Comparison between Camberwell Family Interview and Expressed Emotion Scale in Determining Emotions of Caregivers of Schizophrenic Patients.

INTRODUCTION: The aim of the study was to compare the Camberwell Family Interview (CFI) and the Expressed Emotion Scale (EES) in determining the level of expressed emotion in caregivers of patients with schizophrenia. METHOD: The study sample included caregivers of 22 schizophrenic patients followed in two psychiatric clinics. The level of expressed emotion in the caregivers was assessed by the CFI and the EES. CFI was applied to caregivers of the inpatients and the procedure was audio recorded. These records were later used for the ratings. EES was completed by the caregivers. Total EES scores were used to determine the level of expressed emotion in the caregivers. RESULTS: Forty point nine percent and 50% of the caregivers had high level of expressed emotion based on the analysis of the data obtained from the CFI and EES. Fifty-nine percent and 50% of the caregivers had low level of expressed emotion based on the data obtained from the CFI and EES. The proportion of the caregivers with high level of expressed emotion as measured by the CFI and the EES were not statistically significantly different within the sample (χ2= 0.727). CONCLUSION: The CFI and the EES were similar in determining the level of expressed emotion in caregivers of schizophrenic patients. It can be suggested that the EES, a user friendly tool, may be preferred to determine the level of expressed emotion in caregivers of patients with schizophrenia. However, further studies with larger samples are needed to obtain more reliable results.

Students meeting with caregivers of cancer patient: results of an experience-based learning project.

The communication between medical students and cancer caregivers, and the problems they have experienced as well as the outcomes for their professional development before starting clinical practice was assessed in the context of a student research project. Data were collected by questionnaires or by 20 to 40-min long interviews with cancer caregivers. Their communications with physicians, hearing the bad news, and health service satisfaction were questioned. Therefore, the caregivers trusted the professional approach of their physician. However, they expected more empathic communication in the process of diagnosis and therapy. Development of empathy and trust-based communication between patients and physicians and enhancement of the quality of devoted time to cancer patients and caregivers may have an effect on the course of disease. Interviewer students mentioned that they developed communication skills about difficult clinical tasks and in delivering bad news face to face to cancer caregivers before starting their clinical education.

Maternal psychological problems associated with neonatal intensive care admission.

Background. Mothers of infants admitted to a neonatal intensive care unit (NICU) are believed to have heightened distress. The purpose of this paper was to determine depression and anxiety symptoms and attachment style in NICU mothers. Methods. The NICU group consisted of mothers whose infants were admitted to the NICU and the control group consisted of mothers of healthy term infants. The psychosocial assessments were done at the first month. Results. The mean Edinburgh Postpartum Depression (EPDS) score of NICU mothers was significantly higher than that of the control group mothers (9.6 +/- 5.6 versus 7.3 +/- 4.9, P = .005). NICU mothers who had high EPDS (>/=13) scores had significantly higher anxiety scores and insecure attachment style in comparison to the subgroup of NICU mothers who had low EPDS scores. Conclusion. Mothers of NICU babies had higher EPDS scores. Mothers who had higher EPDS scores had higher anxiety scores as well. These NICU mothers should receive appropriate counseling during the hospitalization of their babies.

The association between individual attachment patterns, the perceived social support, and the psychological well-being of Turkish informal caregivers.

BACKGROUND: This study aimed to investigate the relations among the psychological well-being (i.e. depression and state/trait anxiety levels), attachment patterns (i.e. secure, ambivalent, avoidant), and the perceived social support from family/friends/significant others of caregivers of cancer patients in Turkey. METHODS: Fifty-one caregivers of adult cancer patients were recruited from the oncology outpatient clinic of the Marmara Medical School Hospital in Istanbul. Caregivers were assessed with the Adult Attachment Scale, the Beck Depression Inventory, State-trait Anxiety Inventories, and the Multidimensional Scale of Perceived Social Support. RESULTS: Stepwise multiple regression analysis indicated that depression was predicted by ambivalent attachment and the perceived social support from family. The support from significant others was the significant predictor of trait anxiety and the caregivers' ambivalent attachment score was the significant predictor of state anxiety. CONCLUSIONS: We assert that ambivalent attachment pattern could confer a vulnerability to psychological distress in cancer caregivers. Assessing the psychological experiences and needs of caregivers and being aware of possible risk factors (such as attachment patterns) and protective factors (social support network) for depression and anxiety might be helpful for successful programmes and interventions that support the caregivers of cancer patients.

Breastfeeding duration and postpartum psychological adjustment: role of maternal attachment styles.

