[Family intervention in schizophrenia: long-term effect on main caregivers]. / Intervención familiar en la esquizofrenia: efecto a largo plazo en los cuidadores principales.

INTRODUCTION: The bulk of research on Family Interventions concentrates on assessing its efficacy in reducing psychotic relapses, there being very little research into its ability to reduce the morbidity of the main caregiver over the course of time. METHOD: Follow-up study at five years of a cohort of informal caregivers of persons with schizophrenia who had taken part in an empirical trial with two therapeutic approaches assigned at random. RESULTS: 87.7 % of main caregivers are women and they tend to care for more chronic and inactive patients than men (p < 0.041). More than 55% of main caregivers had high General Health Questionnaire (GHQ) scores, with women suffering more emotional repercussions than men. Morbidity gradually declines over time (GHQ scores: 8.1 before intervention; 6.9 at the end of intervention and 4.6 five years later) although statistical significance was only achieved when taking the entire period into account, i.e., from beginning to the end of follow-up. CONCLUSIONS: Family intervention over a limited period followed by a support group gradually reduces morbidity of the caregiver to a significant level at five years, although this reduction is not associated with the type of setting or the absence or presence of the patient. Clinical implications are discussed and likewise the need for a more equitable distribution of responsibilities and risk.

Intervención familiar en la esquizofrenia: efecto a largo plazo en los cuidadores principales / Family intervention in schizophrenia: long-term effect on main caregivers

Introducción. El grueso de la investigación sobre intervenciones familiares se centra en la evaluación de su eficacia para reducir las recaídas psicóticas, siendo muy escasos los trabajos donde se analiza su capacidad para reducir la morbilidad del cuidador principal a lo largo del tiempo. Método. Estudio de seguimiento a 5 años de una cohorte de cuidadores informales de personas diagnosticas de esquizofrenia que en su día participaron en un ensayo empírico con asignación aleatoria a dos abordajes terapéuticos. Resultados. El 87,7 % de los cuidadores principales son mujeres y tienden a hacerse cargo de pacientes más crónicos e inactivos que los hombres (p < 0,041). Más del 55 % de los cuidadores principales obtuvieron puntuaciones elevadas en el Cuestionario General de Salud (GHQ), siendo las mujeres las que presentaron una mayor repercusión emocional en comparación con los hombres. La reducción de la morbilidad fue progresiva a lo largo del tiempo (medias en el GHQ: 8,1 antes de la intervención, 6,9 al finalizar la misma y 4,6 a los 5 años), aunque sólo llegó a alcanzar significación estadística al considerar todo el período, es decir desde el inicio hasta el final del seguimiento. Conclusiones. Una intervención familiar de duración limitada seguida de un grupo de apoyo reduce la morbilidad del cuidador de forma progresiva, llegando a ser significativa a los 5 años, sin que esta reducción esté asociada al tipo de encuadre o a la presencia o ausencia del paciente. Se discuten las implicaciones clínicas, así como la necesidad de un reparto más equitativo de la carga y de los riesgos

Introduction. The bulk of research on Family Interventions concentrates on assessing its efficacy in reducing psychotic relapses, there being very little research into its ability to reduce the morbidity of the main caregiver over the course of time. Method. Follow-up study at five years of a cohort of informal caregivers of persons with schizophrenia who had taken part in an empirical trial with two therapeutic approaches assigned at random. Results. 87.7 % of main caregivers are women and they tend to care for more chronic and inactive patients than men (p < 0.041). More than 55% of main caregivers had high General Health Questionnaire (GHQ) scores, with women suffering more emotional repercussions than men. Morbidity gradually declines over time (GHQ scores: 8.1 before intervention; 6.9 at the end of intervention and 4.6 five years later) although statistical significance was only achieved when taking the entire period into account, i.e., from beginning to the end of follow-up. Conclusions. Family intervention over a limited period followed by a support group gradually reduces morbidity of the caregiver to a significant level at five years, although this reduction is not associated with the type of setting or the absence or presence of the patient. Clinical implications are discussed and likewise the need for a more equitable distribution of responsibilities and risk

Modificación de la expresividad emocional familiar tras una intervención psicosocial: estabilidad en el tiempo / Modification of family expressed emotion after a psychosocial intervention: stability in time

Introducción. Existe controversia sobre si la expresividad emocional (EE) tiende a mantenerse estable o a fluctuar en el tiempo y apenas hay estudios sobre la evolución de la EE y sus subescalas una vez realizada una intervención familiar. Un mayor conocimiento de su comportamiento temporal tendría importantes implicaciones teóricas y clínicas. Métodos. Se estudian los cambios en la EE y sus subescalas que se producen en una cohorte de 37 familiares de pacientes esquizofrénicos a la que se le realiza una intervención familiar orientada a reducir el estrés ambiental. Los cambios se analizan respecto a tres momentos de evaluación transversales: un momento previo a la intervención, otro al concluir ésta y por último a los 5 años de finalizarla. Resultados. En este trabajo los niveles de la EE tienden a variar en el tiempo. Estos cambios se producen mayoritariamente en el período de realización de la intervención familiar a expensas de la reducción de los niveles de sobreimplicación emocional. Entre la finalización de la terapia y el análisis realizado 5 años después los niveles se mantienen estables. Los escasos cambios en este período, cuando se producen, se asocian con variables de gravedad clínica y ajuste social. Conclusiones. La intervención familiar aparece como el factor determinante para la reducción de niveles de EE, mientras que la gravedad de la clínica productiva y el ajuste social del paciente condicionan los incrementos de sus niveles

