ROLE OF FAMILY PATHOLOGY AND SOCIAL SUPPORT INRELAPSE AMONG BIPOLAR AFFECTIVE DISORDER ANDSCHIZOPHRENIA PATIENTS Bhupendra Singh Ph. D. Scholar Shahid Eqbal Ph. D. Scholar Prof. (Dr.) Amool R. Singh, Director Dr. Manisha Kiran Assistant Professor Ranchi Institute of Neuro Psychiatry and Allied Sciences
BACKGROUND Worldwide, there have been major changes in the delivery of mental health services over the past 25 years. Practice has shifted from an institutional model of care where treatment was centered on the individual and minimal consideration was given to the family and/or significant others (social support and expressed emotion). Despite that centrally, the views and experiences of family on the utility of the present classification system have been little studied.
CONT…… The term “social support” is often used in a broad sense, including social integration. However, Social integration refers to the structure and quantity of social relationships, such as the size and density of networks and the frequency of interaction, but also sometimes to the subjective perception of embeddedness. Social support, in contrast, refers to the function and quality of social relationships, such as perceived availability of help or support actually received. It occurs through an interactive process and can be related to altruism, a sense of obligation, and the perception of reciprocity.
CONT…… The major theoretical perspectives linking family interactions of certain kind with the predisposition to schizophrenia were proposed almost six decades ago by Bateson et al. (1956), Lidz et.al. (1958) and Wynne et al. (1958). These involved skewed relationship between Parents, schizm in the way the parents relate to the children, erotocised parent- child relationships, double-bind, amorphous as well as fragmented nature of communication. Many studies were carried out to examine these hypotheses and these have been reviewed by Jacob (1975) and Goldstein and Rodnick (1975).
CONT…… Family systems have been highly influential in the study of recurrent psychiatric disorders. This study will examine the role of family pathology and social support and its effect on relapses of schizophrenia or bipolar disorder.
CONT…… Recent family studies of schizophrenia which address the question of etiology are reviewed. The majority of these studies continue to focus on two major aspects of family life, deviant role relationships and disordered communication processes among family members. By and large, the research on role relationships has not gone beyond demonstrating that correlations exist between these family variables and the occurrence of schizophrenia in an offspring. By contrast, recent research on disordered communication has begun to employ methodologies appropriate to testing the direction of the relationship between these family interaction patterns and schizophrenia.
Aim:- To assess the role of family pathology and social support in relapse in schizophrenia and bipolar affective disorder patient.
OBJECTIVE: To find out the role of family pathology in relapse in the schizophrenia and bipolar affective disorder patient To find out the role of social support in relapse in the schizophrenia and bipolar affective disorder patient To see the difference of family pathology and social support in relapse in the schizophrenia and bipolar affective disorder patient To see relationship between family pathology and social support.
METHOD In the present study total 60 (30 Bipolar Affective Disorders and 30 Schizophrenia) relapsed patients, from RINPAS OPD were selected on the basis of purposive sampling technique.
