ZEKİYE ÇETİNKAYA DUMAN, NESRİN AŞTI, Alp ÜÇOK, M. Kemal KUŞÇU

Şizofreni hastalarına ve ailelerine 'bağımsız ve sosyal yaşam becerileri topluma yeniden katılım programı' uygulaması, izlenmesi

Amaç: Araştırmada bakım verenlere uygulanan psikoeğitim programının hastalara ve bakım verenlere etkisini incelemek amaçlanmıştır. Bu amaç doğrultusunda bakım verenlere uygulanan psikoeğitim programının hastaların ilaç tedavisi ve kontrol randevularına uyumlarına, hastalığın yinelemesine ve bakım verenlerin duygu anlatımı düzeylerine etkisi incelenmiştir. Yöntem: Araştırmanın örneklemini iki psikiyatri kliniğinde yatan 30 şizofreni hastası ve bakım verenleri oluşturmuştur. Psikoeğitim uygulanan grupta hem hastalara, hem de bakım verenlere program uygulanmış; diğer grupta hastalara program uygulanmış, bakım verenlere uygulanmamıştır. Hastalara İlaç ve Kontrol Randevularına Uyumlarını Değerlendirme Formu, Kısa Psikiyatrik Değerlendirme Ölçeği kullanıl-mış; bakım verenlerle Camberwell Aile Görüşmesi yapılmıştır. Hastalara uygulanan Bağımsız ve Sosyal Yaşam Becerileri Topluma Yeniden Katılım Programı hastalık, ilaç tedavisini yönetim, hastalığın haberci belirtileri ve acil plan geliştirme bölümlerinden oluşmaktadır. Psikoeğitim programı şizofreni ve tedavisi, belirtilerle baş etme, aile tutumlarının hastalığın gidişine etkisi bölümlerinden oluşmaktadır. Bulgular: İki gruptaki hastaların %80’inin yatış öncesinde ilaç tedavisini sürdürmeleri uyumsuz bulunmuştur. Bakım verenlere psikoeğitim uygulanan gruptaki hastaların %66.7’si, psikoeğitim uygulanmayan gruptaki hastaların %46.7’si hastaneye yatış öncesi kontrol rande-vularına uyumsuz bulunmuştur. Bakım verenlere psikoeğitim uygulanan gruptaki hastaların ilaç tedavisi (p=0.004) ve kontrol randevularına uyumlarında (p=0.016), hastaneye yatış öncesine göre anlamlı bir farklılık saptanmıştır. Bakım verenlere psikoeğitim uygulanmayan gruptaki hastaların ilaç tedavisi (p=0.50) ve kontrol randevularına uyumda (p=1.00) fark bulunmamıştır. Bakım verenlere psikoeğitim uygulanan gruptaki hastaların yineleme oranla-rı (%20), psikoeğitim uygulanmayan gruba (%46.7) göre daha düşük olmasına karşın istatistiksel farklılık (p=0.12) bulunmamıştır. Her iki gruptaki bakım verenlerin müdahaleler öncesi ve altı ay sonraki duygu ifadesi düzeyleri arasında fark bulunmamıştır (McN=1.000). Hasta ve bakım verenlere eş zamanlı uygulanan programların hastalar üzerinde etkisi olmasına karşın, bakım verenlerin duygu ifadesi düzeylerine etkisinin olmadığı bulunmuştur. Bakım verenlere duygu ifadesi ile birlikte daha kapsamlı içeriğin olduğu uzun süreli müdahale programlarının geliştirilmesinin ve uygulanmasının gerekli olduğu düşünülmüştür.

Anahtar Kelimeler:

Günlük yaşam etkinlikleri, Görüşme, psikolojik, Kısa psikiyatrik derecelendirme ölçeği, Şizofreni, Bakım verenler, Dışavurulan duygulanım, Tekrarlama, Eğitim

The social and independent living skills, the community re-entery program for and follow-up of patients with schizophrenia and their families

Objective: The purpose of this study was to investigate the effects of caregiver psychoeducation program for both the patients and their caregivers. For this purpose this study was investigated the effects of psychoedu-cation program on the patients’ compliance with their medication and outpatient appointment, on relapse and on the caregivers’ expressed emotions. Methods: The study sample includes 30 inpatients with schizophrenia in two psychiatry clinics and these patients’ care givers. In one group both inpatients and their care givers received psychoeducation, in the other group only the inpatients but not their care givers received psychoeducation. Compliance medication and appointment questionnaire and, Brief Psychiatric Rating Scale tests were appilied to the patients. With care givers Camberwell Family Interview were conducted. Social and Independent Living Skills, The Community Re-Entery Program which are implemented to the patients are composed of such sections as the disease, management of the medication, initial signs of the disease and development of an emergency plan. Psycho-education program consisted of schizophrenia and its treatment, coping strategies with the signs of the disease and effects of family members’ attitudes on the course of the disease. Results: Eighty per cent of the patients in both groups were found to lack compliance with their medication before their admission to the hospital. More than half of the patients in group which received psychoeducation for their care givers (66.7%) and less than half of the patients in the other group (46.7%) were found to lack compliance with their outpatient appointments before the admission. The patients in group which received psychoeducation for their care givers, were significantly different with regards to the compliance with the medication (p=0.004) and outpatient appointment (p=0.016). There were no significant difference between the compliance with the medication (p=0.50) and outpatient appointment (p=1.00) in the patients in the second group. The rate of relapse was found to be considerably high for the patients in the group that did not receive psychoeducation for care givers (46.7%) compared with the the patients in the group which received psychoeducation for their care givers (20%), though the difference was not significant (p=0.12). There was no significant difference between the expressed emotion of care givers in both groups at the onset of the study and six months later (p=1.00). Conclusion: In conclusion, the program implemented simultaneously both on the patients and their caregivers had a strong effect on the patients; but did not affect the expressed emotion in the care givers. Larger studies are needed to investigate not only the expressed emotion but also other parameters in care givers. Thus, long-term programs should be drawn up and carried out.

Keywords:

Activities of Daily Living, Interview, Psychological, Brief Psychiatric Rating Scale, Schizophrenia, Caregivers, Expressed Emotion, Recurrence, Education,

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