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PubMed2000

Brief screening for family psychiatric history: the family history screen.

BACKGROUND: Brief screens to collect lifetime family psychiatric history are useful in clinical practice and for identifying potential families for genetic studies. METHODS: The Family History Screen (FHS) collects information on 15 psychiatric disorders and suicidal behavior in informants and their first-degree relatives. Since each question is posed only once about all family members as a group, the administrative time is 5 to 20 minutes, depending on family size and illness. Data on the validity against best-estimate (BE) diagnosis based on independent and blind direct interviews on 289 probands and 305 relatives and test-retest reliability across 15 months in 417 subjects are presented. RESULTS: Agreement between FHS and BE diagnosis for proband and relative self-report had median sensitivity (SEN) of 67.6 and 71.1 respectively; median specificity (SPC) was 87.6 and 89.4, respectively. Marked decrease in SEN occurred when a single informant (the proband) reported on a relative (median, 37.5); however, median SPC was 95.8. Use of more than 1 informant substantially improved SEN (median, 68.2), with a modest reduction in SPC (median, 86.8). Test-retest reliability across 15 months resulted in a median kappa of 0.56. CONCLUSIONS: The FHS is a promising brief screen for collecting lifetime psychiatric history on an informant and/or first-degree relatives. Its validity is best demonstrated for major depression, anxiety disorders, substance dependence (alcohol and drug dependence), and suicide attempts. It is not a substitute for more lengthy family history if more detail on diagnosis is required.

Adolescent↗
PubMedDate not supplied

Family grief therapy: a preliminary account of a new model to promote healthy family functioning during palliative care and bereavement.

The family is usually the primary provider of care for the terminally ill patient with cancer or other serious progressive illness. The way in which such a family functions is a major determinant of psychological well-being for its members. Through screening with the Family Relationships Index (FRI) (Moos and Moos, 1981), dysfunctional families and those at risk can be identified, and then helped to achieve better family functioning, thus improving psychosocial outcome of their grief. In this paper, we describe the techniques and themes involved in the application of our empirically developed model of family grief therapy, designed as a preventive intervention for use in the setting of palliative care and bereavement.

Adaptation, Psychological↗
PubMed1992

Family management of schizophrenia: a comparison of behavioral and supportive family treatment.

This paper reports a comparison of behavioral and supportive family treatment for family management of schizophrenia. The family project applied two psycho-educational approaches to a highly "treatment resistant" population of young adults afflicted with chronic mental illness. The study compares and contrasts the effects of behavioral and supportive family management programs on clinical outcomes. Clinical improvements were associated with both family interventions. Discussion is provided on the relevance of this work to the growing body of evidence concerning the efficacy of psychoeducational family intervention for the management of schizophrenia.

Adolescent↗
PubMed1996

Family System Test (FAST): the relevance of parental family constructs for clinical intervention.

On the basis of the Family System Test (FAST), family representations of parents with healthy and biopsychosocially distressed children were compared, and family structure changes in the context of interventions on the parent-level were described. Results indicated that parental family constructs are related to offspring's health and clinical intervention. Parents of psychiatric patients showed their families to have low cohesion, and hierarchically unclear generational boundaries (i.e. unbalanced structure). As had been their wish at therapy onset, the family patterns they indicated after completion of treatment were balanced.

Child↗
PubMed2002

Carotid artery intima-media thickness in Finnish families with familial combined hyperlipidemia.

BACKGROUND: Familial combined hyperlipidemia (FCHL) is the most common hereditary lipid disorder that predisposes the patients to premature coronary heart disease. Members of FCHL families are categorised as affected or unaffected according to serum lipid levels. This study is aimed to evaluate whether there is a difference in carotid artery wall thickness between asymptomatic FCHL family members who are affected and those who are unaffected according to the currently used lipid criteria. METHODS AND RESULTS: Carotid artery ultrasonography with intima-media thickness (IMT) measurements was performed for 148 members of 39 Finnish FCHL families. Study subjects who had no history of coronary heart disease or stroke were divided into two groups according to their serum total cholesterol and/or triglyceride levels. The average carotid IMT of the affected subjects (0.75+/-0.15 mm) was not significantly different from that of their unaffected relatives (0.73+/-0.13 mm), P=0.90. In multivariate analysis, age, gender, and pulse pressure, but no lipid variables, contributed significantly to the variation of carotid IMT. CONCLUSIONS: The IMT findings in FCHL family members indicate that the current lipid criteria alone are of limited value in predicting long-term risk of cardiovascular disease in asymptomatic members of FCHL families.

Adult↗
PubMed2000

MEFV mutations in multiplex families with familial Mediterranean fever: is a particular genotype necessary for amyloidosis?