AIM: Depressive and anxiety symptoms are common in new mothers. The aim of this study is to explore the link between postpartum psychological adjustment and feeding preferences of the mothers. METHODS: Sixty mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened by the Edinburgh Postpartum Depression Scale (EPDS), and maternal anxiety level was assessed by the State-Trait Anxiety Inventory at 1 month postpartum. The Multidimensional Scale of Perceived Social Support was used for the assessment of maternal social support. The Adult Attachment Scale was used to determine the attachment style of the mother. Infants were examined and evaluated at 1 and 4 months of life. RESULTS: All mothers started breastfeeding their infants postpartum; 91% and 68.1% continued exclusive breastfeeding at 1 and 4 months, respectively. The first-month median EPDS score of mothers who breastfeed at the fourth month was statistically significantly lower than those who were not breastfeeding (6 and 12, respectively) (P = 0001). The first-month median EPDS score of mothers with secure attachment was lower than the median score of mothers with insecure attachment (5 and 9, respectively) (P < 0001). Exclusive breastfeeding rate was not statistically different among mothers with secure and insecure attachment styles. The median state and trait anxiety scores and social support scores of mothers were not different between groups according to breastfeeding status. CONCLUSIONS: This study has shown an association between higher EPDS scores and breastfeeding cessation by 4 months after delivery.

[Family centered evaluation of treatment outcome in schizophrenia: Marmara Family Interview for the Assesment of Psychiatric Treatment]. / Sizofreni Tedavisinin Aile Merkezli Degerlendirilmesi: Marmara Tedaviyi Degerlendirme Aile Görüsmesi.

OBJECTIVE: Assessment of psychiatric treatment has been a central issue in psychiatric research. Most assessment tools are based on the patient's account and mainly focus on clinical agendas. Assessment tools, which gather the perspective of attached daily needs are limited. The purpose of our study was to evaluate the inter-rater reliability and internal consistency of the Marmara Family Interview for the Assessment of Psychiatric Treatment (MFIPT) in a clinical sample. METHOD: The study also aimed to explore a possible association between the investigated assessment tool and the Brief Psychiatric Rating Scale. Thirty patients were followed over a period of 6 months. RESULTS: The inter-rater reliability for the interview subscales were self care/hygiene: kappa= 0.77; social participation: kappa= 0.84; boundaries in daily life: kappa= 0.76; academic/work activities: r= 0.81, clinical condition/symptom severity: kappa= 0.72; attitude towards treatment: kappa=0.82; participation in family crisis/emotional support: kappa= 0.77; participation in daily routines/household activities: kappa= 0.63; use of psychiatric services: kappa= 0.62. Cronbach's alpha was found to be 0.90 for the overall internal consistency of the assessment tool. The strongest correlation between the Brief Psychiatric Rating Scale and Marmara Family Interview for the Assessment of Psychiatric Treatment was the depression subscale and the participation in family crisis/emotional support item (r= 0.151; P > 0.05). CONCLUSION: Marmara Family Interview for the Assessment of Psychiatric Treatment is a reliable instrument for the assessment of daily results of the treatment and daily functioning by the caregivers. Although, it has some limitations in assessing the clinical course.

[Social phobia in essential tremor]. / Essansiyel Tremorda Sosyal Fobi.

OBJECTIVES: This study is aimed to determine the frequency of social phobia among a group of subjects with essential tremor, to compare subject groups with and without social phobia with regard to the level of social phobia and disability, and to study the effect of the severity of social phobia on disability in essential tremor. METHOD: 45 subjects, diagnosed with essential tremor were included in the study, and their severity of tremor and essential tremor-related functional impairment were determined. Subjects were evaluated in 2 groups; those with a social phobia diagnosis and those without, as determined with the SCID-I interview. Additionally, the Liebowitz Social Anxiety Scale (LSAS) and the Sheehan Disability Scale (SDS) were administered to both groups and the findings were statistically compared. RESULTS: Social phobia was observed in 19 subjects (42.2%) with essential tremor. While no difference was found between the groups in terms of tremor severity scores, the mean score of tremor-related functional disability in the social phobia group was found to be higher. Among subjects with social phobia, the mean fear and avoidance scores on LSAS were higher, whereas social lives and leisure activities of the same group were observed to have been affected more, according to SDS scores. Social avoidance and tremor severity were predictive for the difference on SDS. A significant and positive correlation between fear and avoidance, and disability in the group with social phobia was established. CONCLUSION: It was concluded that essential tremor patients diagnosed with social phobia demonstrated higher social anxiety and disability compared to those without social phobia, and that social avoidance contributed to disability. Identifying social phobia in essential tremor patients and diagnosing these patients with social phobia, contrary to DSM's restrictive approach, would be appropriate and beneficial in terms of providing sufficient treatment.

Geriatric psychiatry consultations in a Turkish university hospital.

OBJECTIVE: The size of the elderly population is growing rapidly in Turkey. We aimed to characterize geriatric psychiatry consultations to obtain the characteristic pattern of these patients for further interventions. METHOD: A retrospective chart review was undertaken for each patient. RESULTS: One hundred and sixty-six patients with a mean age (+/- S.D.) of 75.5 +/- 6.6 years were included in this study. Most referrals came from the Department of Internal Medicine (42.2%), with sleep problems (42.1%), depression (29.5%) and anxiety (28.3%) being the most common reasons for referral. Hypertension was the most frequent medical diagnosis (53.6%). The mean number +/- S.D.) of medications used by each patient was 4.4 +/- 2.0. The leading psychiatric diagnosis at the end of the assessment was adjustment disorder (31.3%). CONCLUSION: Turkish geriatric psychiatry consultation patients display similar characteristics to elderly patients from other western countries. The main difference comes from diagnosis of adjustment disorder, which may be related to hospital conditions and strong family ties in developing countries.