ARTICULOS ESQUIZOFRENIA.docx

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Qualitative research schizophrenia: Focus groups study of

discrimination experiences of patients and their families (Article)

[Investigacin cualitativa en esquizofrenia. Un estudio con grupos

focales para conocer experiencias de discriminacin de pacientesy familiares]

Gonzlez Torres, M..ac,Arstegui, M.b,Ora, R.b,Bustamante, S.ba Departamento de Neurociencias, Universidad del Pas Vasco, Hospital de Basurto, Bilbao, Spainb Servicio de Psiquiatra, Hospital de Basurto, Bilbao, Spain

c Servicio de Psiquiatra, Hospital de Basurto, Avenida de Montevideo 18, 48013 Bilbao, Spain

View references (16)

AbstractThe stigmatization of mental illness has been the subject of numerous studies in the past years.

Surprisingly these studies tend to address the subject in populations not directly connected toschizophrenia, such as the general public or, say, groups of health professionals or university

students. Social stigmatization generates discrimination against patients, and in some ways also

against their relatives. The following study tries to explore the patients' perception of the

discrimination against them. It also looks into how their families perceive the discrimination, which

eventually expands to afflict them as well. Being parent to a schizophrenic patient is sometimes

enough to provoke an attitude of rejection from society at large. Our study is a qualitative one, the

idea being to explore the meanings people attach to their experiences in the social world.

Specifically, focus groups yield information on the discriminatory experiences of patients and,

separately, their relatives. The participants come from three different contexts: our day hospital, our

outpatient unit, and a local association of mental patients and relatives thereof. The project, stillongoing, is described in full detail, emphasizing methodological aspects such us inclusion criteria,

ways of enrollment, and analysis planning. Areas covered by the group leaders are described and

difficulties rising in the course of the development of the project are pointed out. Finally, first

impressions coming from the preliminary analysis are discussed.

Author keywordsFamilies; Groups; Schizophrenia; Stigma

Indexed keywords

EMTREE medical terms:article; attitude; college student; discrimination learning; group therapy;human; mental disease; mental patient; methodology; parental behavior; population dynamics;

public health; qualitative research; relative; schizophrenia; social aspect; social stigma

ISSN: 15760367 CODEN:ADEPFSource Type: Journal Original language: Spanish

Document Type:Article

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doi: 10.1016/S0140-6736(98)08008-8
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48013 Bilbao, Spain

Copyright 2008 Elsevier B.V., All rights reserved.
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Integral rehabilitation of the schizophrenic patient in Mexico: The

model from the National Institute of Psychiatry Ramon de la

Fuente, Group III (Article)

[La rehabilitacin integral del paciente esquizofrnico en Mxico:El modelo del Instituto Nacional de Psiquiatra Ramn de la

Fuente, Grupo III]

Daz Martnez, L.R.a,Ortega Soto, H.b,Leaos Guerrero, C.b,Rodrguez Verdugo, Ma.S.b,Rascn

Gasca, Ma.L.c,Valencia Collazos, M.c,Gutirrez Lpez, M.D.L.c,Mares Gmez, Ma.E.b,Snchez

Snchez, A.da Departamento de Rehabilitacin, Direccin de Servicios Clnicos, Instituto Nacional de Psiquiatra Ramn de la Fuente

(INPRF), Calz. Mxico-Xochimilco, 101, San Lorenzo Huipulco, Tlalpan, 14370, Mexicob Direccin de Servicios Clnicos, Mexico

c Direccin de Investigacionese Epidemiolgicas y Socialesd Programa para la Rehabilitacin Integral del Paciente esquizofrnico

View additional affiliations

View references (55)

AbstractIn this manuscript we describe results obtained for Group III of the Integral Rehabilitation Program

for Outpatient Schizophrenic Patients (IRPS III) at the National Institute of Psychiatry Ramn de la

Fuente. This program was created for Mexican schizophrenic patients as a refined alternative for

the treatment, rehabilitation and integration to a productive life within society. It is interdisciplinary

and integral in nature; both patients and their relatives are involved in the treatment and

rehabilitation. It includes admission, stabilization of clinical symptoms, and application of strategiesfor rehabilitation for one year (pharmacological treatment, group psychotherapy, labor -vocation

induction therapy, music therapy, psychosocial psychotherapy, occupational therapy, artistic

painting, drawing, and Hata-Yoga workshops, psychoeducational workshops for relatives, group

dynamics therapy with responsible relatives, and unifamilial psychotherapy); there were

assessments at the beginning and at end of the study. Objective: To evaluate the efficacy of an

interdisciplinary and integral program in these patients, with respect to a control group that received

the usual medical-psychiatric treatment. Evaluation was carried out according to: a) Severity of

psychiatric symptoms, b) Treatment compliance, c) Everyday performance, d) Psychosocial

functioning, e) Global activity, f) Home occupational activities, g) Expressed emotion and attribution

of the illness, and h) Patterns of communication and relationship within the family. The goals of thisprogram were to reduce the disabilities and to profit from the conserved functions, as well as to

develop other skills in order to increase the quality of life of patients. Methods: This was a quasi-

experimental pretest-postest prospective study where an experimental group and a control group

were compared. The control group (n = 39) received the usual psychiatric management, while the

experimental group (n=39), participated in addition to this management, in a one-year integral

rehabilitation program at the outpatient service of the institute. The sample was obtained in a non-

probabilistic and sequential way, according to the established inclusion and exclusion criteria.
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Variables: Efficacy was evaluated through: a) Severity of psychiatric symptoms; b) Treatment

compliance; c) Everyday functioning; d) Psychosocial functioning; e) Occupational activities at

home; f) Expressed emotion; g) Patterns of communication and relationship within the family.

