Introducción.

La esquizofrenia es un trastorno psicótico crónico cuya prevalencia en adultos es de 0.5 a 1.5%, y su incidencia anual está en un rango de 0.5 a 5 por cada 10,000 habitantes. Los antipsicóticos han demostrado ser efectivos tanto en el tratamiento de la fase aguda de la psicosis como para prevenir las recaías. Sin embargo, con excepción de la clozapina en la psicosis resistente, no han demostrado ser capaces de corregir en su totalidad las alteraciones en el ajuste social y laboral. Diversos autores enfatizan la necesidad de investigar los factores psicosociales que participan en la esquizofrenia, para prevenir las recaídas psicóticas y la rehospitalización. Las aproximaciones que se han hecho respecto a la influencia del entorno familiar se han visto limitadas por cuestiones metodológicas. Si bien es cierto que se ha estudiado el apego para comprender la influencia de la crianza en el proceso evolutivo de la personalidad y de algunas alteraciones psicopatológicas, poco se sabe sobre las relaciones parentales tempranas del esquizofrénico.

Objetivos.

1. Comparar la crianza de los pacientes esquizofrénicos en remisión, con la de sujetos sanos con características sociodemográficas similares; 2. Comparar el patrón de crianza relatado por el paciente esquizofrénico hospitalizado cuando presenta manifestaciones agudas de psicosis, con el que relata después de que estas manifestaciones han sido controladas; 3. Determinar la relación y participación de las dimensiones de la crianza en las manifestaciones de la esquizofrenia y su evolución.

Metodología.

Se realizó un estudio no experimental transeccional correlacional-causal. La población de estudio estuvo formada por los 23 pacientes esquizofrénicos hospitalizados en el Instituto Nacional de Psiquiatría durante el segundo semestre del año 2003, así como por un grupo control formado por 50 sujetos sanos con características sociodemográficas similares. Los instrumentos que se utilizaron en la evaluación fueron la Escala de Síntomas Positivos y Negativos de Esquizofrenia (PANSS, por sus siglas en inglés), y el Instrumento de Evaluación del Vínculo Parental (PBI, por sus siglas en inglés), del que se obtuvieron dos dimensiones: "calidez" y "distancia y frialdad emocional".

Resultados.

Al determinar las diferencias existentes en la percepción de la crianza materna y paterna entre el grupo de pacientes esquizofrénicos en remisión y el grupo control, se encontró que existían diferencias significativas en las dimensiones distancia y frialdad emocional tanto paterna (p = .03) como materna (p = .000). En la comparación de las puntuaciones del PBI materno y paterno de ingreso y egreso, se observó en la crianza materna que la dimensión distancia y frialdad emocional no tuvo cambios significativos; en contraste, la dimensión calidez puntuó más alto al momento del egreso (p =.003). En el caso de la percepción de la crianza paterna, tanto la dimensión calidez (p = .001) como distancia y frialdad emocional (p = .02) obtuvieron una puntuación significativamente más alta al momento del egreso. Para establecer la relación entre estas dimensiones con las variables del padecimiento, se llevó a cabo una correlación de Pearson, encontrándose que en la crianza paterna, la calidez (ingreso) se correlacionó positivamente con los síntomas positivos (ingreso) (p = .032). La calidez (egreso) se correlacionó negativamente con los síntomas positivos (egreso) (p = .027) y el número de hospitalizaciones (p = .034). La distancia y frialdad emocional paterna (ingreso) se correlacionó negativamente con la edad de inicio del padecimiento (p = .04), y positivamente con el tiempo de evolución de la enfermedad (p = .048). La distancia y frialdad emocional (egreso) no tuvo correlación alguna. Respecto a la crianza materna, la calidez (ingreso) se correlacionó positivamente con las puntuaciones de psicopatología general (ingreso) (p = .032) y con los años de estudio del paciente (p = .026). La dimensión calidez (egreso) se correlacionó positivamente sólo con los años de estudio (p = .037). La distanciay frialdad emocional (ingreso) no se correlacionó significativamente, sin embargo al momento de egreso lo hizo positivamente con los años de estudio (p = .03). Para determinar si las dimensiones de la crianza podían predecir la sintomatología del paciente esquizofrénico al momento del egreso, se realizó un análisis de regresión múltiple. Se observó que ambas dimensiones de la crianza tanto materna como paterna pudieron predecir desde 18.2% hasta 44.8% la sintomatología psicótica y otras variables de la enfermedad.

