Carico pratico ed emotivo delle famiglie in relazione alla psicopatologia e all'adattamento sociale di psicotici cronici lungoassistiti e alla diversa organizzazione dei servizi

Background. To evaluate practical and emotional family burden relating to chronic psychotic patients in some Italian community-based psychiatric services (CPSs). Methods. The study has been conducted at four CPSs in Northern Italy on patients who: a) fulfilled the DSM-III-R criteria for diagnosis of schizophrenia, delusional or schizoaffective disorder; b) had been treated for at least 10 years by these services; c) had not been institutionalized for most of the time during the preceding three years; d) had a key relative in contact with both patient and service. Patients were assessed by the Briel Psychiatric Rating Scale and the Global Assessment of Functioning Scale and key-relatives by the Social Behavior Assessment Scale. Results. Seventy-nine subjects have been examined and assessed. Patient's impairment was higher in social functioning than in psychopathology. Relatives experienced a considerable amount of distress as a consequence of some patients behaviors (specifically offensive behavior, heavy drinking, misery, self-neglect) and disabilites (specifically in sexual relationship, support, affection, decision making, everyday conversation, spare-time activities). They had many problems in the areas of leisure time, social life, physical and emotional health; such problems were frequently judged as a consequence of the patient's presence in the family and caused high levels of distress. The relatives judged their link with the CPSs as a source of great psychological relief, but not so efficient in terms of practical help. Conclusions. These data obtained in four Italian CPSs show that chronic psychotic patients may not have high levels of psychopathological symptoms; nevertheless, their behavior and disability may cause high practical and emotional burden in their families. The CPSs included in this study provide considerable psychological relief to relatives and continuity of care; still, these data indicate that strategies aimed at relieving practical family burden should be sharpened.