Introduction. There is some controversy about whether expressed emotion (EE) tends to remain stable or fluctuates in time and there are very few studies on EE evolution and its subscales once a family intervention has been performed. Better knowledge about its behavior in time would have important theoretical and clinical implications. Methods. We have studied changes in EE and its subscales that are produced in a cohort of 37 relatives of schizophrenic patients to whom a familiar intervention orientated to reducing environmental stress was performed. Changes were analyzed according to three crosssectional moments of evaluation: one moment previous to intervention, another one when it was finished and finally, one at five years of finishing it. Results. In this work, the EE levels tend to vary in time. These changes are mainly produced in the period when the family intervention is carried out, at the expense of decreasing the levels of emotional overinvolvement. Between the end of therapy and the analysis carried out five years later, levels remain stable. The few changes that take place in this period, if any, are associated to variables of clinical severity and social adjustment. Conclusions. Family intervention appears as the determining factor for reducing EE levels, whereas productive clinical severity and the patient's social adjustment condition increases in their levels

[Modification of family expressed emotion after a psychosocial intervention: stability in time]. / Modificación de la expresividad emocional familiar tras una intervención psicosocial: estabilidad en el tiempo.

INTRODUCTION: There is some controversy about whether expressed emotion (EE) tends to remain stable or fluctuates in time and there are very few studies on EE evolution and its subscales once a family intervention has been performed. Better knowledge about its behavior in time would have important theoretical and clinical implications. METHODS: We have studied changes in EE and its subscales that are produced in a cohort of 37 relatives of schizophrenic patients to whom a familiar intervention orientated to reducing environmental stress was performed. Changes were analyzed according to three cross-sectional moments of evaluation: one moment previous to intervention, another one when it was finished and finally, one at five years of finishing it. RESULTS: In this work, the EE levels tend to vary in time. These changes are mainly produced in the period when the family intervention is carried out, at the expense of decreasing the levels of emotional overinvolvement. Between the end of therapy and the analysis carried out five years later, levels remain stable. The few changes that take place in this period, if any, are associated to variables of clinical severity and social adjustment. CONCLUSIONS: Family intervention appears as the determining factor for reducing EE levels, whereas productive clinical severity and the patient's social adjustment condition increases in their levels.

[Chest wall destruction: unusual presentation form of pulmonary nocardiosis]. / Destrucción costal: una rara forma de presentación de la nocardiosis pulmonar.

Nocardia spp infection is associated with immunosuppresion states, neoplasms and immunosuppresors and glucocorticoids prolonged treatments. Pulmonary involvement is the most typic feature and the dissemination to chest wall and subcutaneous cellular tissue is uncommon. We report one case of pulmonary nocardiosis by Nocardia asteroides, in a diabetic patient without others risk factors, manifested as a chest wall abscess with fifth rib destruction. The treatment with cotrimoxazol after lesion drainage was successful. We review the literature and remain the different diagnostic and therapeutics attitudes.

Destrucción costal: una rara forma de presentación de la nocardiosis pulmonar / Chest wall destruction: a rare presentation of pulmonary nocardiosis

Clásicamente, la infección por Nocardia spp. se asocia a estados de depresión inmunológica, procesos neoplásicos y tratamientos prolongados con inmunosupresores y glucocorticoides. La afectación pulmonar es la más característica, siendo infrecuente la diseminación del proceso por extensión local a la pared costal y el tejido celular subcutáneo. Presentamos un caso de nocardiosis pulmonar por Nocardia asteroides en una paciente diabética sin otros factores de riesgo conocidos, que se manifestó por el desarrollo de un absceso en la pared torácica con destrucción del 5º arco costal y que respondió adecuadamente al tratamiento prolongado con cotrimoxazol tras el drenaje de la colección. Revisamos la literatura y destacamos el carácter invasivo de la infección, las nuevas formas de diagnóstico y las diferentes pautas de antibioterapia. Así mismo, destacamos la dificultad en el diagnóstico de esta infrecuente entidad, que motiva la falta de un adecuado diagnóstico y tratamiento en muchos pacientes. (AU)

Two strategies for family intervention in schizophrenia: a randomized trial in a Mediterranean environment.