Conclusiones.

El paciente esquizofrénico en remisión percibió a ambos padres más fríos y distantes emocionalmente que el grupo control. En el caso particular de los primeros, se observó que al mejorar la psicosis, mejoraba también la percepción de la crianza. Esta estuvo relacionada con la sintomatología psicótica y con otras variables de la esquizofrenia. Estos descubrimientos señalan la importancia de la crianza en la evolución del paciente esquizofrénico.

Introduction.

Schizophrenia is a chronic psychotic disorder whose prevalence in adults is from 0.5 to 1.5%, and its annual incidence ranks from 0.5 to 5 by each 10,000 inhabitants. Antipsychotic medications have shown to be effective in the treatment of acute psychosis and the prevention of relapse for persons suffering form schizophrenia. However, most of them have not shown to be able to correct fully the alterations in social and labor adjustment. Several studies -refering to the most important advances of the last years regarding this pathology, emphasize the necessity to know which are the psycho-social factors that participate in schizophrenia in order to prevent psychotic relapses and re-hospitalization. Approaches tending to find out the influence of the familiar surroundings have been limited by methodological matters. Although it is certain that attachment has been studied to understand the influence of the raising, in the evolutionary process of the personality and of some mental disorders, little is known about the early parental relations of the schizophrenic.

Objectives.

1. To compare the description of the raising made by the schizophrenic patients in remission, with that made by healthy subjects with similar sociodemographic characteristics; 2. To compare the pattern of raising described by the hospitalized schizophrenic patient while presenting acute manifestations of psychosis, with that described once that such manifestations have been controlled; 3. To determine the relation and participation of the dimensions of the raising in regard to schizophrenia and its evolution.

Methodology.

An explanatory nonexperimental transeccional correlacional causal study was made. The sample was formed by the 23 schizophrenic patients hospitalized in the Instituto Nacional de Psiquiatría during the second semester of 2003, and by a control group formed by 50 healthy subjects with similar socio-demographic characteristics. The schizophrenic patients were evaluated through a clinical history and the application of The Positive and Negative Syndrome Scale (PANSS) and The Parental Bonding Instrument (PBI)(formed by two dimensions: 1. warmth; 2. distance and emotional coldness). These instruments were applied within the first five later days to their hospitalization and within the five previous days to their discharge by improvement. The control group was evaluated only on one occasion. A brief interview was made to collect some sociodemographic data and The Parental Bonding Instrument (PBI) was applied.

Results.

