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Psycology » Psychiatry and psychotherapy » Schizophrenia and schizoaffective disorder » Social environment and course of the disease

Culture background

According to the present-day international study, the incidence of schizophrenia in different countries is almost the same, but its course and outcome are different. During a 12-year follow-up study of 90 patients conducted in Mauritius (Murphy, Raman 1971) observed a more favorable outcome than marked Brown et al. (1966) in the United Kingdom. Among patients Mauritian higher proportion of those who were able to leave the hospital and return to a normal lifestyle. According catamnesis, nearly two-thirds of the patients were classified as socially independent (with symptoms of schizophrenia they were absent) compared with only half of British patients. The two-year observation of patients during the International preliminary study of schizophrenia (World Health Organization 1979), data were obtained for comparison of differences. In India, Colombia and Nigeria outcome was better than in other centers. This could not be explained by any differences in the initial registered patient characteristics. There remains the possibility of influence of differences in the selection, for example, it is possible that in these three countries most hospitalized patients with the acute form of the disease than the disease, gradually developing (see: Stevens 1987). A more recent study, which was intended to overcome these objections, also showed that in less developed countries, the disease is more favorable (see: Jablensky 1987; Jablensky et al. 1986).

Life events

As noted earlier (see p.224), some patients experiencing an excessive amount of stressful events during the three weeks preceding the acute symptoms of schizophrenia. This applies not only to the first attack of the disease, but also to relapse (Brown, Birley 1968). Thus, it seems likely that subjects exposed to multiple stressors, the disease will be less favorable.

Social stimulation

In the 1940s and 1950s, clinicians have recognized that schizophrenics living in medical institutions, many of the clinical signs associated with nestimuliruyuschey environment. Wing and Brown (1970; Brown et al. 1966) examined patients in three psychiatric hospitals. One of them is a traditional institution in another pursued an active rehabilitation program, and the third was known progressive health policy and shorten hospitalization. A team of researchers has developed methods for quantifying the social environment of poverty, taking into account factors such as limited contact with the outside world, a small amount of its own property, the lack of creative activities, pessimistic expectations for the waiting staff. As it turns out, there is a close link between environmental scarcity and the three aspects of the clinical status of patients: social withdrawal, blunting of emotional reaction and poverty of speech. Causal significance of these social conditions confirmed the re-examination of the same hospital four years later. During this time, the situation in these hospitals has changed for the better and these changes were accompanied by an improvement of the three aspects of the clinical status of patients. If the conditions sufficiently stimulative hospital environment is often aggravated by the so-called clinical syndrome of emotional impoverishment, then giperstimuliruyuschaya environment can precipitate acute symptoms and lead to relapse. Because the hospital environment factors greatly affect the prognosis, it is logical to assume that similar factors should be of great importance for patients living outside the walls of the clinic.


Table 9.8 Factors predictive of outcome in schizophrenia


Good prognosis

Outbreak

Lack of a brief episode of mental disorders previously expressed affective symptoms of late onset patient is married Good psychosexual adaptation to normal personality disorders Good track record Good social relationships observes the patient, the treatment plan and comply with the recommendations of medical staff


Poor prognosis

Gradual onset

Long episode of mental disorder history Negative symptoms Early onset patient alone, living apart from his wife, a widower, divorced Bad psychosexual identity Pathological adaptation to disease Bad record Social exclusion violates the patient and the treatment plan does not comply with the recommendations of the medical staff

Domesticity

Brown et al. (1958) concluded that at hospital discharge in schizophrenics, returning to their families, the prognosis is usually worse than those who received a special hostel for the mentally ill. In addition, it was found that most recurrences are frequent in families where relatives demonstrate strongly expressed emotions, making criticisms, showing hostility and showing signs of increased emotional experience (Brown et al. 1962). In such families, the risk of recurrence is particularly high in patients who are in contact with their close relatives for more than 35 hours per week. These findings were confirmed and extended as a result of a study on the interaction between the manifestation of emotions in the family and stressful events during the three months prior to relapse (Leff, Vaughn 1981). Onset of the disease was associated with either a high level of emotional display, or with independent stressful event. On the basis of studies using psychophysiological methods (Sturgeon et al. 1984) reported an association between the expression of emotions and a close relative level of autonomic activation in the patient; thus suggested that this activation may be a mediator (pathogenic) link.
Has been suggested (Vaughn, Leff 1976) a relationship between the manifestation of emotions in the family and the patient's response to neuroleptics. Patients spending more than 35 hours per week in contact with relatives, demonstrating the strong emotions, the recurrence rate was 92% for those who did not take antipsychotics, and only 53% for taking such drugs.

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