INCLUSION CRITERIA: Patients and Parents Both should be available Patients with diagnosis of schizophrenia or Bipolar Affective Disorder Age between 18 to 60 year Must have past episode(s) Who had given informed consent
EXCLUSION CRITERIA: Patients who’s parents have not come along with patients for follow-up Any other first degree family member having present or past history of psychiatric disorder Any psychiatric or Physical co-morbidity in parents
TOOLS: Semi structured Socio Demographic Data Sheet GHQ- 12(Goldberg & Hiller, 1979) Family Pathology Scale (Vimala Veeraraghavan and Archna Dogra; 2000) Social Support Questionnaire ( Nehra et. al., 1995)
SOCIO-DEMOGRAPHIC INFORMATION Bipolar Schizophre Variable Affective X2 df P value nia Disorder Up to 20 2 3 21-40 21 23 Age 1.691 3 .639 41-60 6 4 >60 1 0 Male 27 25 Sex .577 1 .448 Female 3 5 Illiterate 6 4 Primary 7 11Education Inter 12 13 2.996 4 .559 Graduate 4 2 Above 1 0 Marital Married 18 21 .659 1 .417 status Unmarried 12 9 Hindu 21 19 Muslim 4 7Religion 2.418 3 .490 Christian 0 1 Other 5 3
Socio-Demographic Information Bipolar Affective Variable Schizophrenia X2 df P value Disorder Urban 7 8 Domicile Semi-Urban 1 1 .090 2 .956 Rural 22 21 Type of Joint 28 26 .741 1 .389 family Nuclear 2 4 Service 0 4 Agriculture 8 7Occupation House wife 3 5 6.037 4 .196 Domestic 8 8 work Unemployed 11 6 5000 11 17 Monthly 5001-15000 16 12income of 2.857 2 .240the family 15001-25000 3 0 >25000 0 1
COMPARISON OF SOCIAL SUPPORT ANDFAMILY PATHOLOGY Bipolar Variable Schizophrenia affective qui df P value disorder Social Poor 27 13 14.700 1 .000Support Good 3 17 None 6 22 Family Average 12 6 18.286 2 .000Pathology High 12 2
CORRELATION BETWEEN SOCIAL SUPPORT,FAMILY PATHOLOGY AND DIAGNOSIS social support Family Pathology diagnosis social support 1 .849** .377**Family Pathology .849** 1 .295* diagnosis .377** .295* 1**. Correlation is significant at the 0.01 level *. Correlation is significant at the 0.05 level
Present study findings shows that person withschizophrenia is having poor social supportcompare to bipolar affective disorder. On the otherside family pathology score is high in families ofperson with schizophrenia compared to bipolaraffective disorder patients family. Present studyresults found that in the area of social support andfamily pathology significant difference was presentin both the groups.
Theoretical formulations of the past sixtyyears have campaigned the hypothesis that familyinteraction contributes significantly to theetiology of schizophrenia, a position that hasdominated contemporary family therapy even inthe absence of strong empirical confirmation(Bateson et al.1956, Lidz et.al. 1958 and Wynne et al.1958). The possibility that sociogenic modeling ofschizophrenia is not only incorrect but evenharmful to families, and to the relationshipbetween families and clinicians, has never beentaken seriously, despite its implications for thepractice of family therapy.
Singh et al. (2005) found that the patients withinadequate social support were likely to have moredysfunctions in various aspects of life. The role ofsocial support in psychiatric disorder iscontroversial as many researchers believed on itsdirect role and some others, perceived it to have anindirect role upon psychiatric illness.The “so called” buffering hypothesis proposes, thatlack of social support only increases the risk ofsubsequent disorder in the face of adversity.
In this regard, studies by Alloway et al., (1987), Thoits(1982), Cohan and Wills (1985), suggested that socialsupport serves as a protective buffer. On other hand, inanother study by Cohan and Wills (1985), Aneshenseland Stone (1982), suggests the alternative view of maineffect, that the lack of social support increases the risk ofthe disorder.Part of literature suggests that schizophrenic individualshave a small circle of supportive people than usual, andre-hospitalization for the schizophrenics is related to thesize of their social network (Garrison, 1985;Westermeyer et al., 1981).
LIMITATION Sample size was small, and since purposive sampling technique was used for sample recruitment result can not be generalized. Other diagnosis were not included Various domains of patient functioning were not assessed Quality of life of patients and family members were not studied. Expressed Emotion was not assessed
CLINICAL IMPLICATION As present study result shows that relapse in schizophrenia and affective disorder is associated with family pathology, so family should be educated about illness and factor which will lead to relapse. PSWs should be involved for in-depth assessment of patient families to explore and handle family pathology. Psycho-social intervention in both disorder should focus on enhancing patient primary and secondary support in order to minimize the possibility of relapse
CONCLUSION While our emphasis in treatment andrehabilitation is getting the psychiatric disordersitself better, but it is necessary to ameliorateimpeding family processes so that the rehabilitationprocess can proceed.