《[医疗保健]为居美华人精神病患者的照顾者而设的家庭精神卫生教育》由会员分享，可在线阅读，更多相关《[医疗保健]为居美华人精神病患者的照顾者而设的家庭精神卫生教育（30页珍藏版）》请在金锄头文库上搜索。
1、Pilot Study of Ethnically Sensitive Family Psychoeducation for Chinese American Caregivers of Persons Suffering from Schizophrenia為居美華人精神病患者的照顧者而設的家庭精神衛生教育計劃研究初探,Winnie W. Kung, Ph.D. 龔惠明博士Associate Professor 副教授Graduate School of Social Service 社會工作學院Fordham University 富敦大學,Background & Lit. Review
2、研究背景與文獻探討,The relapsing course of schizophrenia exerts enormous stress on patients familiesFamilies, however, can be allies in treatment,精神分裂症週期復發的性質對病人的家庭造成極大的壓力。不過，精神病患者的家庭可以加入聯手治療的行列。,2,Background & Lit. Review研究背景與文獻探討,Negative interactional cycles in these families: Patients deficits in thought
3、 processes = greater vulnerability to internal and external stimuli Positive symptoms (e.g. delusions, hallucination and disruptive behaviors) + negative symptoms (e.g. inertia and paucity of affects) = relatives anxiety, guilt & frustration = intensify criticism and overprotection = heightens patie
4、nt stress = increases relapse rate,這些家庭中負面的互動循環病人思考能力的不足對內在和外在的刺激更脆弱。正性的症狀(例如妄想、幻覺，和擾亂性的行為)與負性的症狀(例如無動力和缺乏情緒反應) 家屬的焦慮、罪惡感和挫折感加強批評與對病人過度保護增加病人的壓力提高復發率。,3,Background & Lit. Review研究背景與文獻探討,Family psychoeducation for individuals with schizophrenia found to be a robust intervention in reducing caregiver
5、 burden and patient relapseHowever, these interventions were not tested with minority groups taking into consideration their cultural beliefs and immigrant experience,研究發現為患有精神病者提供家庭精神衛生教育，是一種降低照顧者負荷和病人疾病復發的極有效的介入方法。不過這些介入方法尚未在少數種族進行檢試，考慮到他們的獨特文化信念和移民經驗。,4,2. Study Aim研究目標,to test the feasibility an
6、d receptivity of an ethnically sensitive family psychoeducation designed specifically for Chinese American patients and their families,檢定為居美華人精神病患者及照顧者而設的家庭精神衛生教育計劃的可行性和被接納程度。,5,3. Adaptation in Intervention Protocol調整介入模式,6 mths Involves both multifamily group and single family groupsAdditional rel
7、ative initiated group topics,六個月同時進行多元家庭小組與單一家庭小組加上家人提出的小組討論主題,6,Multifamily group多元家庭小組,Meets alternative weeks Facilitated by 2 clinicianspatients not presentoriginal design: 2 caregivers from each familyImpart knowledge on mental illness and skills in managing patient behaviorSharing and support
8、among caregiversA topic is designated for each group session based on predetermined themes and caregiver input,每隔週聚會一次。由兩位精神衛生專業人員帶領。病人無需出席。原本設計每個家庭有兩位照顧者出席。提供與精神病有關的知識和與病人相處的有關技巧。家庭照顧者彼此分享和支持。每次小組根據事前設計的主題和照顧者的建議，選定一個題目。,7,Single family groups單一家庭小組,Meets once or twice a month at the clinic or pati
9、ents homesfacilitated by one of the two clinicians of multifamily groupresolves conflicts arising in the care-giving processPromote effective communication between patient and caregiversHelp caregivers implement what they learned in the multifamily group with patient input,在中心或病人家中舉行，每月會面一至兩次。由多元家庭小
10、組其中一位精神衛生專業人員帶領解決照顧過程中引起的衝突促進病人和照顧者之間有效溝通。因應病人的需要及反應，協助照顧者實踐從多元家庭小組當中所學到的。,8,5. Study Design研究設計,Original design: An experimental design with random assignment of intervention and control groups; difficulty in recruitment= comparison group with families interested but cant comeParticipants: 9 famili
11、es in intervention group, 3 families in comparison group,原本設計隨機分派實驗組與控制組的實驗設計；招募有困難有興趣但 無法出席的家庭加入比較組。參加者實驗組有九個家庭，比較組有三個家庭。,9,Inclusion Criteria選入標準,Chinese American patient with a schizophrenic form of disorderBoth patient and relative speak Mandarin or CantoneseBoth age 18 or abovePatient currently
12、 receiving service for medication and individual counseling or day treatmentboth caregiver and patient willing to participateall relationships of caregivers accepted,經診斷患有精神分裂症的居美華人。病人和家屬都會說廣東話或普通話/國語。病人的家屬均須年滿十八歲。病人現正接受門診藥物治療和個人輔導或日間治療服務。病人的家屬都願意參加研究計畫。接受與病人有任何關係的照顧者。,10,6. Recruitment of Participa
13、nts招募參加者,Through referrals from clinicians at the family service center and day treatment program of a mental health clinic in N.E. of the U.S.,透過美國東北一所精神衛生機構家庭服務中心和日間治療計劃的精神衛生專業人員轉介。,11,7. Outcome Evaluation結果評估,Treatment outcome and satisfaction with the program assessed at baseline, 3 months, ter
14、mination, and 3-month follow-up evaluated by patients, caregivers and psychiatrist through individual interviews,在(1)接受介入之前，(2)介入開始三個月後， (3)介入結束時，和(4)介入結束三個月後，由病人、家屬和精神科醫生評估結果以及對計劃的滿意程度。,12,Measures: Caregivers outcome評估照顧者結果的測量工具,Burden Assessment Scale (Reinhard, Gubman, Horwitz, & Minsky, 1994)Pe
15、rceived Social Support and Social Conflict Scales (Goodman, 1991)Mental Health Belief (Krause, 1991)North-Sacher Family Life Questionnaire (North, Pollio, Sacher, Hong, Isenberg & Bufe, 1998)Caregiver Satisfaction (Kung, 2008)Patient Rejection Scale (Krelsman, Slmmens, & Joy, 1979)Perceived Criticis
16、m Scale (Hooley & Teasdale, 1989),照顧者負荷評估量表 (Reinhard, Gubman, Horwitz, & Minsky, 1994)社會支持和社會衝突感知量表 (Goodman, 1991)精神健康的信念 (Krause, 1991)North-Sacher家庭生活問卷 (North, Pollio, Sacher, Hong, Isenberg & Bufe, 1998)照顧者滿意程度 (Kung, 2008)照顧者拒絕病人程度量表 (Krelsman, Slmmens, & Joy, 1979)挑剔量表 (Hooley & Teasdale, 19
17、89),13,Measures: Patient outcome評估病人結果的測量工具,Patient perspective:Wisconsin Quality of Life (Becker, 2000)Caregiver perspective:Specific Level of Functioning Scale (Schneider & Struening, 1983)Perceived Criticism Scale (Hooley & Teasdale, 1989)Psychiatrist perspective:Brief Psychiatrc Rating Scale (BPRS, Overall & Gorham, 1962)Scale for Assessment of Negative Symptoms (SANS, Andreasan, 2000),