Controlled intervention studies carried out in families of schizophrenia patients have been shown to have a positive impact in relapse prevention, but it remains to be seen whether different forms of family intervention affect outcomes other than relapse and hospital readmission in different ways. This study compared the outcome profile of relevant clinical variables after two different family intervention strategies for schizophrenia patients in public health care in a Spanish sample. We conducted a randomized controlled study comparing (1) a relatives group (RG) and (2) a single-family behavioral family therapy (BFT), both offered as standard treatment in one catchment area in Valencia. All randomized patients were included in the main analysis, and all cases remained in the therapy group to which they were originally assigned regardless of whether they suffered a relapse. The relapse rate at 12 months for the 87 cases studied was not significantly different in the two groups, but the two approaches did affect outcomes other than relapse and rehospitalization (such as social functioning, dose of antipsychotic medication, "delusions" and "thought disorder") in different ways. The BFT approach offered more advantages than the RG approach. The results suggest that these approaches should always be implemented in a clinical environment in a Mediterranean setting.

[The effect of human immunodeficiency virus infection on the consumption of hospital resources. A correlation with the degree of immunodeficiency]. / Efecto de la infección por el virus de inmunodeficiencia humana en el consumo de recursos hospitalarios. Correlación con grado de inmunodeficiencia.

BACKGROUND: To calculate the real cost of the Human Immunodeficiency Virus (HIV) infection in the use of hospital resources. PATIENTS AND METHODS: All the episodes of hospitalization of the years 1993, 1994 and 1995 of a general hospital have been analyzed. The patients have been classified according to the Patients Management Categories version 5.0 system. The patients with HIV infection were also classified according to the CD4+T-lymphocyte counts and the existence of AIDS. The derived cost of the stay and the consumption of diagnostic and complementary tests were calculated according to PMC Relative Intensity Score. RESULTS: In 293 hospitalizations the hospital cost of the HIV patients ascended to 145,372,650 ptas, what represents 40,230,000 ptas 100,000 person-years. HIV patients presented mean of stay (12 vs 5 days, p < 0.001) and hospital cost (433,029 vs 218,646 ptas, p < 0.001), significantly higher than non-HIV patients. 79% of hospitalizations corresponded to patient with AIDS. As much the stay as the hospital cost vary significantly in function of the degree of immunologic deterioration (lymphocyte count and AIDS diagnostic). During the years of study a stabilization was observed in the cost and the hospital stay of these patients. CONCLUSIONS: HIV infection originates a high consumption of hospital resources, mainly in patient with advanced immunodeficiency. The hospital stay is very high to the general population. In the last years it seems to exist a tendency toward the stabilization in the use of hospital resources, possibly to expense of the non hospital cost.

Efecto de la infección por el virus de inmunodeficiencia humana en el consumo de recursos hospitalarios. Correlación con grado de inmunodeficiencia / Effect of the human immunodeficiency virus infection in hospital resources utilization: correlation with the immunodeficiency degree

Fundamento: Calcular el coste real de la infección por el virus de la inmunodeficiencia humana (VIH) en la utilización de recursos hospitalarios. Pacientes y métodos: Se han analizado todos los episodios de hospitalización de los años 1993,1994 y 1995 de un hospital general. Los pacientes fueron clasificados según el sistema Patient Management Categories (PMC) versión 5.0. Los pacientes con infección por VIH se clasificaron además según el recuento de linfocitos CD4 y la existencia de enfermedad diagnóstica de SIDA. Se calculó el coste derivado de la estancia más el consumo de pruebas diagnósticas y complementarias según el Relative Intensity Score del PMC. Resultados: En 293 hospitalizaciones el gasto hospitalario de los pacientes VIH ascendió a 145.372.650 ptas, lo que representa 40.230.000/100.000 habitantes/año. Los pacientes VIH presentaron una estancia (12 vs 5 días, p< 0,001) y un coste hospitalario anual (433.029 vs 218.646 ptas, p<0,001) significativamente superior a los no VIH. El 79 porciento de hospitalizaciones correspondieron a pacientes con SIDA. Tanto la estancia como el gasto hospitalario varió significativamente en función del grado de deterioro inmunológico (nivel de linfocitos y diagnóstico de SIDA). Durante los años de estudio se observó una estabilización en el coste y la estancia hospitalaria de estos pacientes. Conclusiones: La infección por VIH origina un elevado consumo de recursos hospitalarios, principalmente en pacientes con inmunodeficiencia avanzada. La estancia hospitalaria es muy superior a la población general. En los últimos años parece existir una tendencia hacia la estabilización del gasto hospitalario, posiblemente a expensas del gasto extrahospitalario (AU)

[Emotional family environment and clinical profile in schizophrenia]. / Clima emocional familiar y perfil clínico en la esquizofrenia.

Despite the strong evidence in the literature for considering Expressed Emotion (EE) as a relapse predicting factor in schizophrenia, there are still several aspects open to discussion. One of the controversial issues is whether EE is only an intrinsic characteristic of the family or, at least partially, a response to schizophrenic symptoms. The aim of this study is to analyse the relationship between EE, and each one of its single components, and the patients clinical characteristics. It is an observational study including a sample of 120 schizophrenic patients and their families. Patients have been evaluated for their clinical status as well as their social adjustment, and the key relatives have been assessed with the Camberwell Family Interview. We have found a statistically significant association between the severity of psycotic symptoms and critical comments, as well as with hostility. However, no association was found between clinical severity and the global status of EE. Results are compared with other studies and possible explanations for those discussed.