LA COMUNICACIÓN_ EL AMOR Y LA SEXUALIDAD HUMANA

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					INFLUENCE OF PSYCHOPATHOLOGICAL
 DISORDERS OF CHILDREN IN FAMILY
    STRUCTURE AND FUNCTIONING




                                        Adrián Cano Prous
                                         Baras Pastor et al.
                     Dpto. Psiquiatría y Psicología Medica
                           University Hospital of Navarra
                                               www.cun.es
                                               CHILD AND ADOLESCENT
                                                    PSYCHIATRY




SPECIALIZED NURSERY                                                   SPECIALIZED NURSERY




                                   MARITAL AND FAMILY
     PARENTS                                                               CHILDREN
                                        THERAPY




  SOCIAL WORKERS                                                        SOCIAL WORKERS




                      ADULT PSYCHIATRY
MARITAL AND FAMILY THERAPY FRAME

                         CHILD PSYCHOPATHOLOGY



       ¿         ?                                   ¿       ?


     MARITAL                                                FAMILY
   FUNCTIONING                 MFT                       FUNCTIONING


      -                                                            -

                     -                           -
                     ADULT PSYCHOPATHOLOGY
CURRENT SITUATION

          1. MARITAL FUNCTIONING


          2. FAMILY FUNCTIONING


          3. ADULT PSYCHOPATHOLOGY


          4. CHILDREN PSYCHOPATHOLOGY
Marital breakdown I




                      More than 1 million annual
                      divorces

                      One marital breakdown
                      every 30 seconds

                      Over 10 million marital
                      breakdowns in 10 years,
                      that have affected over 15
                      million children
  Marital break-down II
                                        Family breakdown has
                                        increased by far the most
                                        in Spain in the last 10
                                        years.

                                        In Spain, family
                                        breakdown has increased
                                        by 268% in 10 years…




     Germany, UK, France and
     Spain are the UE27 countries
     with the highest number of
     divorces.

Source: Institute for Family Policies
Marital break-down III
                              In europe, marriages
                              that fail last a mean of
                              13 years.

                              Italy is the country
                              where marriage lasts
                              longest (16.8), and
                              Austria the one where
                              it lasts least (10.6).

                              In Spain, marriage
                              lasts a mean of 14
                              years




                         Source: Institute for Family Policies
CURRENT SITUATION

          1. MARITAL FUNCTIONING


          2. FAMILY FUNCTIONING


          3. ADULT PSYCHOPATHOLOGY


          4. CHILDREN PSYCHOPATHOLOGY
 European households I
                                        Only 2.4 members per
                                        household

                                        1.5 persons per
                                        household have been
                                        ‘lost’ since 1980




 Malta, Cyprus, Romania and
 Spain are the countries with
 the highest number of
 members per household

Source: Institute for Family Policies
European households II




                             Households have fewer
                             children.

                             2 out of 3 households
                             have no children

                             Only 17% of households
                             have 2 or more children




                         Fuente: Instituto de Política Familiar
CURRENT SITUATION

          1. MARITAL FUNCTIONING


          2. FAMILY FUNCTIONING


          3. ADULT PSYCHOPATHOLOGY


          4. CHILDREN PSYCHOPATHOLOGY
HOSPITAL ADMISSIONS IN 2007

    ADULTS

   1200000
                                                                Men
   1000000
                                                                Women
     800000                                                     Both
     600000
     400000
     200000
           0
                 25 - 34      35 - 44      45 - 54               55 - 64

       35 – 44 years old: 1.037.803 days admitted to hospital
                                           Source: Spanish National Institute of Statistics
HOSPITAL DISCHARGES IN 2007


  16000
  14000                                                                                                                    Men
  12000                                                                                                                    Women
  10000                                                                                                                    Both
   8000
   6000
   4000
   2000
      0
              2   9          3   4          3   9          4   4          4   9          5   4          5   9          6   4          6   9
       2   5-         3   0-         3   5-         4   0-         4   5-         5   0-         5   5-         6   0-         6   5-




           35 – 44 years old: 27.376 mental illness discharges
                                                                                                     Source: Spanish National Institute of Statistics
CURRENT SITUATION

