Matías Irarrázaval

Schizophrenia: Impact on Family Dynamics

In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.

Objective and subjective burden in relatives of patients with schizophrenia and its influence on care relationships in Chile

This study examined the burden on family members of patients with schizophrenia in a Chilean community. Sixty-five caregivers underwent the Subjective and Objective Family Burden Interview. The results showed moderate to high levels of subjective burden and low levels of support from others in providing care. Burden and containment of disturbed behaviour were correlated with worse relationships between patients and caregivers, with the latter spending less time working outside the home. The assessed sample showed a similar pattern of burden to that of caregivers from developed countries; however, the extent of the burden tended to be higher in Chilean caregivers.

Adherencia a la medicación antipsicótica en pacientes indígenas con esquizofrenia

Introduction. Non-adherence to antipsychotic medication remains a complex problem in the treatment of schizophrenia patients, especially in indigenous population. Objective. The aim of the study was to assess the differences in drug adherence, measured by the attitude towards the antipsychotics among Aymara and Non-Aymara patients with schizophrenia. Method. The sample consisted of patients receiving treatment in the Mental Health Public Services in Bolivia (32.8%), Peru (33.6%) and Chile (33.6%). We used the Drug Attitude Inventory (DAI-10); the Barnes Akathisia Scale (BAS), as a measure of side effects, and the Positive and Negative Syndrome Scale (PANSS) to assess the severity of the disorder. Results. The findings showed that Aymara patients present less adherence than Non-Aymara people; however, these differences were not significant (t = 1.29; p = 0.19). The severity of the disorder, as well as the age, showed a significant association with adherence, revealing that younger patients and with greater symptoms presented a more negative attitude toward the drugs. Discussion and conclusion. The lack of significant differences between the groups responds to three possible reasons: 1. This sample of indigenous patients is integrated on Mental Health Services that offer a clear biomedical approach where drug therapy is the primary treatment. 2. It is possible that these indigenous patients are changing their conception of mental disorder, and 3. A significant number of families have migrated to urban areas. These migratory dynamics have promoted the loss of traditions and customs of the ethnic group, which gradually adopts new and intercultural lifestyles. Professionals should be warned about applying stereotypes regarding the relationship between ethnicity and antipsychotics.

PREVENCIÓN E INTERVENCIONES TEMPRANAS EN SALUD MENTAL: UNA PERSPECTIVA INTERNACIONAL

Las enfermedades mentales son comunes, cronicas y discapacitantes, y representan un problema de salud publica importante en nuestro pais y en todo el mundo. Para las enfermedades mentales mas comunes, disponemos actualmente de intervenciones medicas y psicosociales con eficacia probada. Sin embargo, estas aun son insuficientes, y su disponibilidad no se condice con la alta morbilidad y mortalidad que encontramos para las enfermedades mentales. En respuesta a esto, en los ultimos 15 anos se ha realizado un esfuerzo considerable para desarrollar tecnicas de deteccion temprana, para personas con alto riesgo clinico de desarrollo de enfermedad mental, e intervenciones precoces para prevenir o retrasar la progresion a la enfermedad completa. Un mayor enfasis en la salud mental y la integracion de la atencion a la salud mental en todos los programas de desarrollo pertinentes, fortaleceran el esfuerzo general de desarrollo, asi como garantizara, por primera vez, la atencion sostenida de la inversion y la investigacion al principal contribuyente mundial de la perdida de productividad y carga de enfermedad.

¿Afecta la forma de puntuación la estructura factorial del GHQ-12? Estudio exploratorio en estudiantes iberoamericanos

El objetivo de este estudio fue evaluar si el sistema de puntuacion del Cuestionario de Salud General (GHQ-12) puede alterar la estructura factorial del instrumento. El metodo utilizado considero a 1.972 estudiantes universitarios, correspondientes a 9 paises iberoamericanos. Se realizo un modelamiento con ecuaciones estructurales para 1, 2, y 3 factores latentes. Dentro de cada tipo de estructura se analizo el mecanismo de puntuacion de las preguntas. Los resultados indican que los modelos de 2 y 3 factores presentan mejores indicadores de bondad de ajuste. En relacion a los mecanismos de puntuacion, el procedimiento 0-1-1-1 para los modelos de 2 y 3 factores presenta mejor ajuste. En conclusion, pareciera existir una relacion entre el formato de respuesta y el numero de factores identificados en la estructura del instrumento. El modelo que muestra mejor ajuste entre todos es el de 3 factores con formato 0-1-1-1, sin embargo, el formato 0-1-2-3 tiene indicadores aceptables y mas estables, siendo un mejor formato para modelos bi y tridimensionales.This study aimed to evaluate whether the scoring system of the General Health Questionnaire (GHQ-12) alters the instruments factor structure. The method considered 1,972 university students from nine Ibero American countries. Modeling was performed with structural equations for 1, 2, and 3 latent factors. The mechanism for scoring the questions was analyzed within each type of structure. The results indicate that models with 2 and 3 factors show better goodness-of-fit. In relation to scoring mechanisms, procedure 0-1-1-1 for models with 2 and 3 factors showed the best fit. In conclusion, there appears to be a relationship between the response format and the number of factors identified in the instruments structure. The model with the best fit was 3-factor 0-1-1-1-formatted, but 0-1-2-3 has acceptable and more stable indicators and provides a better format for two- and three-dimensional models.

