ATTENTION NEEDS OF THE RESPONSIBLE RELATIVE IN CHANGE OF THE SCHIZOPHRENIC PATIENT

Schizophrenia is one of the mental disorders that cause more difficult ies within the family environment, in most cases with a negative effec t on the disorder, as the burden basically falls on the patient himsel f and on those living with him. An important alteration on the family dynamics is observed when there is a member of the family with an shiz ophrenic disorder. Clinical characteristics generate a great number of negative effects such as: difficult family relations which decrease t he quality of life, social isolation that interferes and with home, wo rk and education increase of the existing stress. All these turn into additional anguish for the family and the patient, which result in rel apses, symptom exacerbation, and re-hospitalizations. It is evident th at the family members need help in order to be able to manage these pa tients at home and at the hospital. A long-term integral treatment of the patient is convenient when dealing with such a complex disease as schizophrenia. The family can play a fundamental role in trying to inc rease the global functioning on the patient, his quality of life and h is treatment attachment. To meet these goals, the patient himself, his family, an interdisciplinary team of professionals and a social suppo rting network are needed. This work is part of the study of the family functioning and schizophrenia, which is integrated within the '' Proj ect for the study, treatment and rehabilitation of the schizophrenic p atient '' (13) carried out at the Mexican Institute of Psychiatry. Its objective is to describe through structured and semistructured interv iews, the way in which the relative responsible of the patient replies to the following questions: Is there comorbility in the relative in c harge? Which is the burden of the responsible relative? How does the r elative in charge conceives mental disease? Do relatives receive any k ind of family, social or professional support from an integral service ? Which are the attention needs of the relative in charge of a chronic schizophrenic patient? All these questions were made in order to stra tegically include them in an integral service. The study is descriptiv e, a prospective study of cases where the sample was circumstantial an d not probabilistic. Families were contacted at a third level hospital in the outpatient service. The relative responsible of the schizophre nic patient was always selected on the basis of voluntary cooperation. From 50 relatives evaluated only 36 remained in the study. We obtaine d an approximate rate of 28.0 % of rejection or abandonment either fro m the relative or from the patient. The instruments used were: 1. SEAS (The Patients Behavioral Evaluation Schedule) (second edition) by Pla tt S., Weyman and Hirsch. (30) and Platt. (31). SEAS is an standardize d semistructured instrument. Interviewers confidence was obtained for Mexico; global confidence was significative (Kappa: .78). Otero. R.; R ascon ML: (29) 2. CIDI (The Composite International Diagnostic Intervi ew 1.0 version). This is a totally structured diagnostic interview for the evaluation of the mental disorders according to the definitions a nd criteria of the International Classification of Disorders (ICD-IO), (32), the Diagnostic Criteria of Research and the Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IIIR, 1987). (42). 3. CONENF. (Disease conception) A questionnaire was desi gned ad hoc for the porpuse of evaluating the conception of disease of the relative in charge of the patient. A 4307 internal global Alpha c onsistency of the scale was obtained. The following areas were covered : Disease causality, type of disorder, future perception of the diseas e, social and family perception, type of family cost, support and help perception of the patient and attitudes towards disease. The relation ship of the relative who takes care of the patient, with him, is a fol lows: his mother, 72.2 %, and his father, 27.7 %. Their age was 54.5 y ears with an standard deviation of 13.6. From 30 % of the relatives pr esenting one or more diagnoses, 16.6 presented affective disorders and 11.1 % phobic or somatoform disorders. The relation between psychiatr ic disorders and any other disorder, either physical of emoticnal (cli nically diagnosed) was 13.8 %. As for the family history 39.4 % had fi rst level relatives (parents or brothers), 44.7 % second level relativ es (grandparents, uncles and cousins) and finally, 7.9 % third level r elatives (other relatives) affected by some mental dysfunction. The co st of the illness was reported as follows: emotional 72.2 %, economica l 52.7 %, physical 44.4 %, social 33.3 % and only 19.4 % considered th ere was no cost. As for the cause of the disease, relatives mention mo stly family problems (55.5 %), unfavorable situations (41.6 %), study or working pressures (36.1 %), witchcraft or sorcery (11.1%), which sh ows lack of the necessary information. 94.3 % of the relatives conside r that the cause of the dysfunction is mental disease or schizophrenia , 58.2 % perceive it as a nervous and physical disease and 11.1 % cons ider the mentally ill as bewitched. The results of this study show the need to integrally approach the patient and his family. An informativ e psychoeducational and therapeutic attention model for relatives is p resented for solving the detected needs for the purpose of diminishing relapses and modifying family dynamics caused by the clinical charact eristics of this illness.