          1. MARITAL FUNCTIONING


          2. FAMILY FUNCTIONING


          3. ADULT PSYCHOPATHOLOGY


          4. CHILDREN PSYCHOPATHOLOGY
EVOLUTION OF CHILDREN AND ADOLESCENT
PSYCHIATRY CONSULTATIONS
450

400

350

300

250

200                                                                  Patients
150
                                                                                                4000
100

50                                                                                              3500

 0                                                                                              3000
        93     94     95     96     97     98     99     00     01
      19     19     19     19     19     19     19     20     20                                2500

                                                                                                2000

                                                                                                1500

                                                                                                1000

                                                                                                500

                                                                                                  0
                                                                                Total #
                                                                                                         93     94     95     96     97     98     99     00     01
                                                                                consultations          19     19     19     19     19     19     19     20     20
                                                                                                                          Ps




                                                                                                                                                          0
                                                                                                                                                         10
                                                                                                                                                         20
                                                                                                                                                         30
                                                                                                                                                         40
                                                                                                                                                         50
                                                                                                                                                         60
                                                                                                                                                         70
                                                                                                                                                         80
                                                                                                                                                         90
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                                                                                                                         rs
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                                                                                                                               fa
                                                                                                                                  ct
                                                                                                                   O                 or




This program includes all patients under 17 years attended at Mental Health Centres in our community
                                                                                                                      th                s
                                                                                                                         er
                                                                                                                            in
                                                                                                                               fa
                                                                                                                                  nt
                                                                                                                                      D
                                                                                                                                        .
                                                                                                                                                              CHILDREN AND ADOLESCENT PROGRAM




                                                                                                                         Ad
                                                                                                                              di
                                                                                                                                 ct
                                                                                                                  Su               io
                                                                                                                     ic               ns
                                                                                                                        id
                                                                                                                          e
                                                                                                                             at
                                                                                                                                te
                                                                                                                  O                m
                                                                                                                    th                pt
                                                                                                                       er
                                                                                                                           di
                                                                                                                              ag
                                                                                                                W                 no
                                                                                                                 ith
                                                                                                                                     si
                                                                                                                     ou                 s
                                                                                                                         td
                                                                                                                            ia
                                                                                                                               gn
                                                                                                                                   os
                                                                                                                                       is
HOSPITAL ADMISSIONS




     7000
     6000        Men
     5000        Women
     4000        Both
     3000
     2000
     1000
        0
            < 1 año   1a4   5a9    10 a 14   15 a 19      20 a 24



  15 - 24 years old: 10.329 mental illness discharges

                                             Source: Spanish National Institute of Statistics
ADHD
CONSEQUENCES OF UNTREATED ADHD
                                                                  PATIENT
                          HEALTH                                                                 FAMILY
               50%  bike accidents 1                                                            3–5 x  divorce
            33%  emergency room visits2                                                        or separation11,12
                                                                                         2–4 x  fights among siblings 13
           2–4 x other vehicle accidents 3-5                                                  depression in parents


                                                         SOCIETY
                                                         2x risk of                          WORK (PARENTS)
                                                    Substance abuse 8
                                                                                                   Work absence
                                                       Early onset 9
      SCHOOL/WORK                                   More likelihood of                          Lower productivity14
        46% expelled                                   consumption
        35% leaving 6                                 in adulthood10
  Lower occupational level7


 1 DiScala et al, 1998.
 2 Liebson et al, 2001.           6 Barkley et al, 1990.      9 Pomerleau et al, 1995.               12 Brown & Pacini, 1989.
 3 NHTSA, 1997.                   7 Mannuzza et al, 1997.     10 Wilens et al, 1995.                 13 Mash & Johnston, 1983.
 4-5 Barkley et al, 1993, 1996.   8 Biederman et al, 1997.    11 Barkley et al, 1991.                14 Noe et al, 1999.
IMPACT ON THE FAMILY



                                     •    Stress
                                     •    Self-guilt
                                     •    Social isolation
                                     •    Depression
                                     •    Marital disruption



    Mash EJ, Johnston C. J Child Psychol. 1990; 19
PROFESSIONAL IMPACT ON PARENTS OF UNTREATED ADHD CHILDREN


      44%                                     21%

                                                       10%

                                                                  Change work shifts
                                                                  Give up working
                           14%              11%
                                                                  Others
                                                                  Change type of work
                                                                  Shorter time at work




 Note. American Academy of Family Physicians Annual Scientific Assembly, Dallas, September, 2000
HYPOTHESIS AND OBJECTIVES


 MARITAL/FAMILY DYSFUNCTION             DIVORCES/SEPARATIONS

    ¿ ?


