The Association for Research on Schizophrenia is a non-profit organization, recognized as tax-exempt by the Regione Lombardia (Registro del Volontariato, foglio n.165 progr. N.493). It is animated by an earnest desire to research on the causes and the evolution of Family distress in all medical and psychiatric illnesses; it also aims at promoting links of solidarity with the patients and their families. The aims of the Association include social, scientific, and clinical activities.

a) SOCIAL ACTIVITIES

- to promote, develop and entertain links of solidarity with the patients and the families whose members are directly or indirectly involved in the illness;
- to inform the general public, mainly by the mass-media, about the risk-factors and the early symptoms of psychiatric diseases, and of the Family distress connected with medical and neuropsychiatric illnesses.

b) RESEARCH ACTIVITIES

- to stimulate and promote studies focused on the concept of integration, the research on the biological, psychological and social factors which concur in the determinism, the evolution and the treatment of the various psychiatric syndromes and of psychiatric correlates of other medical conditions (e.g. multiple sclerosis, HIV-related pathologies, etc.)
- to work out articulate research and prevention projects.

c) CLINICAL ACTIVITIES

- to offer an articulated multidimensional Family treatment program for families in distress;
- to directly help patients through outpatient service for diagnosis, drug therapy and psychotherapy;
- to work with families of children and adolescents with specific clinical conditions.

Historical notes

The Association for Research on Schizophrenia (ARS) was created in Italy by Prof. Carlo Lorenzo Cazzullo (the founder of the new Italian scientific Psychiatry), a few years after the psychiatric law of reform was passed, transforming psychiatric assistance from hospital- to Family-based.

Immediately became evident that intervention with the Family was the critical area for dealing with the most important psychiatric disorders. There was an "area of distress" which seemed to surround the clinical manifestations of any psychiatric illness. The borders of this area almost always touched on family limits. Consequently the family was chosen as the focus of research and intervention.

The Association team immediately proposed two different orientations. On one hand it was considered the importance of providing an immediate and concrete help to families, by giving information about the manifestations of the illnesses and how to deal with them. On the other hand the attention was focused upon the necessity of having a direct influence on the interactions among family members, thus inducting support by reorganization of relationship (the work on the so-called "expressed emotion" - EE).

It was decided to explore both directions, including only relatives and excluding patients. The "multidimensional" model proposed is a family psychoeducational intervention.

In practice it employs a four-step procedure:

1. First contact and Family counseling
2. Information group
3. Support group
4. Family therapy or Multifamily Group Therapy or Self-help Group. Subsequently, the family intervention model was established in regard to schizophrenia, through the long lasting partnership with the Legrenzi Foundation for Family Aid another non-profit organization, recognized by the President of the Italian Republic.

The Associatin for Research on Schizphrenia is affiliated as a member society to the World Psychiatric Association. Presently, ARS is also involved in research on the biological causes of schizophrenia (immunology), while the Legrenzi Foundation carries out research on family dynamics. In the last few years, the activity of the A.R.S. have targeted all family and individual implication and distress due to chronic organic and psychiatric illnesses.

In 1996 a new experimental Center for the Psychotherapy of Infants and Adolescents has been activated through a convention partnership with the School of Child Neuropsychiatry of the University of Milano and recognized by Regione Lombardia. The Center works in continual contact with the family therapy team. All activities are recognized by Regione Lombardia and by all the relevant public and private institutions of the city of Milan. The Association is specifically recognized by a legal act of the University of Milan.

The Model of Intervention of the a.r.s.

The A.R.S. family intervention system is based on two characteristics: immediateness and flexible acknowledgment of the subjective and objective burden that families are to endure, when dealing with any chronic pathology.

1. FIRST CONTACT AND FAMILY COUNSELLING

Usually the first contact is by phone (national help-line). The calls, received by one of the team members, have an immediate supportive-effect. The main goals are:

a) to collect information about the family situation;
b) to create a link between the team and the relative, and if necessary to give immediate information and counseling in case of high anxiety levels;
c) to choose a preliminary strategy of intervention.
The family or the relative who has established the first contact has an interview with a therapist, in which the expectations and requests are clearly defined. The therapist takes the role of the "family counselor": this figure should first of all develop a therapeutic alliance with family members. In this way, a strong relationship between therapist and family will be established.

2. INFORMATION GROUP

The information groups for relatives are composed of a maximum of 15-18 members and last 6-7 months, consisting of ninety-minute meetings once a week. There are two leaders (psychiatric professionals) and for every specific subject we call in an expert in the field. The program includes the following subjects:
a) clinical aspects;
b) methods of treatment and cure (pharmacological therapy, rehabilitation, family therapy, psychoeducation, psychotherapy);
c) behavioral pathology;

d) legal aspects;
e) social aspects (stigma, burden of care).
Every single subject is presented in a clear and comprehensive way by the expert. In each session, after presentation, the group will discuss the information received the week before. Besides the therapeutic potential of informing, other positive factors are activated that are all part of a correct management of the dynamics within a group, such as:
- giving hope,
- sharing the common problem,
- reducing the tension in the family members,
- learning and confronting the opinions.

3. FAMILY PSYCHOEDUCATIONAL TREATMENT: SUPPORT GROUP

The fundamental aim of this group is to lead the relatives to modify their relational attitude by developing a higher level of empathy and an ability of coping with problems. Each relative should acquire the following skills:

1. understanding of the psychological necessities underlying the symptoms and disturbing behavior;
2. realistic acceptance of each other's needs;
3. reduction of excessive expectations that could overload the patient;
4. more effective channels of communication that have to be reinforced by the elaboration of the group.

The passage from one step to the next is not automatic, but is the consequence of a team decision, based on the characteristics (EE profile) and requests (burden of care) of the families. The phases mentioned above are an orientation framework for the therapist, but the treatment may include more or fewer steps.

Fund raising

The funding of the Association consist in:
- donations,
- legacies,
- fund-raising and subscriptions promoted by the members and by private or public Institutions.

How is possible to contribute to the work of the Association ?

- spreading the news about the Association and the Association to people who can be interested in our activities,
- offering help in the organization of conferences, symposia, meetings,
- offering scholarships and awards for studies in the psychiatric field.

Scientific activities

The scientific activities of the Association have targeted several subjects, and namely:

- family dynamics in schizophrenia, with specific regard to the emotional climate (expressed emotion);
- family dynamics in other pathologies (i.e., multiple sclerosis, mood disorders, HIV-related pathologies);
- organization of congresses, workshops and panels with national and international proceedings.

The Association has been actively organizing national and international congresses since 1986;

- an important yearly appointment is the "Legrenzi Lecture", which has involved the most important figures in psychiatry, such as E. Costa, E. Borgna, N. Sartorius and others;
- the Association Work Group has published several scientific papers in the main Journals of the field, as well as books directed both to professionals and to the general public;
- the President of the Association is the director of the Italian Journal of Psychiatry and Behavioural Sciences, the official Journal of the Italian Psychiatric Association.
- "Albert Schweitzer" Gold Medal for high merits in the Humanization of Medicine.