Stress-indicative patterns of non-verbal behaviour. Their role in family interaction.
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Arousal↗
Biomedical subjects
M J Goldstein
Publications and source records attributed to M J Goldstein.
Family interaction versus individual psychopathology. Do they indicate the same processes in the families of schizophrenics?
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Bipolar Disorder↗
Psychosocial strategies for maximizing the effects of psychotropic medications for schizophrenia and mood disorder.
This paper reviews strategies for dealing with psychosocial processes underlying resistance to compliance with psychotropic agents in schizophrenic and bipolar patients. The nature of those processes are described and methods for resolving them are suggested. The strengths and limitations of a narrow psychoeducational approach are discussed. Conditions in which other psychotherapeutic approaches are needed to buttress psychoeducation are illustrated.
Bipolar Disorder↗
Cross-national reliability, concurrent validity, and stability of a brief method for assessing expressed emotion.
The Five-Minute Speech Sample (FMSS; Magana et al., 1986) is a brief method designed to assess the "expressed emotion" (EE) status of a respondent. The FMSS-EE rating is derived from statements made by a patient's key relative during a 5-minute monologue, with codes similar to those used in the original EE rating system (e.g., criticism and emotional overinvolvement). Rating is done from the audiotape and takes about 15-30 minutes. The article reports on the results of a cross-national study carried out in Germany using the FMSS with a sample of 60 relatives of schizophrenic patients. Results indicated that (1) German investigators could readily learn the system and could achieve a high degree of interrater reliability; (2) the association with the original index of EE, the Camberwell Family Interview, was comparable to that found by Magana et al.; and (3) the method yields very stable data over a 4-5 week retest period.
Adolescent↗
Communication deviance in families of schizophrenic and manic patients.
Levels of communication deviance (CD) distinguish parents of schizophrenic patients from parents of nonpsychotic patients, but the prevalence of intrafamilial CD in other psychotic disorders has not been examined. Levels of CD were compared across biological parents of schizophrenic (n = 39) and bipolar manic (n = 16) patients and across patients themselves. CD ratings were based on Thematic Apperception Test protocols (parents only) and family interactions (parents and patients). Total levels of CD did not distinguish between groups of parents or patients. However, instances of odd word usage were more frequent among parents of manic patients than among parents of schizophrenic patients on both CD measures. Also, during the interaction task, odd word usage was more frequent among manic patients, whereas schizophrenic patients made more ambiguous references. Results suggest that high levels of intrafamilial CD are not unique to schizophrenia.
Adolescent↗
Parental affective style risk and the family system: a social relations model analysis.
Social relations model analysis was used to clarify family dynamics associated with parental affective style, an index of parent-to-child behavior associated with severe psychopathology in the child. Results from 70 families who had sought clinical services for an adolescent family member (39 girls and 31 boys) suggest (a) that adolescents elicit the negative parental affective style that puts them at risk and (b) that elicitation of negative parental affect is strongly tied to adolescents' expression of negative affect toward their parents (i.e., a reciprocity effect). The findings support the views that children contribute to their own risk of psychopathology and that parent-child behavior ought to be interpreted in the broader context of the family system.
Adaptation, Psychological↗
Determinants of expressed emotion in families of disturbed and normal children.
Both high expressed emotion (EE) and psychiatric disorders were frequent in the parents of children and adolescents with disruptive behavior disorder (DBD, N = 34) and obsessive compulsive disorder (OCD, N = 49) compared to normal controls (NC, N = 41). Parental psychiatric diagnosis was significantly related to high-EE in fathers (p = .0002) and mothers (p = .0001) of all groups combined, and in parents of the ill groups (p = .03). Absence of diagnosis was associated with low-EE in fathers (p = .0006) and mothers (p = .04) of the controls. Psychiatric diagnosis was the only significant predictor for high-EE in fathers, while for mothers child's diagnosis was a stronger predictor.
Adolescent↗
Changes in patient coping style following individual and family treatment for schizophrenia.
Changes in relatives' affective attitudes are important contributors to the impact of family psychoeducational programmes on the course of schizophrenia. It remains unclear whether similar changes occur in the interactional style of schizophrenic patients participating in psychoeducational treatment. This study examined changes in the interactional style (coping style) of 33 schizophrenic patients in individual or family treatment. Significant changes were seen in the interactional style of the patients participating in the individual treatment. Similar changes were evident, but not significant, in the family treatment group. The quality of patient interactional style before or after treatment did not predict relapse in either group. Changes in relatives' interactional style early in family treatment are necessary to affect the short-term course of schizophrenia. Modification in patient behaviour during the early phase does not have similar predictive value.