                    CHILDREN PSYCHOPATHOLOGY    ¿ ?




                     PSYCHIATRY CONSULTATION
                             Family of children going for follow-up to
                                     GENERAL PEDIATRICS




          Family of children
                                                                     Family of children going to
          first-time going to
                                                                     SPECIALIZED PEDIATRICS
CHILDREN AND ADOLESCENT PSYCHIATRY




                            SOCIODEMOGRAPHIC DATA




                       CHILDREN                                    PARENTS
                       Gender                                    Civil status
                       Age                                 Years of marriage
                       Biologic/adopted                 Socioeconomic level
                       Number of siblings                 Place or residence
                       Position among siblings             Educational level
                       Academic year                             Occupation
                                           Family of children going for
                                                   follow-up to
                                             GENERAL PEDIATRICS




            Family of children
                                                                          Family of children going to
            first-time going to
                                                                          SPECIALIZED PEDIATRICS
  CHILDREN AND ADOLESCENT PSYCHIATRY




                                    SOCIODEMOGRAPHIC DATA



DAS: Dyadic Adjustment Scale: measures quality               FACES III: Family Adaptability and
in family relations                                          Cohesion Evalution Scale: measures adaptability
                                                             and family cohesion




                                FAD: McMaster Family Assessment Device:
                                assesses family functioning
SOCIODEMOGRAPHIC DATA
Ages of family members

            50                          45,1
                                               42,1
            45
            40    37,4
                         34,8
            35
            30
                                                             Fathers
            25
                                                             Mothers
            20                                               Children
            15                                        10,9
            10                  4,7
             5
             0
                 Families healthy     Families patients
SOCIODEMOGRAPHIC DATA


                    15,6
16

14                                            10
                                               9
12
        9,6                                    8
10                                             7

                           Families healthy    6
 8                                                     4,4             Fam
                                                                 4,3
                           Families illness    5                       Fam
 6                                             4
                                               3
 4
                                               2
 2                                             1
                                                   Household members
 0
     Years of marriage
NATURE OF CHILDREN

                        Biologic
      6,6%              Adopted




                                                  Biologic
                                   2,6%           Adopted
                93,4%

     Patients


                                      97,4%


                                              Healthy
CHILDREN GENDER


  37,2%
                        Male

                        Female

                62,8%

     Patients                  42,1%
                                                 Male

                                                 Female

                                       57,9%


                                       Healthy
SOCIOECONOMIC STATUS

                                   2,3%2,3%
                           31,9%                63,5%




             5,8%   5,8%                                Healthy
    38,0%
                           50,4%
                                         Medium-Low
                                         Medium
                                         Medium-High
  Patients
                                         High
PSYCHIATRIC DIAGNOSIS OF CHILDREN



                                        ADHD
            13,0%                       Behavior D.
     3,6%                               ED
  3,7%
                                        Developm ent D.
5,6%                                    Anxiety




                                74,0%
AGE – ACADEMIC YEAR


   11,6%   2,5%



                          Matches
                          Doesn't match

                  85,9%   Doesn't answer

                                              2,6%
      Patients




                                                 97,4%
                                    Healthy
DAS: Dyadic Adjustment Scale: measures the
quality of dyadic relationships
 • FORMAT:
    – 32 items.
    – Different response formats (Likert scales from 2 to
      7 points)
 • SCALES:
    –   Dyadic Consensus
    –   Dyadic Satisfaction
    –   Affectional Expression
    –   Dyadic Cohesion
    –   Dyadic Adjustment (global scale)
DAS - PARENTS OF ILL CHILDREN


   60

   55

   50
                                                                                 Fathers
   45
                                                                                 Mothers
   40

   35

   30
        DYADIC CONSENSUS      DYADIC       AFFECTIVE   DYADIC COHESION   TOTAL
                           SATISFACTION   EXPRESSION
DAS - PARENTS OF HEALTHY CHILDREN


