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

Bhupendra Singh Ph. D. ScholarShahid Eqbal Ph. D. ScholarProf. (Dr.) Amool R. Singh, DirectorDr. 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)

RESULTS

SOCIO-DEMOGRAPHIC INFORMATION

VariableSchizophre

nia

Bipolar Affective Disorder

X2 df P value

Age

Up to 20 2 3

1.691 3 .63921-40 21 23

41-60 6 4

>60 1 0

Sex Male 27 25

.577 1 .448Female 3 5

Education

Illiterate 6 4

2.996 4 .559

Primary 7 11

Inter 12 13

Graduate 4 2

Above 1 0

Marital status

Married 18 21.659 1 .417

Unmarried 12 9

Religion

Hindu 21 19

2.418 3 .490Muslim 4 7

Christian 0 1Other 5 3

Socio-Demographic Information

Variable Schizophrenia Bipolar Affective Disorder X2 df P value

Domicile

Urban 7 8

.090 2 .956Semi-Urban 1 1

Rural 22 21

Type of family

Joint 28 26.741 1 .389

Nuclear 2 4

Occupation

Service 0 4

6.037 4 .196

Agriculture 8 7

House wife 3 5

Domestic work

8 8

Unemployed 11 6

Monthly income of the family

5000 11 17

2.857 2 .2405001-15000 16 12

15001-25000 3 0

>25000 0 1

COMPARISON OF SOCIAL SUPPORT AND FAMILY PATHOLOGY

Variable Schizophrenia

Bipolar

affective

disorder

qui df P value

Social

Support

Poor 27 1314.700 1 .000

Good 3 17

Family

Pathology

None 6 22

18.286 2 .000Average 12 6

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

DISCUSSION

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.

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.

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.

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).

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 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. 

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