Adaptation, Psychological↗
Defining treatment refractoriness in schizophrenia.
Addressing the need for research on the nature of refractoriness to antipsychotic drug therapy exhibited by a substantial minority of schizophrenic patients, Philip R.A. May and Sven Jonas Dencker instigated an international study group to discuss this problem, beginning with the International Congress of Neuropsychopharmacology in Göteborg, Sweden, in 1980. The study group subsequently met in Haar, Federal Republic of Germany, in 1985; in Banff, Canada, in 1986; and again in Telfs, Austria, in 1988. The study group set three objectives: (1) to clarify the concept of treatment resistance or refractoriness; (2) to suggest criteria for defining or rating the degree of treatment refractoriness; and (3) to explore the role of psychosocial and drug therapies in increasing the responsiveness of the treatment refractory patient. This position article represents a distillation of the study group's efforts to define treatment refractoriness in schizophrenia.
Activities of Daily Living↗
Family factors associated with aggressive symptomatology in boys with attention deficit hyperactivity disorder: a research note.
This study tested whether parent and child affective attitudes and interactional behavior co-varied with the presence or absence of associated aggressive symptomatology in families with an attention deficit hyperactivity disorder (ADHD) child. Affective attitudes of both parents and their ADHD sons were studied using a modified measure of expressed emotion, the five minute speech sample (FMSS-EE), in 29 families. A direct interaction task was also used to measure verbal and non-verbal communication. FMSS-EE status predicted parental interactional behavior, but the degree of child aggressiveness did not. The child's behavior towards parents, however, was highly correlated with their aggressiveness but not their EE status regarding their parents, despite the fact that child and parent EE were highly correlated. The study supports the notion that aggressiveness and a negative family climate may be independent factors in determining the long-term course of ADHD children.
Adolescent↗
Can communication deviance be measured in a family problem-solving interaction?
Communication deviance (CD) refers to confusing and fragmented communication that prevents family members from attaining a shared focus of attention and meaning. Levels of communication deviance based on individual parental projective test protocols--Thematic Apperception Test (TAT) and Rorschach--have repeatedly been found to be higher in parents of schizophrenic offspring than in parents of normal or nonpsychotic offspring. CD has also been measured in family transactions in which parents and their offspring interact with one another around a projective test stimulus, the Consensus Rorschach. There have been relatively few attempts to measure specific CD codes in familial interaction that is not initiated around an ambiguous visual stimulus. The present article examines the reliability and construct validity of an interactional measure (ICD) obtained from family transactions in which parents and patients are working toward the solution of a salient family problem. ICD from this family problem-solving task was compared to more traditional measures of CD from parental TAT protocols in a sample of 59 parents of 37 recent-onset schizophrenic patients. Results indicated that CD could be reliably measured in an interactive setting not initiated around a projective test stimulus, and provided evidence for the construct validity of ICD.
Adolescent↗
Behavioral family treatment for patients with bipolar affective disorder.
Techniques of behavioral family management (BFM), which have been found to be highly effective in delaying relapse for schizophrenic patients when used as adjuncts to medication maintenance, are also applicable in the outpatient treatment of recently hospitalized bipolar, manic patients. The authors describe their adaptation of the educational, communication skills training, and problem-solving skills training modules of BFM to families containing a bipolar member. The observations that families of bipolar patients are often high functioning, and that these families seem to enjoy interchanges that are highly affective and spontaneous, led to certain modifications in the original BFM approach. The authors found it necessary to be (a) more flexible and less didactic, (b) more oriented toward dealing with affect and resistance to change, and (c) more focused on the patient's and family members' feelings about labeling, stigmatization, and medication usage. Research issues relevant to testing the efficacy of this approach are also discussed.
Adult↗
Expressed emotion and patient-relative interaction in families of recent onset schizophrenics.