   60

   55

   50
                                                                                 Fathers
   45
                                                                                 Mothers
   40

   35

   30
        DYADIC CONSENSUS      DYADIC       AFFECTIVE   DYADIC COHESION   TOTAL
                           SATISFACTION   EXPRESSION
DAS - FATHERS OF BOTH SAMPLES


   60

   55
                               *
   50
                                                                                 Patients
   45
                                                                                 Healthy
   40

   35

   30
        DYADIC CONSENSUS      DYADIC       AFFECTIVE   DYADIC COHESION   TOTAL
                           SATISFACTION   EXPRESSION
DAS - MOTHERS OF BOTH SAMPLES


   60

   55
                               *
   50
                                                                                 Patients
   45
                                                                                 Healthy
   40

   35

   30
        DYADIC CONSENSUS      DYADIC       AFFECTIVE   DYADIC COHESION   TOTAL
                           SATISFACTION   EXPRESSION
                                 Familia de niños que
                                 acuden a revisión de
    FAD: McMaster Family Assessment Device:
                                PEDIATRÍA GENERAL

    measures family functioning
    Familia de niños que acuden
                                                      Familia de niños que acude a
• FORMAT: 60 items.
        por primera vez a
 PSIQUIATRÍA INFANTO-JUVENIL
                                                     PEDIATRÍA ESPECIALIZADA

• SCALES:
      – Problem solving
                          DATOS SOCIODEMOGRÁFICOS
      – Communication
      – Roles
DAS:– Affective responsiveness
       Dyadic Adjustment Scale: que mide FACES III: Family Adaptability and
la calidad de la relación conyugal       Cohesion Evaluation Scale: que mide la
      – Affective involvement            adaptabilidad y la cohesión familiar
      – Behaviour control
                        FAD: McMaster Family Assessment Device:
                        que evalúa el funcionamiento familiar
                                             Functional
          Pr
               ob
                 le




                                       30
                                            35
                                                          40
                                                               45
                                                                     50
                                                                          55
                                                                               Dysfunctional60
                    m
                          so
                            lv
                              in
           C                       g
               om
                 m
                     un
                       ic
                          at
                             io
                               n


     A                     R
         ffe                   ol
                                 es
            ct
               iv
                 e
                     re
A                         sp
    ffe                     on
                                                                                                 FAD - PARENTS OF PATIENTS




       ct
          iv               e  s
            e
              in
                vo
                  lv
                    em
                        en
           B               t
             eh
               av
                 .C
                     on
                        tro
                            l


                           To
                             ta
                                   l
                                                           Fathers
                                                           Mothers
                                             Functional
          Pr
               ob
                 le




                                       30
                                            35
                                                          40
                                                               45
                                                                     50
                                                                          55
                                                                               Dysfunctional 60
                    m
                          so
                            lv
                              in
           C                       g
               om
                 m
                     un
                       ic
                          at
                             io
                               n


     A                     R
         ffe                   ol
                                 es
            ct
               iv
                 e
                     re
A                         sp
    ffe                     on
       ct
          iv               e  s
            e
              in
                vo
                  lv
                    em
                        en
           B               t
             eh
               av
                 .C
                     on
                        tro
                                                                                                  FAD - PARENTS OF HEALTHY CHILDREN




                            l


                           To
                             ta
                                   l
                                                           Fathers
                                                           Mothers
                                             Functional
          Pr




                                                                                Dysfunctional
               ob
                 le




                                       30
                                            35
                                                          40
                                                               45
                                                                    50
                                                                           55
                                                                                            60
                    m
                          so
                            lv
                              in
           C                       g
               om
                 m
                     un
                       ic
                          at
                             io
                               n


     A                     R
         ffe                   ol
                                 es
            ct
                                                                    *
               iv
                 e
                     re
A                         sp
    ffe                     on
       ct
          iv                  s   e
            e
              in
                vo
                  lv
                    em
                        en
           B               t
                                                                                                 FAD - FATHERS OF BOTH SAMPLES




             eh
               av
                 .C
                     on
                        tro
                            l
                                                                    *




