key-relatives of the first consecutive 25 subjects with schizophrenia, and the nurses and psychiatrists who had been working in the service for at least one year, were asked to complete the Questionnaire on the Opinions about Mental Illness (QO). Results: The factors most frequently mentioned by psychiatrists and nurses among the causes of schizophrenia were heredity, stress and family conflicts, while those most frequently mentioned by relatives were stress, traumas and love breakdown. Nurses had opinions: (a) similar to those expressed by psychiatrists concerning patients’ ability to work equally as other people, and patients’ punishability in case of illegal acts; (b) similar to those expressed by relatives about patients’ unpredictability and political rights; (c) significantly different from the other two samples as concerns recognition of patients’ affective rights. Conclusions: Family psychoeducational interventions and nurses’ training should address not only clinical aspects but also disability and psychosocial consequences of schizophrenia.

Perception of patients' unpredictability and beliefs on the causes and consequences of schizophrenia- a community survey

Abstract.Background:The belief that mental disorders involve a high risk of unpredictable behaviours is a factor which influences negatively the social acceptance of the mentally ill. In this paper, we compare the beliefs about the causes and psychosocial consequences of schizophrenia expressed by 536 respondents who had the firm conviction that patients with schizophrenia are unpredictable and by 457 respondents who firmly believed that they are not.Methods:The survey was conducted in 30 Italian geographic areas, randomly selected taking into account their location and population density. The data were collected by the Questionnaire about Opinions on Mental Illness (QO).Results:Respondents who believed that patients with schizophrenia are unpredictable reported more frequently factors such as use of alcohol and drugs and frequenting bad company as being involved in the development of the disorder. In addition, this group showed more restrictive opinions about patients’ civil and affective rights. Low education was found to be significantly associated with perception of “unpredictability” in schizophrenia.Conclusions:These results suggest the need to: a) inform the general public on the main clinical characteristics of schizophrenia and on the risk of unpredictable behaviours in the acute phases of this mental disorder; b) carry out sensitisation campaigns against discrimination toward people with schizophrenia emphasising successful experiences of social integration.

Prescription of psychotropic drugs to patients with schizophrenia: an Italian national survey

Objectives This study aims to: (a) describe the type and doses of psychotropic drugs received by outpatients with schizophrenia in Italy; (b) explore the relationship between prescription and patients’ clinical conditions, disability and socio-demographic characteristics; and (c) estimate the percentage of patients receiving polypharmacy and antipsychotics within the official recommended ranges.Methods A total of 682 patients with schizophrenia were consecutively recruited in 30 Italian mental health departments, randomly selected taking into account the geographic location and population density of their catchment areas.ResultsOf the sample, 98% were in treatment with neuroleptics, 47% received benzodiazepines, 25% were on anticholinergics, 10% were prescribed antidepressants and 8% were on mood stabilisers. Polypharmacy was found in 29% of the sample. Patients treated with one neuroleptic received this within therapeutic doses in 77% of cases. In patients who received two neuroleptics (24%), the former was prescribed within the official range in 71% of cases and the latter in 46%. Polytherapy was more frequently prescribed in patients treated with typicals (60% versus 34%) and in those who also received benzodiazepines (61% versus 41%) and anticholinergics (44% versus 16%). Patients in treatment with atypicals (45%) were mainly younger and lived in highly populated areas. Depot medications (25%) were more frequently prescribed to patients living in areas of low population density, who were older and who had a lower educational level, a longer duration of illness and milder anxiety/depression symptoms.ConclusionsThe consistent percentage of patients receiving polypharmacy and neuroleptics outside the therapeutic doses highlights the need to promote interventions aimed at increasing a rational use of psychotropic drugs among mental health professionals.

