Psychosis and Family Intervention handbook

Authors:
Diane Gosselin, M.S.W.
Hélène Viau, B.A., Social Work
Contributors:
Christiane Bergeron-Leclerc, M.S.W.
Marc-André Roy, MD, FRCP, Psychiatrist
Xavier De Vriendt, MD, FRCP, Psychiatrist
Julie Lesage, B.A., Social Work,
Myreille St- Onge, Ph.D, School of Social Work, Laval University
English translation:
Elizabeth Doyle, Certified Translator
Cover:
La danse des bouleaux
Hubert-Antoine Wallot, MD, FRCP, Psychiatrist
Production:
Department of Communications
Centre hospitalier Robert-Giffard,
Institut universitaire en santé mentale
The production of this document was made possible through the financial contribution of
AstraZeneca, in the framework of its training support program.
Legal deposit
Bibliothèque et Archives nationales du Québec, 2006
Bibliothèque et Archives Canada
ISBN 978-2- 922451-25-2
All rights reserved © 2006
2601, Chemin de la Canardière
Québec, Québec
Canada G1J 2G3
www.rgiffard.qc.ca
FOREWORD
When it was first thought to look at the family of a psychotic individual, as portrayed in
psychoanalytical theory and in communication theories, the family system itself came under
suspicion and was perhaps even considered to be a condition for triggering the psychosis.
Like some English-speaking groups, also working with families confronted with psychoses, a
team from the Social Work Department of the Centre hospitalier Robert-Giffard, Institut
universitaire en santé mentale has been working for almost twenty years with a somewhat
different and innovative approach, that of joining forces with the family to help it overcome
the difficulties of living with a psychotic relative.
A family intervention handbook was designed to share this team’s wealth of experience
gained from the many adjustments made along the way while dealing with their clients’
problems.
At first, this handbook was intended for the families of clients suffering from chronic
psychosis, and its emphasis was on psychoeducational activities.
It was used by the families of a clientele of young psychotic adults, offering a systemic
approach to problems, both valuable in its capacity to help understand the family’s distress
and effective in remedying it.
Having been, like the social work team of the Centre hospitalier Robert-Giffard, Institut
universitaire en santé mentale, in relation with these families for a number of years, I was
able to see how profitable it was for them to be accompanied in an enlightened, systematic
and ongoing way. This family intervention handbook has become their survivor’s kit and
rekindled their hope.
Although this family intervention handbook was designed with individuals suffering from
psychosis in mind, the principles and intervention methods it proposes can be extended to
other mental health clienteles and be used, we hope, as a reference handbook by several
teams and an encouragement to many families.
Xavier De Vriendt, MD, FRCP
Psychiatrist
Centre hospitalier Robert-Giffard, Institut universitaire en santé mentale
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TABLE OF CONTENTS
FOREWORD..................................................................................................................... 3
ACKNOWLEDGEMENTS................................................................................................. 5
TABLE OF CONTENTS ................................................................................................... 7
INTRODUCTION............................................................................................................... 9
CHAPTER 1 PSYCHOSIS.............................................................................................. 11
Definition of psychosis ................................................................................................ 11
Manifestations of psychosis ........................................................................................ 12
Types of psychosis...................................................................................................... 14
Possible causes of psychosis ..................................................................................... 15
Treatment of psychosis ............................................................................................... 16
CHAPTER 2 CLINIQUE NOTRE-DAME DES VICTOIRES ........................................... 17
Description of the program at the Clinique Notre-Dame des Victoires........................ 18
Roles and functions of the Social Work Department................................................... 20
CHAPTER 3 FAMILY INTERVENTION PROTOCOL .................................................... 23
Theoretical foundations............................................................................................... 23
Application................................................................................................................... 26
PHASE I: Alliance ................................................................................................... 27
Assessment of the impact of the illness on the family: the family burden ........... 30
Assessment of the family system ........................................................................ 31
PHASE II: Sharing of knowledge ............................................................................ 33
PHASE III: Integration of coping strategies ............................................................. 36
CHAPTER 4 ASSESSMENT INSTRUMENTS ............................................................... 39
Psychosocial and family assessment follow-up .......................................................... 40
Assessment of the family burden ................................................................................ 41
Assessment of the family's structure and functioning ................................................. 67
Rating scales............................................................................................................... 75
Report outlines .......................................................................................................... 101
CONCLUSION .............................................................................................................. 113
BIBLIOGRAPHY........................................................................................................... 115
APPENDIX: CONTENTS OF SIX MULTI-FAMILY MEETINGS..........................................119
Centre hospitalier Robert-Giffard, Institut universitaire en santé mentale
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Intervention Handbook
CHAPTER 1
PSYCHOSIS
DEFINITION OF PSYCHOSIS
Psychosis refers to a perturbed mental state, characterized by an ongoing inability to
interpret reality, not attributable to cultural differences. It is mainly characterized by:
• An impaired sense of reality and lack of judgement to varying degrees;
•
Disturbed mental functioning;
•
Appearance of first manifestations in early adulthood;
•
Brief, sporadic or prolonged periods.