Instruments: Composite International Diagnostic Interview (CIDI), Positive and Negative Syndrome

Scale (PANNS), Clinical Interview and File, Everyday Unemployment Scale, Psychosocial

Functioning Scale, Global Assessment Scale, Assessment and Follow-up Questionnaire, PatientLabor Performance Scale, Social Behavior Assessment Schedule (SBAS), Five Minute Speech

Sample (FMSS), Verification of the Performance in Occupational Activities for Schizophrenic

Patients, Extrapyramidal Symptom Scale. Procedures: a) Incorporation of patients and relatives to

the study; b) Stabilization of clinical symptoms; c) Initial assessment; d) Program application; e)

Final assessment. Results: Demographic data: There were 47 subjects in the final sample, 25 in the

experimental group, and 22 controls. There were more males than females in both groups (76% in

the experimental group and 63.6% in controls). Being single was the most frequent marital status

among patients (88% in the experimental group and 91% in controls). Education was slightly higher

in the experimental group, were 40% had a bachelor's degree as opposed to 27.2% in controls.

Treatment compliance: The program had a final efficiency of 64% for the experimental group and56% for controls. Some of the experimental subject's characteristics at the beginning of the program

were related with treatment compliance: age, years of illness history, and number of different

diagnoses. It was determined that 62% of the patients who completed the program were less than

30 years old, and in 80% of the cases the onset of the illness was less than 10 years ago.

Regarding the number of diagnoses per patient, 60% of those who completed the study had one

diagnosis, 40% had two or more. On the contrary, 30% of the patients who abandoned the study

had one diagnosis and 70% had two or more. In other words, almost three fourths of the subsample

that abandoned the Program had more than one diagnosis: 31% had two, 31% had three, and 10%

had four or more. Clinical area: In the clinical area, there were no significant differences between

groups. However, patients in the experimental group had a higher level of clinical adaptation andtreatment compliance. Everyday performance: The everyday performance was improved in patients

from the experimental group, with statistically significant changes in 71.5% of the pretest-postest

evaluated areas, with emphasis on self-care, family and interpersonal relationships, and

remunerated work. In the control group, there was an improvement only in 28.5% of the areas.

Psychosocial functioning: Global and by-area psychosocial functioning showed statistically

significant differences in the experimental group in all functioning areas; there was an improvement

from three to two, the latter number meaning feeling satisfied. This was not the case in the control

group. Behavior at home: In the experimental group, the perception in families was that

occupational behavior at home was improved, according to the final score. Family assessment:

Relatives in the experimental group attributed the problems they had with the patient to personality

characteristics. These problems were diminished at the end of the study, but not in the control

group. When relatives attributed problems to the way of being and attitudes of patients, there was a

decrease of problems from 31.6% to 26.3%. Emotional Expression in relatives from the

experimental group was observed in 79.2% at the beginning of the treatment program, which

decreased to 33.3% at the end of the study, with a significant difference of p


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communication patterns. The patient showed rejection to communication. Relatives blamed

schizophrenia for the lack of communication. At the end of the program, patterns of communication

had importantly improved. Conclusions: Demographic data in our sample are similar to those

described in previous reports for male:female ratio, marital status, and education. Some

characteristics of the patients, in particular age, years from onset of illness, and psychiatric

comorbidity assessed at recruitment were associated with completing or not the program. At theend of the study it was clear the program reached its goals of reducing the patients' disabilities and

profiting of conserved functions: 64% of the patients in the experimental group were more stable in

clinical terms, and treatment compliance was better. Also, everyday performance was notably

improved. In the experimental group there were pretest-postest statistically significant differences in

71.5% of the studied area, especially in self-care and interpersonal relationships. In the control

group there were significant changes only in 28.5% of the areas. One level of improvement was

observed in global and by-area psychosocial functioning in the experimental group, but not in

controls. Patients at the end of the study had switched from a score of three (neutral, unconcerned)

to level two (satisfied with their own functioning). In the control group there were no statistically

significant differences. Emotional expression in relatives in the experimental group significantlydecreased at the end of the study (p


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Instituto Mexicano Psiquiatra

6
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Consenso Nacional de Esquizpfrenia

Ortega SH, Daz-Martnez A (eds.). Universidad Nacional Autnoma de Mxico/Pfizer. En prensa
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