Depersonalization in patients with schizophrenia spectrum disorders, first-degree relatives and normal controls.

BACKGROUND: Depersonalization occurs in healthy individuals and across a broad range of psychiatric patients. Data on depersonalization in persons linked to patients through genetics, environment or education are scarce. Due to their higher risk of developing psychosis, first-degree healthy relatives might show differences with the general population. This study examines depersonalization in patients with schizophrenia or schizophrenia spectrum disorders, their first-degree healthy relatives and normal controls. METHODS: The Cambridge Depersonalization Scale was used to measure depersonalization in a sample of 147 clinically stable patients with schizophrenia or schizophrenia spectrum disorders, 73 first-degree relatives with no psychiatric history and 172 healthy controls. Mixed effect models were used to account for both the familial structure of the data and the effect of sociodemographic characteristics. RESULTS: Patients obtained higher scores than relatives and controls for frequency and duration of depersonalization experiences, number of items responded positively and total depersonalization, while first-degree relatives obtained lower scores than patients and controls for all these characteristics. CONCLUSIONS: First-degree relatives of patients reported fewer episodes of depersonalization, which were less intense and of shorter duration, than healthy controls. This finding might be related to a protection mechanism that keeps first-degree relatives away from near-psychotic experiences. The nature of such a mechanism remains to be discovered.

Temperament and character dimensions in patients with schizophrenia, relatives, and controls.

Studies of patients with schizophrenia or schizophrenia spectrum disorders and general population control groups consistently show differences regarding personality dimensions. However, the profile of personality dimensions in first-degree relatives of those patients is not well understood. We used Temperament and Character Inventory to explore personality dimensions in 61 clinically stable patients with schizophrenia or schizophrenia spectrum disorders, 59 of their first-degree relatives, and 64 healthy controls. Patients scored significantly higher than controls in harm avoidance and self-transcendence and lower in self-directedness and cooperativeness. First-degree relatives showed a tendency to lower novelty seeking and self-transcendence than controls. Interpretations of these findings include the possibility that lower novelty seeking and lower self-transcendence provide a protective influence in the relatives. Further studies are needed to go into this issue in greater depth.

Stigma and discrimination towards people with schizophrenia and their family members. A qualitative study with focus groups.

BACKGROUND: There is a scarcity of data regarding the actual stigma and discrimination experienced by schizophrenic patients and their relatives. Those experiences can vary significantly depending on the specific social group involved. We have explored such phenomena in our culture with a qualitative technique. METHODS: We developed a qualitative study with focus groups of clinically stable schizophrenic outpatients (N = 18) and relatives (N = 26). Three groups were performed in each sample. RESULTS: Six categories of stigma and discrimination experiences were extracted from the patients' data: Mental illness vs. Lack of will, Prejudice related to dangerousness, Over-protection-infantilization, Daily social discrimination, Discrimination in health care, Descendants, Avoidance-social isolation. Data from relatives were divided into three sets: discrimination towards the patients witnessed by relatives, discrimination suffered by the relatives themselves and discrimination exerted by the relatives on the patients. CONCLUSIONS: Patients and relatives describe a great variety of stigma and discrimination experiences in all areas of life, including health care. Isolation and avoidance are common reactions to those experiences. Publicizing these stigma and discrimination experiences could help to reduce stigmatizing attitudes in society and result in healthier reactions from patients, favoring a better course of the illness.

Investigación cualitativa en esquizofrenia. Un estudio can grupos focales para conocer experiencias de discrimination de pacientes y familiares / Qualitative research in schizophrenia: focus groups study of discrimination experiences of patients and their families

La estigmatización relacionada con la enfermedad mental ha sido el foco de numerosos estudios en los últimos años. Sorprendentemente, estos estudios tienden a abordar el tema en poblaciones alejadas de los pacientes, tales como público en general, profesionales de la salud o estudiantes universitarios. La estigmatización social da lugar a discriminación de los pacientes y, en alguna medida, de sus familiares. Intentamos explorar la percepción de los pacientes de esas experiencias de discriminación. También estudiamos la percepción de los familiares de la discriminación que afecta a los pacientes e incluso a ellos mismos. Ser padre de un esquizofrénico podría ser un factor por sí solo que indujera el rechazo social. Con este objetivo, utilizamos un diseño cualitativo, útil para explorar los significados que la gente otorga a sus experiencias en el mundo social. Específicamente, organizamos grupos focales para estudiar experiencias de discriminación en pacientes y, separadamente, en familiares de pacientes. Todos ellos proceden de tres lugares diferentes: nuestro Hospital de Día, nuestra Unidad de Consulta Externa y una asociación local de personas con problemas psiquiátricos y sus familiares. Se describe con todo detalle el proyecto, todavía en marcha, destacando aspectos como los criterios de inclusión, reclutamiento de participantes y planificación del análisis. Se detallan asimismo las áreas cubiertas por los conductores de los grupos en las sesiones y también algunas de las dificultades encontradas en el desarrollo del proyecto. Finalmente, se discuten algunas primeras impresiones, fruto de los análisis preliminares ya realizados (AU)