Influence of Family Life on the Course of Schizophrenic Disorders: A Replication
Influence of Family Life on the Course of Schizophrenic Disorders: A Replication
复制标题
家庭生活对精神分裂症病程的影响：复制
DOI：
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发表时间：
1972
影响因子：
10.5
通讯作者：
J. Wing
中科院分区：
文献类型：
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作者：
G. W. Brown;J. Birley;J. Wing
尽管在过去的十五年中引入了新的治疗和护理方法，但精神分裂症患者仍然容易复发，伴随着诸如妄想、幻觉和不安行为的华丽症状的复发，并且可能对所有相关者造成巨大的痛苦（Brown等人，1966年）。研究表明，患者的社会环境在前三周发生显著变化后，往往会出现明显的潮红症状（Brown and伯利，1968;伯利and Brown，1970）。其他研究则集中在更持久的环境因素的影响上，例如与患者生活在一起的亲属对患者表达的情感。在对出院的长期住院男性进行的探索性调查中发现，与父母或妻子的密切情感联系表明预后不良（Brown，卡斯泰尔斯和Topping，1958; Brown，1959）。在进一步的研究中，患者在出院前在医院接受了访问，他们的亲属同时在家中接受了采访，并且在出院后不久一起接受了联合采访。研究发现，那些回到家中与与他们高度情感相关的亲属一起生活的患者（根据亲属行为的评级来判断）更有可能遭受华丽症状的复发，即使考虑到出院时精神障碍的严重程度（Brown et al.，1962年）。对患者自己表达的情绪的评级显示参与程度要低得多，并且与随后的复发高度相关。也有人认为，短期和长期的影响可能会产生累积效应;例如，如果患者的社会环境发生重大变化，家庭紧张程度的提高会使复发的可能性更大（Brown和伯利，1968）。这些事实，再加上精神分裂症患者对刺激不足的社会环境的相反但同样的障碍反应，被综合在一起，形成了一个更普遍的环境影响精神分裂症病程的理论（Wing和Brown，1970）。这也考虑到了在大多数孤僻的精神分裂症患者中发现的高度生理唤醒（Venables，1968; Venables和Wing，1962）。有人认为，在一个社会侵入性的环境中，病人的思维障碍无论如何都容易在环境变得过于复杂时变得明显，病人会倾向于试图通过社会退缩来保护自己;但是这个过程很容易走得太远，无论是在医院还是在医院外，都会导致完全的社会孤立和无法照顾自己。对于那些仍然残疾的人来说，最佳的社会环境被认为是一个结构化的和中性的刺激环境，几乎没有必要做出复杂的决策。
In spite of the new methods of treatment and care introduced during the past fifteen years, schizophrenic patients are still liable to relapse with a recurrence of florid symptoms such as delusions, hallucinations and disturbed behaviour, and great suffering can be caused to all concerned (Brown et al., 1966). It has been shown that the onset of florid symptoms is often preceded during the previous three weeks by a significant change in the patient's social environment (Brown and Birley, 1968; Birley and Brown, 1970). Other studies have focused on the influence of more persistent environmental factors, such as the emotion expressed towards the patients by relatives with whom they were living. In an exploratory survey of discharged long-stay men it was found that close emotional ties with parents or wives indicated a poor prognosis (Brown, Carstairs and Topping, 1958; Brown, 1959). In a further study, patients were seen in hospital just before discharge, and their relatives were interviewed at home at the same time, and both were seen together at a joint interview shortly after discharge. It was found that those patients who returned home to live with relatives who were highly emotionally involved with them (as judged by ratings of the relatives' behaviour) were more likely to suffer a relapse of florid symptoms, even when the severity of psychiatric disturbance at the time of discharge was taken into account (Brown et al., 1962). Ratings of the patient's own expressed emotion showed much less involvement, and were much less highly associated with subsequent relapse. There was also a suggestion that short-term and long-term influences might have a cumulative effect; for example, that a raised level of tension in the home made relapse more likely in the event of a critical change in the patient's social environment (Brown and Birley, 1968). These facts, together with the contrasting but just as handicapping reaction of schizophrenic patients to an under-stimulating social milieu, were brought together in a more general theory of environmental influences on the course of schizophrenia (Wing and Brown, 1970). This also took account of the high physiological arousal which had been found in the most withdrawn schizophrenic patients (Venables, 1968; Venables and Wing, 1962). It was argued that in a socially intrusive environment acting upon a patient whose thought disorder was in any case liable to become manifest whenever circumstances became too complicated, a patient would tend to attempt to protect himself by social withdrawal; but this process might easily go too far, both in hospital and outside it, leading to complete social isolation and inability to care for himself. The optimum social environment, for those who remained handicapped, was seen as a structured and neutrally stimulating one with little necessity for complex decision making.