[Evaluation of the combination of psychosocial and pharmacological treatment in schizophrenic patients]. / Evaluación de la combianación de los tratamientos psicosocial y farmacológico en pacientes con esquizofrenia.

INTRODUCTION: The present treatment of schizophrenia should initially focus on bringing psychotic symptoms under control with the use of antipsychotic medication, but it also should include the psychosocial management of the illness, with the implementation of psychosocial treatment. The purpose of the present study is to describe the results of the comparison of two groups (experimental and control) of schizophrenic out-patients of The National Institute of Psychiatry Ramón de la Fuente in Mexico City. The experimental group received a combination of psychosocial and pharmacological treatment, while the control group received the pharmacological treatment alone. MATERIAL AND METHODS: A quasi-experimental design which included the two groups under study, experimental (n=25) and control group (n=22), was used. Both groups were assessed at the beginning and at the end of a one-year interventions considering variables such as: symptomatology, psychosocial functioning, global functioning, compliance with antipsychotic medication, relapses, rehospitalizations, therapeutic non-compliance, and adherence. RESULTS: Experimental patients, in comparison with control patients, improved their symptomatology, psychosocial functioning and global functioning considerably. They also presented the following: lower relapse frequency - 12% versus 31,8% of the controls as well as low rehospitalizacion rate - 0% versus 13.6% of the control patients, higher antipsychotic medication compliance (90%) when compared with patients under the control condition (80%), a reduced rate of therapeutic non-compliace (19.3%) and a higher degree of adherence (80.7%). On the other hand, control patients remained stabilized in their symptomatology, but did not improved in any of the psychosocial variables. CONCLUSIONS: The results show that the combination of psychosocial and pharmacological therapy is a more effective form of treatment in comparison with the other approach of pharmacotherapy alone. It may be concluded that there is sound evidence that indicates that combined psychosocial and pharmacological therapy combined report beneficial effects for the patients; therefore, it should be considered as an important therapeutic alternative in the treatment of schizophrenic patients.

[Psychosocial factors associated with hospital readmission of patients with organic psychoses]. / Factores psicosociales relacionados con la rehospitalización de pacientes con psicosis orgánica.

OBJECTIVE: To assess the relationship between psychosocial factors, frequent relapses and hospital readmissions in patients with organic psychoses. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted among 33 patients diagnosed with organic psychosis, seen at Hospital Psiquiatrico Guillermo Dávila, of Instituto Mexicano del Seguro Social in Mexico City. Patients had been readmitted more than two occasions during 1993-1994. Data collection instruments consisted of recorded interviews, five-minute dialogues of expressed emotions (EE), and combined questionnaires to assess perception of illness and the physician-patient relationship. The Kappa statistic and Cronbach's alpha were used to establish the validity and reliability of the measurements; descriptive and inferential methods were used for statistical data analysis. RESULTS: A high percentage (60.9%) of patient's relatives showed high level of EE, as measured by their expression of criticism, hostility, or emotional over-involvement; 64.3% of study subjects lived for more than 35 hours per week with relatives having high EE levels. CONCLUSIONS: High EE levels were associated with frequent readmissions to the psychiatric ward. Greater perception of illness characteristics was observed among relatives than in patients. Even though a satisfactory physician-patient relationship was found, it was not conducive to improving the perception of illness nor compliance with therapy.