María Luisa Rascón

A psychosocial skills training approach in Mexican out-patients with schizophrenia

BACKGROUND The effectiveness of a psychosocial skills training (PSST) approach applied to chronic out-patients with schizophrenia was examined. We hypothesized that the PSST programme, which included treatment as usual (TAU), PSST and family therapy (FT), would reduce positive and negative symptoms, prevent relapse and rehospitalization, and improve psychosocial functioning (PSF), global functioning and treatment adherence. METHOD Eighty-two patients were randomly assigned to receive either TAU [antipsychotic medication (AP); n=39] or the PSST approach (TAU+PSST+FT; n=43). The two groups were assessed at intake and after completion of 1 year of treatment. RESULTS There were statistically significant differences between the two groups. Patients in the PSST group improved their symptomatology, psychosocial and global functioning (symptoms and psychological, social and occupational functioning), showed lower relapse, rehospitalization and drop-out rates, a higher level of compliance with AP medication, and a high level of therapeutic adherence in comparison with TAU patients, whose symptoms also improved although they showed no improvement in any of the clinical or psychosocial variables. A comparison of the standardized effect sizes showed a medium and a large effect size of PSF and global functioning for the PSST group and a non-effect size for the TAU group. CONCLUSIONS A higher level of effectiveness was demonstrated when combining TAU, PSST and FT in comparison with AP medication alone. The PSST approach should be recommended for clinical practice.

Application in Mexico of psychosocial rehabilitation with schizophrenia patients.

To determine whether evidence-based, psychosocial treatments developed in the United States and England are applicable to Mexican outpatients with schizophrenia, the present study was carried out to evaluate the relative effectiveness of family psycho-education and psychosocial skills training added to customary treatment vs. customary treatment alone. Clinically stable outpatients with schizophrenia participated in a 12-month randomized, controlled trial at the National Institute of Psychiatry in Mexico City. An experimental group (N = 47) received the combination of psychosocial skills training, family psycho-education and customary pharmacotherapy while the comparison group (N = 36) received customary treatment alone. Patients were assessed at baseline and one year after commencement of treatment. Significant differences favoring the group that received psychosocial rehabilitation were found in ratings of adherence to medication, attendance at appointments, symptoms, social functioning, relapse, and re-hospitalization. While some adaptations were made in the psychosocial treatments to resolve cultural differences, the results provide cross-national validation of evidence-based treatments for persons with schizophrenia.

Anorexia nervosa: experiencias familiares sobre el inicio del padecimiento, el tratamiento, la recaída y la remisión

Antecedentes: La anorexia nervosa es un padecimiento de la conducta alimentaria en el que se ha observado que la familia desempena un papel relevante, ya que una grave disfuncion familiar puede ser un factor de riesgo y mantener la sintomatologia. La participacion de la familia en el tratamiento incrementa la posibilidad de exito. La presente investigacion pretende contribuir con un analisis de la forma en la que los propios sujetos que padecen anorexia nervosa y sus padres, conviven con el padecimiento y narran su historia. Material y metodos: Se llevo a cabo un estudio cualitativo y un analisis de narrativa por ejes tematicos de acuerdo al modelo de Kolher Riessman. Los informantes se eligieron de acuerdo a un muestreo teorico no probabilistico y se realizaron entrevistas a profundidad focalizadas. Se eligio a una familia para este reporte. Resultados: La familia analizada estuvo conformada por tres miembros: la madre, el padre y la hija con anorexia nervosa, presentandose conductas excesivamente rigidas que oscilan entre el control y la impulsividad. La paciente funciona como confidente de la madre, en tanto que el padre se muestra rigido y exigente. El tratamiento duro tres anos aproximadamente en impasse ya que la paciente no mostro ninguna evolucion. Discusion: En los cuatro momentos de la evolucion del padecimiento se observo que cada uno de los participantes tenia diferentes puntos de vista. En la bibliografia se menciona la relacion simbiotica de la hija con la madre y la relacion periferica establecida con el padre, en la informacion obtenida en este caso se confirma esa estructura. Conclusiones: Estos hallazgos son un primer paso para conocer las experiencias de cada uno de los integrantes de la familia durante el inicio de la enfermedad, el tratamiento, la recaida y las expectativas que se tienen en cuanto a la remision del padecimiento.