Roughly 3% of the population is affected.
At the first manifestations of a psychotic episode, it is difficult to reach an accurate
diagnosis. These first manifestations may lead to several different diagnoses.
Clinico-diagnostic constellation of an early psychosis
Depressive
characteristics
Delusional
Disorder
Schizophrenia
Psychosis :
Disorde
Schizophreniforme
Delirium
Thought disorders
Hallucinations
Bizarre Behaviour
Organic-based
Disorder
Substance-incluced
Disorder
Schizoaffective
Disorder
Bipolar
Disorder
Psychose
Disoder
Source: Grivois and Grosso, (1998) p 24.
Centre hospitalier Robert-Giffard, Institut universitaire en santé mentale
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CHAPTER 2
CLINIQUE NOTRE-DAME
DES VICTOIRES
70 Dalhousie
Suite 40
Québec, Québec
G1K 4B2
Phone : (418) 694-2223
Fax : (418) 694-2003
E-mail :
diane_gosselin_chrg@ssss.gouv.qc.ca
helene_viau@ssss.gouv.qc.ca
Centre hospitalier Robert-Giffard, Institut universitaire en santé mentale
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CHAPTER 3
FAMILY INTERVENTION PROTOCOL
THEORETICAL FOUNDATIONS
Main studies involving psychoeducational intervention
These studies have focused on four main areas or intervention targets by four research
teams:
•
Crisis anticipation and resolution: Goldstein (1981), Los Angeles;
•
Modification of expressed emotion: Leff, Kuipers, Berkowitz, Eberlein-Vries and
Sturgeon (1982) and (1990), London;
•
Communication and learning of problem-solving skills: Falloon, McGill, Boyd and
Pederson (1987), Los Angeles;
•
Stress management: Anderson, Reiss and Hogarty (1986), Pittsburgh.
These teams share a common goal: to reduce the environmental stressors around the
psychotic individual and in his/her family.
Centre hospitalier Robert-Giffard, Institut universitaire en santé mentale
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CHAPTER 4
ASSESSMENT INSTRUMENTS
To make it easier to understand how the assessment instruments are used and why the
reports are completed, this chapter presents the tools developed and each of the
instruments used.
The form Psychosocial and Family Evaluation Follow-Up (page 40) is the evaluation
checklist. Ideally, information should be gathered in two stages, once at the beginning and
once at the end of the intervention.
Next comes the questionnaire on Sociodemographic Information (page 42-46), including, at
the end, some information on the respondents’ state of health (relatives or significant
others).
The section on the Assessment of the Family Burden (pages 47-65) follows, with three
questionnaires covering the objective and subjective impact of the situation. Up to here, only
the relatives or significant others playing a parental role complete the evaluation.
Following this, an Assessment of the Family’s Structure and Functioning in daily living is
conducted. The two selected instruments are among the most used in clinical research
(Benoît, Malarewicz, Beaujean, Colas and Kannas, 1988).
It should be noted that these instruments can be completed by all family members who are
fourteen years of age and over.
Although a version for clinicians exists, we opted for self-evaluation by each family member,
which enables us to see how each member perceives the family’s functioning.
Following these evaluations, a rating scale makes it possible to compile and interpret the
information (pages 75-100), while two report outlines (pages 101-112) facilitate the
professional’s clinical appraisal both in terms of evaluation and possible avenues for
intervention.
Centre hospitalier Robert-Giffard, Institut universitaire en santé mentale
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