                           To
                             ta
                                   l
                                                                Healthy
                                                                Patients
                                             Functional
                                                                                Dysfunctional
          Pr
               ob
                 le




                                       30
                                            35
                                                          40
                                                               45
                                                                    50
                                                                           55
                                                                                60
                    m
                          so
                            lv
                              in
           C                       g
               om
                 m
                     un
                       ic
                          at
                             io
                               n


     A                     R
                                                                    *
         ffe                   ol
                                 es
            ct
               iv
                 e
                     re
A                         sp
    ffe                     on
       ct
          iv               e  s
            e
              in
                vo
                  lv
                    em
                        en
           B               t
                                                                                                FAD - MOTHERS OF BOTH SAMPLES




             eh
               av
                 .C
                     on
                        tro
                            l
                                                                    *




                           To
                             ta
                                   l
                                                                Healthy
                                                                Patients
                                 Familia de niños que
                                 acuden a revisión de
      FACES III: Family Adaptability and
                                PEDIATRÍA GENERAL
      Cohesion Evaluation Scale: measures
      adaptability and
     Familia de niños que acuden family cohesion
                                                Familia de niños que acude a
        por primera vez a
                                                     PEDIATRÍA ESPECIALIZADA
    • FORMAT: 20 items.
 PSIQUIATRÍA INFANTO-JUVENIL


    • SCALES:
           – Cohesion: assesses emotional bonds betwen family
                          DATOS SOCIODEMOGRÁFICOS
              members
           – Adaptability: assesses family ability to vary its
DAS: Dyadic Adjustment Scale: que mide    FACES III: Family Adaptability and
              structure when needed
la calidad de la relación conyugal        Cohesion Evaluation Scale: que mide la
           – Both scales are represented with the Olsoncohesión familiar
                                          adaptabilidad y la Circumplex

              Model
                        FAD: McMaster Family Assessment Device:
                        que evalúa el funcionamiento familiar
FACES - PARENTS OF PATIENTS
                                   Baja         COHESION           Alta
                            DISENGAGED    SEPARATED   CONNECTED      ENMESHED


                        8
       High
              CHAOTIC

                   7
          F
          L
          E
          X        6                                                            Father patients
          I FLEXI-
          B  BLE
          I        5                                                            Mother patients
          L
          I
          T
                   4
          Y
              STRUCTU-
                RED

                        3


                        2
               RIGID
        Low
                        1



                             EXTREME            MEDIUM            BALANCED
FACES – PARENTS OF HEALTHY CHILDREN
                                  Low         COHESION          High
                           DISENGAGED   SEPARATED   CONNECTED     ENMESHED


                       8
       High
             CHAOTIC

                  7
         F
         L
         E
         X        6                                                          Father healthy
         I FLEXI-
         B  BLE
         I        5                                                          Mother healthy
         L
         I
         T
                  4
         Y
              STRUCTU-
                RED

                       3


                       2
               RIGID
       Low
                       1



                            EXTREME           MEDIUM            BALANCED
FACES III PADRES
                                   High         COHESION          Low
                            DISENGAGED    SEPARATED   CONNECTED     ENMESHED


                        8
        High
              CHAOTIC

                   7
          F
          L
          E
          X        6                                                           Father healthy
          I FLEXI-
          B  BLE
          I        5
          L
          I
          T
                   4
          Y
               STRUC-
                                                                               Father patient
               TURED

                        3


                        2
               RIGID
        Low
                        1



                             EXTREME            MEDIUM            BALANCED
FACES III MADRES
                                  Low         COHESION *        High
                           DISENGAGED   SEPARATED   CONNECTED     ENMESHED


                       8
       High
             CHAOTIC

                  7
         F
         L
         E
         X        6                                                          Mother healthy
         I FLEXI-
         B  BLE
         I        5
         L
         I
         T
                  4
         Y
              STRUC-
                                                                             Mother patient
              TURED

                       3


                       2
              RIGID
       Low
                       1



                            EXTREME           MEDIUM            BALANCED
THANKS FOR YOUR ATTENTION




                                      Adrián Cano Prous
                                       Baras Pastor et al.
                   Dpto. Psiquiatría y Psicología Medica
                         University Hospital of Navarra
                                             www.cun.es