Role of Family Pathology....Bhupendra singh

1. ROLE OF FAMILY PATHOLOGY AND SOCIAL SUPPORT IN
RELAPSE AMONG BIPOLAR AFFECTIVE DISORDER AND
SCHIZOPHRENIA 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

2. 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.

3. 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.

4. 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).

5. 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.

6. 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.

7. Aim:-
 To assess the role of family pathology and social support
in relapse in schizophrenia and bipolar affective disorder
patient.

8. 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.

9. 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.

10. 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

11. 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

12. 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)

13. RESULTS

14. 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 11
Education 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 7
Religion 2.418 3 .490
Christian 0 1
Other 5 3

15. 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 7
Occupation House wife 3 5 6.037 4 .196
Domestic
8 8
work
Unemployed 11 6
5000 11 17
Monthly 5001-15000 16 12
income of 2.857 2 .240
the family 15001-25000 3 0
>25000 0 1

16. COMPARISON OF SOCIAL SUPPORT AND
FAMILY PATHOLOGY
Bipolar
Variable Schizophrenia affective qui df P value
disorder
Social Poor 27 13
14.700 1 .000
Support Good 3 17
None 6 22
Family
Average 12 6 18.286 2 .000
Pathology
High 12 2

17. 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

18. DISCUSSION

19. Present study findings shows that person with
schizophrenia is having poor social support
compare to bipolar affective disorder. On the other
side family pathology score is high in families of
person with schizophrenia compared to bipolar
affective disorder patients family. Present study
results found that in the area of social support and
family pathology significant difference was present
in both the groups.

20. Theoretical formulations of the past sixty
years have campaigned the hypothesis that family
interaction contributes significantly to the
etiology of schizophrenia, a position that has
dominated contemporary family therapy even in
the absence of strong empirical confirmation
(Bateson et al.1956, Lidz et.al. 1958 and Wynne et al.
1958).
The possibility that sociogenic modeling of
schizophrenia is not only incorrect but even
harmful to families, and to the relationship
between families and clinicians, has never been
taken seriously, despite its implications for the
practice of family therapy.

21. Singh et al. (2005) found that the patients with
inadequate social support were likely to have more
dysfunctions in various aspects of life. The role of
social support in psychiatric disorder is
controversial as many researchers believed on its
direct role and some others, perceived it to have an
indirect role upon psychiatric illness.
The “so called” buffering hypothesis proposes, that
lack of social support only increases the risk of
subsequent disorder in the face of adversity.

22. In this regard, studies by Alloway et al., (1987), Thoits
(1982), Cohan and Wills (1985), suggested that social
support serves as a protective buffer. On other hand, in
another study by Cohan and Wills (1985), Aneshensel
and Stone (1982), suggests the alternative view of main
effect, that the lack of social support increases the risk of
the disorder.
Part of literature suggests that schizophrenic individuals
have a small circle of supportive people than usual, and
re-hospitalization for the schizophrenics is related to the
size of their social network (Garrison, 1985;
Westermeyer et al., 1981).

23. 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

24. 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

25. CONCLUSION
While our emphasis in treatment and
rehabilitation is getting the psychiatric disorders
itself better, but it is necessary to ameliorate
impeding family processes so that the rehabilitation
process can proceed.

26. Thank
you