Quale rapporto tra stile di cure genitoriali, caratteristiche premorbose e presentazione clinica nei pazienti psicotici all’esordio di malattia ?

Aims: Attachment theory had a significant impact on research and may help us in understanding the relationship deficit observed in psychotic patients. In the last years, research and clinical practice focused on a critical intervention area represented by early onset psychosis. The psychosis are characterized, since the onset, by symptoms and social disability, by a worsening trend while the disease advances. The attachment patterns are significantly related with the development of psychosis, and they can condition the course and onset of the illness. For instance, different attachment styles during the childhood could influence, on the adulthood, the mode of illness onset and, ultimately, the prognosis. The concept of attachment derives from Bowlby’s attachment theory, which has had considerable impact on research in developmental psychology. Based on the attachment theory, specific bonding patterns in the early life stages may be key factors for the development of mental disorders in the adulthood. Few research has been conducted on the relationship between parental bonding and the development of psychosis. This study aims to evaluate, in first-episode psychosis patients, if a dysfunctional parental style is associated with: 1) a worse premorbid functioning in childhood and adolescence 2) greater severity in psychopathology 3) a worse social disability since the illness onset. Method: Patients were assessed with a set of standardized measures:Parental Bonding Instrument (PBI), the Premorbid Social Adjustment Scale (PSA), the Positive and Negative Syndrome Scale (PANSS) and the Disability Assessment Schedule (WHO-DAS II), to assess, respectively, perception of parental styles, premorbid adjustment, psychopathology and social disability. Parental Bonding Instrument (PBI; Parker et al., 1979; Favaretto et al., 2001), for parental behavoiur and style evaluation About the Parental Bonding Instrument (PBI), the main instrument investigated, it’s a measures the perception of being parented up to the age of 16 years. Low scores on the care dimension and high scores on the overprotection dimension are considered to be risk factors of depression. While the PBI has been shown to be a reliable and valid instrument, the stability of the PBI over extended periods (taking into account individual characteristics and life experience) has yet to be demonstrated. Two scales termed ‘care’ and ‘overprotection’ or ‘control’, measure fundamental parental styles as perceived by the child. The measure is ‘retrospective’, meaning that adults (over 16 years) complete the measure for how they remember their parents during their first 16 years. The measure is to be completed for both mothers and fathers separately. There are 25 item questions, including 12 ‘care’ items and 13 ‘overprotection’ items. Results: according with literature date, in our sample, the affectionless control style, (high protection e low care) is the most representative in the psychotic patients, (n=120 that is the 48.4%). The optimal style called in literature optimal parenting, characterized by high care e low protection, in our sample is reported only by 44 subjects, that are 17.7% . High care’s levels and high protection’s level, characterizing the affectionless control style, are reported by 53 subjects, that’s the 21.4% of our sample. Low care and low protection, negletful parenting style, characterize the 31 subjects, that’s the 12.5% of our sample. The four quadrants of Parker are represented here, considering the cut-off expected in the literature, or 27 for size 13.5 for the care and protection dimensions. Conclusions: This preliminary results seem to confirm the relevance of the maternal care style in conditioning the first phases of premorbid life in the patients that later will develop a psychosis. In our sample, the so called Affectionless Control style seems to characterize high psychopathology levels and disability at the onset, and is associated with more severe symptoms in specific areas. It is important to note that Care dimension, described by Parker, is the common indicator at the bottom of the psychopathology. This preliminary results, suggest the opportunity to start educational programs focusing on parental style. Psychosis vulnerability is a complex puzzle with many parts still unexplored. More research is needed to clarify the role of each single risk factor and the links between them.