Some aspects of family interventions in schizophrenia. II: Financial considerations

Article Abstract:

The economic implications of any new treatment are under scrutiny more than ever, even when the treatment is proven useful. The economic aspects of adding family intervention to a standard treatment program for schizophrenics are described. It was hypothesized that the extra costs for such a program would be offset by savings realized by the reduced usage of other facilities and a reduced rate of relapse. Four treatment groups were formed from a pool of 73 schizophrenics and their families. The groups were defined on the assessment of expressed emotion (EE) apparent in the family on interview. In two groups, which included families rated as high on expressed emotion (HEE), a nine-month family intervention program was offered to reduce expressed emotion in the family. Research has shown that high familial EE is associated with poor outcome in schizophrenics. The third group, also consisting of HEE families, received a short educational program consisting of two sessions, and the fourth HEE group, the controls, received only routine care. Patients whose families rated as low in expressed emotion (LEE) were assigned to one of the latter two groups. All contacts with mental health services were recorded for the patients for the duration of the study and the related costs were calculated. Over the nine-month period, there were no significant differences in the costs of maintaining the HEE patients who received the nine-month intervention as compared to the LEE patients. When comparing the HEE nine-month intervention group with the HEE control group, a significant cost savings was evident in the former. The savings was about 27 percent per patient over the nine months, totalling an overall 37 percent financial benefit. It is clear, therefore, that despite the costs associated with the implementation and maintenance of the family intervention, costs over the long-term were reduced. The costs were therefore outweighed by the benefits. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Some aspects of family interventions in schizophrenia. I: Adherence to intervention programmes

Article Abstract:

Although treatment failures are important to the further definition and development of successful treatment strategies, they are rarely reported in the literature. Treatment failures can be classified into four groups: patient refusal, treatment drop-outs, treatment nonresponders, and those who relapse into illness. Treatment adherence problems (i.e., treatment drop-outs and refusal to participate in treatment) in family management programs for the treatment of families of schizophrenic patients are discussed. Research has shown that family involvement in the treatment of schizophrenics significantly reduces relapse when used in combination with medication. Unfortunately, however, families often lack the enthusiasm to participate in family interventions. Many of those who do not refuse to participate outright drop out of treatment prematurely. By studying treatment failures, psychologists have used a cost-benefit analysis model to describe the decision-making that leads to treatment noncompliance. Factors such as the family's perceived susceptibility to the illness (or perceived likelihood of relapse, in this case), the perceived effectiveness of the intervention, and the perceived costs, including psychological, physical, and economic costs, have been identified as central. These must all be interpreted in the context of characteristics of the client, characteristics of the treatment regimen, features of the disease, the relationship between the health care provider and the client (or family), and the clinical setting. The determinants of adherence in individual families needs to be assessed and methods to maximize adherence need to be designed. Given the success of treating schizophrenics when family intervention is included, the problem of the family's adherence to treatment cannot be ignored. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Morbid jealousy: a review and cognitive-behavioural formulation

Article Abstract:

While jealousy may affect everyone to some degree, extreme, or morbid jealousy may be considered a psychiatric disorder, as it can produce destructive effects, including violence. Because jealousy is so common an emotion, the term is difficult to classify as normal or morbid. In this review of the concept, morbid jealousy is defined according to its primary and secondary characteristics, and an attempt is made to place the disorder within a cognitive-behavioral framework. A core concept of morbid jealousy is an unfounded preoccupation with the partner's infidelity based upon belief or suspicion. Further, jealousy is characterized by intrusive, almost obsessional thoughts; behavior geared toward confirmation of the suspicions; avoidance of jealousy-provoking situations; depression or personal distress; and possible violence and aggression stemming from arguments and accusations. Morbidly jealous persons typically have low self-esteem, feelings of insecurity, and poor self-image. To account for these manifestations, the cognitive-behavioral model would propose that the morbidly jealous person has a tendency to make systematic perceptual errors and inaccurately interpret events and information. The individual's underlying assumptions about relationships and human behavior are then activated by some event, leading to an ongoing misinterpretation although the original event has passed. The faulty information processing results in secondary responses, such as avoidance behavior at one extreme, and violence at the other. The authors claim that the cognitive-behavioral approach for interpreting morbid jealousy might be useful for developing treatment strategies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Methods, Models, Identification and classification, Self-esteem, Self esteem, Cognitive therapy, Jealousy

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