Efficacy of psychoeducational family intervention for bipolar I disorder: A controlled, multicentric, real-world study

BACKGROUND This study assessed the efficacy of the Falloon model of psychoeducational family intervention (PFI), originally developed for schizophrenia management and adapted to bipolar I disorder. The efficacy of the intervention was evaluated in terms of improvement of patients׳ social functioning and reduction of family burden. METHODS This was a multicentre, real-world, controlled, outpatient trial carried out in 11 randomly recruited Italian mental health centres. Enroled patients and key-relatives were consecutively allocated either to receive PFI and Treatment As Usual (TAU) or to a waiting list receiving TAU alone. The efficacy of the intervention was evaluated in terms of improvement in patients׳ social functioning (primary outcome) and reduction of family burden (secondary outcome). RESULTS Of the 137 recruited families, 70 were allocated to the experimental group and 67 to the control group. At the end of the intervention, significant improvements in patients׳ social functioning and in relatives׳ burden were found in the treated group compared to TAU. This effect of the intervention remained also after controlling for several confounding patient׳s socio-demographic and clinical factors. The experimental intervention had an impact also on other outcome measures, such as patients׳ clinical status and personal burden. LIMITATIONS Lack of an active control group. CONCLUSIONS The results of this study clearly show that the psychoeducational family intervention according to the Falloon model is effective in improving the social outcome of patients with bipolar I disorder.

A ‘family affair’? The impact of family psychoeducational interventions on depression

Major depressive disorder is reported to be the most common mental disorder, and one of the leading causes of disability-adjusted life years. It causes high levels of family burden and of expressed emotions. Research interest in family functioning in mental disorders has recently shifted from schizophrenia to unipolar and bipolar affective disorders. However, studies on family burden and on the effect of family psychoeducational interventions on major depression are still very few in number and lack a rigorous methodology, clear outcome measures and adequate follow-ups. Despite this, the few available studies on the efficacy of psychoeducational family intervention in unipolar major depression have had promising results. A comprehensive management of unipolar major depression should include psychoeducational family intervention.

Feasibility of a psychoeducational family intervention for people with bipolar I disorder and their relatives: Results from an Italian real-world multicentre study

BACKGROUND Despite several guidelines recommend the use of psychoeducational family interventions (PFIs) as add-on in the treatment of patients with bipolar I disorder, their implementation on a large scale remains limited. The aim of the present study is to identify obstacles for the feasibility of PFIs in routine care. METHODS This was a multicentre, real-world, controlled, outpatient trial, carried out in 11 randomly recruited Italian mental health centres. Two mental health professionals from each center attended a modular training course on PFI and provided the intervention. Difficulties and benefits experienced by mental health professionals in implementing the intervention were assessed through the Family Intervention Schedule (FIS-R), which was administered six times. RESULTS Sixteen out of the 22 recruited professionals completed the training and administered the PFI to 70 patients with bipolar I disorder and their relatives. The retention rate of families receiving the intervention was 93%. Mental health professionals reported high levels of organizational difficulties, several benefits in their daily clinical work and low levels of intervention-related difficulties. The most important organizational obstacles were related to the need to integrate the intervention with other work responsibilities and to the lack of time to carry out the intervention. These difficulties did not decrease over time. Intervention-related difficulties were rated as less problematic since the first time assessment and tended to improve over time. LIMITATIONS Low number of recruited professionals; use of a not previously validated assessment instrument. CONCLUSIONS PFIs are feasible in routine care for the treatment of patients with bipolar I disorder and their relatives, and main obstacles are related to the organization/structure of mental health centres, and not to the characteristics of the intervention itself.

Causes and psychosocial consequences of schizophrenia: the opinions of Italian population

Summary Objective – Description of opinions on schizophrenia and its psychosocial consequences in a sample of general population. Methods – The study has been carried out in 29 GP units stratified by geographic area and population density of their catchment areas and randomly selected. Each respondent was asked to read a case-vignette describing a patient who met ICD-10 criteria for schizophrenia, and then to fill the Questionnaire on the Opinions about Mental Illness General Populations version (QO-GP). Results – Data on 714 respondents were collected. 21% of the sample identified a case of schizophrenia, 66% of depression/anxiety disorder, and 13% of “nervous breakdown”. Factors most frequently mentioned as causes of detected disorder were stress (72%), heredity (62%), family difficulties and psychological traumas (45%). More pessimistic opinions about psychosocial consequences of schizophrenia were found among respondents with lower educational level and older age. Respondents who referred the case-vignette to schizophrenia reported more pessimistic opinions about psychosocial consequences of detected disorder. Conclusions – The results of this study outline the need to plan educational campaigns on mental illnesses, which take into account the socio-cultural characteristics of the target populations. Declaration of interest : none of the seven authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work, in the last 2 years.