In order to determine the existing differences in the perception of the paternal and maternal raising between the group of schizophrenic patients in remission and the control group, a t test for independent samples was made. As established in the first hypothesis, significant differences in both groups were found, but only in the dimension paternal of distance and emotional coldness (p = .03) and maternal distance and emotional coldness (p = .000). With the purpose of determining the differences in the perception of the raising by the schizophrenic patients while suffering from acute psychosis and once they were in remission, the punctuation of the paternal and maternal PBI of admission and discharge were compared. In the maternal raising it was observed, in spite that both dimensions scored higher at the discharge, that distance and emotional coldness did not show significant changes. Warmth scored significantly higher at discharge (p = .003). In the case of perception of the parental raising, warmth (p = .001) as will as distance and emotional coldness (p = .02) scored significantly higher at the time of discharge. When analyzing with more detail the items of PBI that showed a significant change with the improvement of acute psychosis, it was observed that in the paternal warmth those were items 5 (p = .008), 7 (p = .021), 11 (p = .015), 12 (p = .049) and 17 (p = .047). As to distance and emotional coldness the items that changed were 16 (p = .002), 18 (p = .004) and 23 (p = .012). In the case of maternal warmth, the items that showed a significant change with the improvement of acute psychosis were 3 (p = .03) and 13 (p = .004). In distance and emotional coldness, only number 14 (p = .015) changed. Of the items of paternal being up that showed a significant change at the time of discharge, it was observed that item 5 had direct relation with the positive symptoms of discharge (p = .03); 7 with the positive symptoms of discharge (p = .01), the general psychopathology of discharge (p = .029) and the total qualification of the PANSS of discharge (p = .012); 11 with the positive symptoms of discharge (p = .04), the general psychopathology of discharge (p = .045) and the total qualification of the PANSS of discharge (p = .037); 12 with the positive symptoms of discharge (p = .003), the general psychopathology of discharge (p = .006) and the total qualification of the PANSS of discharge (p = .009); 18 with the general psychopathology of discharge (p = .041). With respect to the maternal raising it was observed that only number 13 correlated with the positive symptoms of admission (p = .014). In order to determine the relation between these dimensions with the variables and evolution of schizophrenia, a correlation of Pearson was made. In the paternal raising, Warmth (admission) correlated positively with the positive symptoms (admission) (p = .032). Warmth (discharge) was negatively correlated with the positive symptoms (admission) (p = .032) and the number of hospitalizations (p = .034).

The paternal Distance and Emotional Coldness (admission) correlated negatively with the age of beginning of the schizophrenia (p = .04), and positively with time of evolution of the disease (p = .048). Distance and emotional coldness (discharge) did not have correlation. With respect to the maternal raising, warmth (admission) was positively correlated with the punctuation of general psychopathology (admission) (p = .032) and the years of study of the patient (p = .026). Distance and Emotional Coldness (admission) did not correlate significantly, nevertheless at the time of discharge did it positively with years of study (p = .03). In order to deter mine if the dimensions of the raising could predict the symptoms of the schizophrenic patient at the time of discharge, a multiple regression analysis was made. It was found that the positive symptoms could be predicted in 41.5% (R² = .415) through the punctuation of the paternal Distance and Emotional Coldness (admission) (P = .510) and paternal Warmth (discharge) (P = -.622). Negative symptoms were not influenced neither by the paternal raising, nor by the maternal one. The punctuation of the scale of general psychopathology of the PANSS could be predicted in 26.3% (R² = .263) through maternal warmth (P = -1.01) (discharge) and maternal distance and emotional coldness (P = .805) (discharge). The total qualification of the PANSS at the time of discharge could be predicted in 29.8% (R² = .298) by maternal warmth (P = .516) (admission) and paternal Warmth (P = -.620) (discharge). The age in with the patient got sick could be predicted though the punctuation of the paternal distance and emotional coldness (P = -.625) (admission) and maternal warmth (P = .5) (discharge) in 44.8% (R² = .448). The time of evolution could be predicted in 18.2% (R² = .182) through paternal Distance and Emotional Coldness (P = .427) (admission). The number of hospitalizations was predicted in 37.5% (R² = .375) by paternal Distance and Emotional Coldness (P = .543) (admission), maternal Warmth (P = -.916) (discharge) and maternal distance and emotional coldness (P = .811) (discharge). The number of days that was committed the patient at the moment of the evaluation could be predicted in 19.6% (R² = .196) by paternal distance and emotional coldness (P = .484) (admission). Other variables, as the years of study were predicted in 18.6% (R² = .186) by maternal warmth (P = .474) (admission).

Conclusions.

The schizophrenic patient in remission had a different perception of their parents than the control group. Schizophrenic patients perceived both parents colder and distant than the control group. In the particular case of first, it was observed that when improving the psychosis, also improved the perception of the raising. This one was related to the psychotic symptoms and other variables of the schizophrenia. These findings indicate the importance of the raising in the evolution of the schizophrenic patient.