Study of intrafamilial relationships of patients with severe psychiatric disorders in the early stages of their illness

by Aikaterini Koutra

Institution: University of Crete (UOC); Πανεπιστήμιο Κρήτης
Year: 2015
Keywords: Οικογειακή συνοχή; Οικογενειακή ευελιξία; Εκφραζόμενο συναίσθημα; Οικογενειακή επιβάρυνση; Ψυχολογική δυσφορία; Αρχική φάση ψύχωσης; Family cohesion; Family flexibility; Expressed emotion; Family burden; Psychological distress; First episode psychosis
Record ID: 1152990
Full text PDF: http://hdl.handle.net/10442/hedi/35490


Background: The role of the family in the psychosocial rehabilitation of patients with severe psychiatric disorders, such as schizophrenia and bipolar disorder, is considered extremely important as family members are the major source of caregiving. Most of the research on family functioning has included primarily chronic patients and examined certain aspects of intrafamilial transactions, such as expressed emotion and family burden. Much less attention has been given to more diverse aspects of family functioning, focusing on cohesion, flexibility and communication of the members to the families of people with severe psychiatric disorders, particularly in the early stages of the illness, right after the onset of the first episode. The study of intrafamilial relationships is especially important in the early stages of psychiatric illness since it can set the foundation for understanding the interaction and communication patterns in families of patients. Moreover, although there are plenty of reliable and valid psychometric tools to assess intrafamilial relationships, very few are translated and adapted to the Greek population.Aim: Given the dearth of research on family functioning in patients experiencing their first episode of psychosis (FEP) and the particularities of Greek families, the primary aim of the present PhD thesis is to provide a comprehensive assessment of intrafamilial relationships in the early stages of the illness by examining a variety of aspects of family life and examine possible differences in family functioning of FEP patients in comparison with chronic patients with psychosis and healthy controls. More specific aims of this thesis are to describe the socio-demographic and illness-related characteristics associated with family functioning in psychosis and identify the determinants of unhealthy family functioning in FEP and chronic patients with psychosis and their families; furthermore, to examine the interplay of family dynamics, as indexed by cohesion and flexibility, with caregiver’s expressed emotion, family burden, and psychological distress; finally, to determine whether dysfunctional family functioning contributes to patient relapse and rehospitalisation during a two-year follow-up. Given the lack of validated scales to evaluate family dynamics in the Greek context additional aims of this thesis are to translate and validate two useful psychometric instruments for assessing family dynamics: a) the Family Adaptability and Cohesion Evaluation Scales IV (FACES IV), and b) the Family Questionnaire for assessing expressed emotion (FQ). Methods: A total of 50 FEP and 50 chronic patients recruited from the Inpatient Psychiatric Unit of the University Hospital of Heraklion, Crete, Greece, and their family caregivers participated in the study. Family functioning was assessed in terms of cohesion and flexibility (FACES IV), expressed emotion (FQ), family burden (Family Burden Scale; FBS) and caregivers’ psychological distress (General Health Questionnaire-28; GHQ-28). Patients’ symptom severity…