Effects of attachment quality on caregiving of a parent with dementia.

OBJECTIVES: The purpose of the current study was to examine the moderating role of attachment quality on the relationship between dementia-specific stressors and: (a) caregiver distress and (b) caregiver satisfaction. METHOD: Caregivers (N = 91) of a parent with dementia completed questionnaires that assessed caregiving stressors (parental cognitive impairment and behavioral problems), attachment (early and present-day attachment) and measures of caregiver distress and satisfaction. A series of regression analyses were conducted to test the hypothesis that better attachment quality may buffer the effects of cognitive impairment and behavioral problems on the caregiver's experience of distress and enhance caregiver satisfaction. RESULTS: Results did suggest that present-day attachment moderates the effects of both cognitive impairment and behavioral problems on global distress but, contrary to our hypotheses, attachment security did not buffer the negative impact associated with these demands. Instead, secure present-day attachment was positively associated with an increased risk for emotional distress at mild levels of care-recipient cognitive impairment. Most analyses indicated no significant relationship between caregiving stressors and caregiver distress or satisfaction and few interactions based on attachment quality were found. CONCLUSIONS: Our study indicates that attachment security does not always have a protective or stress-buffering function but may amplify the effect of stressors under certain conditions. Different ways of understanding the obtained pattern of findings are discussed and additional work is required to test if secure attachment may be associated with increased resilience when the disease is more advanced. Clinical implications of the present findings are discussed.

[Operationalized psychodynamic diagnostics (OPD) in patients in a prodromal state of schizophrenia--an explorative study]. / Operationalisierte Psychodynamische Diagnostik (OPD) bei Patienten im schizophrenen Prodromalstadium--Eine explorative Studie.

OBJECTIVES: To obtain data and hypotheses regarding the amelioration of risk estimation and preventive psychotherapy in patients in a prodromal state of schizophrenia by using OPD. METHODS: 20 participants with a prodromal condition--6 subjects far from psychosis and 14 close to psychosis--along with 10 patients with paranoid schizophrenia as reference group were examined using the first four OPD axes. RESULTS: Both groups differed considerably in all four axes. Compared to the schizophrenic participants, prodromal probands appear to have more favourable preconditions for therapy. Moreover, they experienced the interaction partners, including the investigator, as less aversive and induced less distanced behaviour in the investigator. Conflicts of self-esteem were prominent in both prodromal subgroups. However, patients farther from psychosis showed less conflicts of autonomy versus dependence and displayed a higher integration in structures such as "defence" and "attachment" when compared to participants closer to psychosis. CONCLUSIONS: Particularly the differences between the prodromal subgroups suggest that application of the OPD may positively complement previous approaches of early detection, prevention,and psychotherapy for prodromal conditions. The hypotheses obtained should be tested in longitudinal studies with larger sample sizes.