Does the GHQ-12 scoring system affect its factor structure? An exploratory study of Ibero American students

El objetivo de este estudio fue evaluar si el sistema de puntuacion del Cuestionario de Salud General (GHQ-12) puede alterar la estructura factorial del instrumento. El metodo utilizado considero a 1.972 estudiantes universitarios, correspondientes a 9 paises iberoamericanos. Se realizo un modelamiento con ecuaciones estructurales para 1, 2, y 3 factores latentes. Dentro de cada tipo de estructura se analizo el mecanismo de puntuacion de las preguntas. Los resultados indican que los modelos de 2 y 3 factores presentan mejores indicadores de bondad de ajuste. En relacion a los mecanismos de puntuacion, el procedimiento 0-1-1-1 para los modelos de 2 y 3 factores presenta mejor ajuste. En conclusion, pareciera existir una relacion entre el formato de respuesta y el numero de factores identificados en la estructura del instrumento. El modelo que muestra mejor ajuste entre todos es el de 3 factores con formato 0-1-1-1, sin embargo, el formato 0-1-2-3 tiene indicadores aceptables y mas estables, siendo un mejor formato para modelos bi y tridimensionales.This study aimed to evaluate whether the scoring system of the General Health Questionnaire (GHQ-12) alters the instruments factor structure. The method considered 1,972 university students from nine Ibero American countries. Modeling was performed with structural equations for 1, 2, and 3 latent factors. The mechanism for scoring the questions was analyzed within each type of structure. The results indicate that models with 2 and 3 factors show better goodness-of-fit. In relation to scoring mechanisms, procedure 0-1-1-1 for models with 2 and 3 factors showed the best fit. In conclusion, there appears to be a relationship between the response format and the number of factors identified in the instruments structure. The model with the best fit was 3-factor 0-1-1-1-formatted, but 0-1-2-3 has acceptable and more stable indicators and provides a better format for two- and three-dimensional models.

A forma de pontuação do GHQ-12 afeta o fator de estrutura do instrumento? Estudo exploratório sobre estudantes ibero-americanos

El objetivo de este estudio fue evaluar si el sistema de puntuacion del Cuestionario de Salud General (GHQ-12) puede alterar la estructura factorial del instrumento. El metodo utilizado considero a 1.972 estudiantes universitarios, correspondientes a 9 paises iberoamericanos. Se realizo un modelamiento con ecuaciones estructurales para 1, 2, y 3 factores latentes. Dentro de cada tipo de estructura se analizo el mecanismo de puntuacion de las preguntas. Los resultados indican que los modelos de 2 y 3 factores presentan mejores indicadores de bondad de ajuste. En relacion a los mecanismos de puntuacion, el procedimiento 0-1-1-1 para los modelos de 2 y 3 factores presenta mejor ajuste. En conclusion, pareciera existir una relacion entre el formato de respuesta y el numero de factores identificados en la estructura del instrumento. El modelo que muestra mejor ajuste entre todos es el de 3 factores con formato 0-1-1-1, sin embargo, el formato 0-1-2-3 tiene indicadores aceptables y mas estables, siendo un mejor formato para modelos bi y tridimensionales.This study aimed to evaluate whether the scoring system of the General Health Questionnaire (GHQ-12) alters the instruments factor structure. The method considered 1,972 university students from nine Ibero American countries. Modeling was performed with structural equations for 1, 2, and 3 latent factors. The mechanism for scoring the questions was analyzed within each type of structure. The results indicate that models with 2 and 3 factors show better goodness-of-fit. In relation to scoring mechanisms, procedure 0-1-1-1 for models with 2 and 3 factors showed the best fit. In conclusion, there appears to be a relationship between the response format and the number of factors identified in the instruments structure. The model with the best fit was 3-factor 0-1-1-1-formatted, but 0-1-2-3 has acceptable and more stable indicators and provides a better format for two- and three-dimensional models.