This article examines the interaction patterns of relatives of young, recent onset schizophrenic patients classified as displaying either high or low expressed emotion (EE) by two measures, the original Camberwell interview method and a recently developed brief method. The former was administered during the hospitalization period and the latter was administered approximately 2 months later when the patient was in the community. Family interactions were coded with an observational coding system that permitted sequential patterns to be analyzed as a function of the EE status of the family. No relation between the Camberwell EE rating and interactional behavior was found. However, high EE-critical relatives, defined by the brief EE method, were more negative in direct interactions than low EE relatives or high EE relatives classified as emotionally overinvolved. Sequential analyses indicated that high EE-critical relatives showed extreme negative escalation patterns. Patients' reactions to high EE-critical relatives were characterized by self-justification and negative nonverbal behavior.
Adult↗
Is expressed emotion an index of a transactional process? I. Parents' affective style.
The degree to which expressed emotion (EE) attitudes in key relatives reflect ongoing transactional processes in families is a topic of controversy. The associations between EE attitudes, as measured during an acute hospitalization (using the Camberwell Family Interview) and during the aftercare period (using 5-minute speech samples), and interactional behavior in parents of recent-onset schizophrenics (this article) and in patients themselves (second article), were investigated. In the first study, EE attitudes manifested by parents during the aftercare period were stronger correlates of their interactional behaviors during the aftercare period than were EE attitudes measured during the inpatient period, despite the frequent correspondence between the two EE measures. The pattern of attitudes shown between the inpatient and outpatient periods also predicted transactional styles in parents during the outpatient period, findings not accounted for by clinical attributes of patients. When high-EE attitudes persist during the aftercare period and are reflected in transactional behaviors, the risk for subsequent patient relapse may be enhanced.
Adolescent↗
Is expressed emotion an index of a transactional process? II. Patient's coping style.
This article examines the extent to which expressed emotion (EE) indexes not only relatives' behavior toward schizophrenic patients but also patients' behavior toward their relatives. The coping styles (CS) of schizophrenic patients were assessed during interactions with their parents and were compared with parental EE attitudes assessed during an acute hospitalization and during the aftercare period. It was found that parental EE attitudes measured during the inpatient period strongly predicted patients' outpatient transactional behavior: patients interacting with low-EE relatives showed significantly fewer critical and more autonomous statements than patients interacting with high-EE relatives. Further, the dominant patient coping style (autonomous, neutral, externalizing, or internalizing) was strongly related to the relatives' interactional affective style (AS) and to their pattern of EE attitudes. Patient coping style was not related to clinical attributes of these patients themselves. This article and its preceding companion (17) together suggest that EE indexes a transactional process so that the quality of both parents' and patients' transactional behaviors may predict subsequent patient functioning.
Adaptation, Psychological↗
Expressed emotion and reciprocal affective relationships in families of disturbed adolescents.
Relatives' expressed emotion (EE) is a known risk factor for relapse among recovering psychiatric patients. Recent research has focused on the behavioral correlates of EE, seeking better understanding of the family processes associated with this important variable. The present study used sequence analysis to explore interactions of high-EE and low-EE parent-child dyads in a sample of disturbed adolescents. High-EE mother-child interactions were characterized by bidirectional influence, and, in contrast to adolescents in low-EE dyads, adolescents in high-EE dyads had an oppositional style of responding. In Low-EE mother-child interactions, the adolescents showed more temporal consistency (stability) of affect than their high-EE counterparts. Overall, the results suggest that high-EE mother-child dyads constitute more tightly joined emotional systems than low-EE dyads. Consequently, interventions designed to reduce this connectedness might also reduce the risk of adolescent psychiatric problems.
Adolescent↗
The initial onset of schizophrenia and family expressed emotion. Some methodological considerations.
The relationships between duration of schizophrenic illness before first hospital admission, expressed emotion in key relatives, and illness course have yielded conflicting reports. This study examined the issue from a methodological perspective in a sample of first-episode schizophrenic patients. A 'best estimate' of illness onset, based on a compilation of all sources, was compared with an estimate based on parental report. Parental estimates suggested that the children of high-EE parents had been ill for significantly longer, but this difference was not confirmed by the best estimate. In most cases, the ill children of high-EE parents were living at home before hospital admission and their parents' estimates of duration were quite accurate. In the few cases in which the child was living away from home, high-EE parents strikingly overestimated duration. Children of low-EE families were more likely to be living away from home, but this factor did not explain the consistent underestimates of duration made by their parents. Although duration of illness did not relate to EE, successful engagement in out-patient before in-patient treatment was more common among children from low-EE families.
Adolescent↗
Patterns of expressed emotion and patient coping styles that characterise the families of recent onset schizophrenics.
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Adaptation, Psychological↗