Familial Mediterranean fever (FMF) is an autosomal recessive disease. It is characterized by recurrent febrile episodes in association with peritonitis, pleuritis, and arthritis. Progressive systemic amyloidosis is the most important complication of FMF that inevitably leads to chronic renal failure. Recently, the gene for FMF, MEFV, has been cloned and four missense mutations have been described: M694V, M680I, V726A, and M694I. Initial studies have suggested that the presence of the M694V mutation carries a significant risk for the development of amyloidosis. In this study, we present seven families, in which at least two individuals have been diagnosed with FMF and at least one with amyloidosis. Among 18 individuals, in whom molecular testing was performed for the four aforementioned mutations, ten had amyloidosis. None of these ten individuals was found to be homozygous for the M694V mutation. In three families, there were two sibs with amyloidosis. None of the sib-pairs with amyloidosis was found to have the same genotype. There were two or more sibs with the same genotype in four families. Only one sib from each family developed amyloidosis in these families. These results provide evidence that FMF patients without the M694V mutation are also at risk for the development of amyloidosis. Particular mutations themselves do not appear to be sufficient to explain the occurrence of amyloidosis in all cases with FMF.

Adolescent↗
PubMed2004

Family income and its relation to preschool children's adjustment for families in the NICHD Study of Early Child Care.

The current study examines relations of mean-level estimates, linear changes, and instability in income and family processes to child outcomes and addresses whether income, through its impact on family functioning, matters more for children living in poverty. Temporal changes and instability in family processes, but not income, predicted children's adjustment. Cross-sectional mediational analyses indicated that for families living at the poverty threshold, family processes fully mediated the effect of average income over the study period on social behavior but only partially mediated its effect on cognitive-linguistic development. The strength of these associations diminished as average income exceeded the poverty threshold. That is, income had a greater impact on the family functioning and development of poor children than of nonpoor children.

Child Behavior Disorders↗
PubMed2004

Coexistence of familial transthyretin amyloidosis ATTR Val30Met and spinocerebellar ataxia type 1 in a Japanese family--a follow-up autopsy report.

Three brothers in a family with Val30Met transthyretin (TTR) amyloid polyneuropathy (FAP) in Iiyama, Japan were studied pathologically. In this family, affected members have been reported to show typical clinical features of FAP, and some have been documented to exhibit symptoms and signs of central nervous system (CNS) involvement consisting of cerebellar ataxia and pyramidal tract signs. After the original description, this family was regarded as a unique phenotype of this form of FAP; however, subsequent molecular genetic studies revealed that some patients and asymptomatic members in the family had Val30Met TTR and/or spinocerebellar ataxia type 1 (SCA1) gene mutations. In this study, pathological examination of two patients with both FAP and CNS symptoms showed (1) TTR-immunoreactive leptomeningeal and cerebrovascular amyloid deposition compatible with Val30Met TTR FAP, and (2) neuronal loss and gliosis mainly in the Purkinje cell layer, spinocerebellar system, olivo-ponto-cerebellar system, dentato-rubral system, gracile nuclei, cuneate nuclei, and various nuclei of cranial nerves, accompanied by anti-expanded polyglutamine tract antibody positive neuronal intranuclear inclusions, all of which were compatible with the pathological findings of SCA1. On the other hand, the remaining patient with FAP symptoms only showed the former pathological finding alone. The present study demonstrates, at the pathological level, that Val30Met TTR FAP and SCA1 coexist in the same family members, and that the CNS dysfunction seen in the patients in this family is ascribable to SCA1 pathology but not to CNS amyloidosis.

Amino Acid Substitution↗
PubMed2006

Effects of behavioral family systems therapy for diabetes on adolescents' family relationships, treatment adherence, and metabolic control.

BACKGROUND: Behavioral family systems therapy (BFST) for adolescents with diabetes has improved family relationships and communication, but effects on adherence and metabolic control were weak. We evaluated a revised intervention, BFST for diabetes (BFST-D). METHODS: One hundred and four families were randomized to standard care (SC) or to 12 sessions of either an educational support group (ES) or a BFST-D over 6 months. Family relationships, adherence, glycosylated hemoglobin (HbA1c), and health care utilization were measured at baseline and after treatment. RESULTS: BFST-D significantly improved family conflict and adherence compared to SC and ES, especially among those with baseline HbA1c > or = 9.0%. BFST-D and ES significantly improved HbA1c compared to SC among those with baseline HbA1c > or = 9.0%. CONCLUSIONS: The revised intervention (BFST-D) improved family conflict and treatment adherence significantly, while both ES and BFST-D reduced HbA1c significantly, particularly among adolescents with poor metabolic control. Clinical translation of BFST-D requires further study.

