Schizophrenia

The aims of schizophrenia treatment are to reduce the severity and frequency of active episodes and to maximize healthy functioning between episodes (American Psychiatric Association 1997). Medications that reduce psychotic symptoms have been available since the 1950s and have contributed substantially to the deinstitutionalization of schizophrenia patients over the last half-century. Unfortunately, the medications do not provide a cure and have unpleasant side effects that, along with denial of illness, homelessness, cultural beliefs, and the stigma associated with the diagnosis, can reduce treatment compliance. Enhancement of medication treatment compliance is often a goal of psychosocial treatment. Psychosocial treatment is also intended to enhance occupational and social functioning by providing ongoing outpatient care following hospitalization that emphasizes vocational and social skills training.

When family members participate in programs combining education about the illness with training in problem solving skills, family support, and crisis intervention, relapse rates for schizophrenia patients are significantly reduced (Lauriello, Bustillo, and Keith 1999). Several studies support the role of specific relational influences on the risk for recurrence of active schizophrenia symptoms. Expressed emotion refers to the level of criticism, emotional overinvolvement, and hostility held about a psychiatric patient by another individual, typically a family member. Schizophrenia patients who have been hospitalized and return to households characterized by a high level of expressed emotion have increased likelihood of relapse. Cultural factors or ethnicity may mediate the impact or nature of expressed emotion (Butzlaff and Hooley 1998). Communication deviance, or the degree to which a relative's communication is unclear, fragmented, or disruptive, also increases relapse risk. When minimized, these factors, which may be related to the stress and burden of coping with a patient's illness, have been found to protect against relapse.

Because family members may be directly involved in the care of an affected relative, they can experience difficulties such as disruptions to family relationships, constraints on social leisure and work, financial problems, and feelings of loss, depression, anxiety, or embarrassment. As a result, various family and relative self-help group treatments have been developed to improve family members' knowledge of schizophrenia and available coping strategies and to enhance involvement in patient treatment. Despite the availability and efficacy of individual and family interventions, services to patients and family members appear to be underimplemented, with families of older patients and African-American families being among those least likely to take advantage of such services (Lehman, Steinwachs, and Co-Investigators 1998).