Family, twin and adoption studies suggest that susceptibility to schizophrenia is based at least to some extent on genes. The results of these studies vary and depend greatly on the diagnostic criteria used. When a broad definition of schizophrenia is employed, even high degrees of heritability are observed. However, when more narrow criteria are employed, the degrees of heritability decrease. According to a large Finnish adoption study, the patient-family interaction has an even more important role in the origin of schizophrenia than purely genetic factors. Interaction between the genetic factors on the one hand and physical, psychological and psychosocial factors on the other hand is emphasized.
This article describes a psychotherapeutically oriented approach to schizophrenia developed especially to meet the needs of the community psychiatric field. Because of the heterogeneous nature of the schizophrenic psychoses, the authors emphasize that these patients should always be treated based on case-specific premises. The main principles of the need-adapted approach are: 1. The therapeutic activities are planned and carried out flexibly and individually in each case so that they meet the real and changing needs of the patients as well as of their family members. 2. Examination and treatment are dominated by a psychotherapeutic attitude. 3. The different therapeutic activities should support and not impair each other. 4. The process quality of therapy is clearly perceived. A family-centred initiation of the treatment is especially emphasized for both diagnostic and therapeutic reasons. The positive experiences of this led the Finnish national programme for the treatment and rehabilitation of schizophrenic patients to recommend the establishment of family- and environment-oriented acute psychosis teams (APT) in the mental health districts. In later phases of treatment, the significance of individual psychotherapy is increased. The preliminary results of the approach are presented and compared with an earlier sample of patients.
The concept of need-related care for schizophrenia patients, evolved in Abo during the 1980s, consists in a flexible form of psychotherapy oriented care, which in its planning and execution is tailored to meet varying individual needs. It is based both on family and individual therapy and therapeutic groups, drugs being used as support. The results have been promising and it has been possible to reduce hospitalisation.
Comment In: Nord Med. 1993;108(12):326-7, 3298272396