Esquizofrenia: ¿Enfermedad crónica? I. Consideraciones teóricas

Resumen

Se revisa el concepto de Esquizofrenia en base a una síntesis de la literatura reciente sobre la evolución a largo plazo de la enfermedad. De acuerdo con el modelo de enfermedad de diátesis-stress, se analizan los indicadores de la vulnerabilidad, la influencia de los acontecimientos vitales, de los stressores psicosociales crónicos, especialmente de la Expresión Emocional familiar, y del mantenimiento con medicación antipsicótica, en el curso de la Esquizofrenia. Se sugiere la existencia de una relación entre la llamada «Esquizofrenia Crónica» y las influencias yatrogénicas.     

Esquizofrenia: ¿Enfermedad crónica? II. Implicaciones prácticas

Resumen

Se revisan las intervenciones terapéuticas en la Esquizofrenia, considerándola como una afección en la que diversidad de componentes congénitos y adquiridos conducen a una personalidad premórbida vulnerable, con una estructura poco clara de sistemas internalizados de referencia y enfrentamiento, con mecanismos distorsionados de procesamiento de la información y con una aumentada tendencia a las reacciones psicóticas frente al stress. Se considera esencial suministrar la mayor claridad, simplicidad y continuidad en todas las medidas terapéuticas con el paciente; crear una actitud cooperadora y no culpabilizadora con las familias, como principales cuidadores del esquizofrénico, y reducir la vulnerabilidad del paciente mediante la medicación psicotrópica, el aprendizaje social y el soporte social.     

Looking into the One‐way Mirror: A Pilot Study on the Impact of Reflecting Teams on Family Members

Reflecting Teams (RTs) are an internationally recognized clinical consultation methodology, first developed by Tom Andersen in 1985. Over the last three decades, family therapists around the world have used RTs to enhance treatment. However, this innovation to family therapy practice is not well‐standardized nor evaluated. The pilot study described in this article is an attempt to expand on the previous studies on RTs, and quantitatively examines RTs conducted with family therapy participants at a university medical center psychiatric institute. Preliminary analyses indicate that after participating in a single RT, family members may feel more hopeful, believe they can better support each other in times of stress, have more confidence in working together, and resolve conflicts. Additionally, the analyses suggest that family members may feel better understood and have more ideas about how to have a conversation with their family members, even though, after the RT, they may not view their family differently. These preliminary results suggest that further studies should explore the influence of RTs on family functioning.     

Role of psychosocial risk factors in predicting maternal and paternal depressive symptomatology during pregnancy

The aim of the present study was to investigate the role of several psychosocial risk factors in predicting depressive symptomatology during pregnancy in mothers and fathers, respectively. A total of 146 primiparous mothers and 105 primiparous fathers reporting a psychosocial risk condition were recruited independently from maternity and child health services, during the second trimester of pregnancy. All parents were evaluated for depressive symptomatology, anxiety, and perceived social support. Two hierarchical multiple regression analyses were performed to determine the role of psychosocial factors in predicting depressive symptomatology during pregnancy, in mothers and fathers. Marital dissatisfaction, personal history of depression, and personal trait anxiety were identified as significant predictors of depressive symptomatology during pregnancy, both in mothers and in fathers. Family history of substance abuse, conflictual relationship with the parents in the past year, and bereavement in the past year were identified as significant factors contributing to elevated depressive symptoms during pregnancy in mothers, but not fathers. In this study, several psychosocial risk factors were consistently related to an increase in maternal and paternal depressive symptoms during pregnancy; some of these factors seem to be specifically related to maternal depressive mood.     

Systematic Review of Self‐Report Family Assessment Measures

A systematic review of self‐report family assessment measures was conducted with reference to their psychometric properties, clinical utility and theoretical underpinnings. Eight instruments were reviewed: The McMaster Family Assessment Device (FAD); Circumplex Model Family Adaptability and Cohesion Evaluation Scales (FACES); Beavers Systems Model Self‐Report Family Inventory (SFI); Family Assessment Measure III (FAM III); Family Environment Scale (FES); Family Relations Scale (FRS); and Systemic Therapy Inventory of Change (STIC); and the Systemic Clinical Outcome Routine Evaluation (SCORE). Results indicated that five family assessment measures are suitable for clinical use (FAD, FACES‐IV, SFI, FAM III, SCORE), two are not (FES, FRS), and one is a new system currently under‐going validation (STIC).