Adolescent↗
PubMed1987

Permutation analyses of familial association arrays for lipoprotein concentrations in families of the Stanford Five City Project.

Permutation models are introduced as a formal method for assigning significance to association matrices that assess the correlation of spouse, parent-offspring, and sibling similarity over an entire class of data transformations (usually, the class of all increasing functions). Analysis of 218 nuclear families who participated in the Stanford Five City Project revealed that parent and offspring triglyceride concentrations correlated more strongly when data transformations emphasized contrasts among low to moderate levels, and that high density lipoprotein (HDL) cholesterol correlated more strongly between family members with relatively higher HDL cholesterol concentrations. Application of family weights to the association matrices revealed a tendency for greater correlation among sibling triglyceride concentrations in larger families. Parent-child, mother-child, father-child, parent-daughter, and sibling total cholesterol concentrations correlated significantly for all monotonically increasing transformations (designated strong association), and father-daughter and parent-son cholesterol concentrations correlated significantly for most increasing transformations of the data (moderate association). There were fewer significant associations for plasma triglyceride concentrations: parent-child and sibling (both strong), parent-daughter and mother-daughter (both moderate), and mother-child (weak). HDL cholesterol showed no strong or moderate familial associations and was weakly associated only among siblings. Thus, concordance in familial lipoprotein levels appears to be restricted to a narrower range of values for triglycerides and HDL cholesterol than total cholesterol levels, possibly reflecting in part the influences of diet or other environmental factors on specific regions of the HDL cholesterol or triglyceride distributions in casual blood samples.

Adolescent↗
PubMed2000

Valuing families: social work practice with families from a strengths perspective.

Social work and social workers have long been concerned with families. Historically, most approaches to social work with families have focused on individual pathology and problem solving or have considered problems of a family member to be symptoms of family dysfunction. In contrast, other approaches to social work have focused on growth, function, and healing. This article describes both problem-focused and growth-focused approaches to practice and presents a strengths approach to practice that values families and builds resilience. Assumptions of the strengths approach are discussed and applied to work with families through a case example.

Family↗
PubMed2002

Family routines: a structural perspective for viewing family health.

Although rituals are considered in the anthropological and sociological literature, less attention is given to associated biophysical and health perspectives. Three ethnographic studies were conducted to identify the ways family health was defined and practiced. Findings indicated that routines were an important aspect of family health. Families described routines linked to family health and discussed how they evolved, ways they were modified over time, and how families recreated them when stress and change were encountered. Findings indicated that routines provide a structural perspective for assessments, interventions, and outcome evaluations related to health and useful to nursing practice. This article explains some of what is known about family routines, describes the author's findings, and suggests implications for nursing.

Activities of Daily Living↗
PubMedDate not supplied

Family interdependence and academic adjustment in college: youth from immigrant and U.S.-born families.

This study is an examination of family interdependence and its implications for academic adjustment among late adolescents and young adults in college (18 to 25 years). Survey data and university records were collected on 998 American youth with Asian Pacific, Latino, African/Afro-Caribbean, and European backgrounds. Results indicate that Asian Pacific Americans placed more importance on family interdependence than did European Americans. Across all panethnic groups, youth with immigrant parents placed greater emphasis on family interdependence than did youth with U.S.-born parents. The study distinguished between family interdependence attitudes and behaviors and found that they had counteracting influences on academic adjustment: Family obligation attitudes contributed to greater academic motivation among youth from immigrant as compared with U.S.-born families, but greater behavioral demands detracted from achievement.

Adaptation, Psychological↗
PubMed1976

Family of origin as a therapeutic resource for adults in marital and family therapy: you can and should go home again.

This paper presents a general method of involving adults who are in marital and family therapy in sessions with their family of origin, offering a clinical application of the author's depth theoretical orientation. The method is based on the thesis that current marital and family difficulties are elaborations of relationship problems of the spouses in their original families. If adults are able to go back to deal directly with past and present issues with their families or origin, an opportunity exists for reconstructive changes to come about in their present family. This present work is compared with Bowen's methods. Procedures are outlined for preparing for these sessions and for overcoming resistances. Typical courses these sessions tend to take are described, and some preliminary results are presented. Several case histories are presented, and theoretical and clinical implications of this method are discussed.

Adult↗
PubMed1982

The therapeutic advantage to the family therapist of intervening in the family-clinician system.

Attempting family therapy in the context of a family-clinician system poses extreme difficulties for the therapist. He cannot be effective if he diagnoses only the family system. He must broaden his analysis to include other clinicians' transactions with the family. Once he accomplishes this perceptual leap, he can intervene in the family-clinician system most effectively with paradoxical methods. He may find that a change in his own contribution to the system solves the family's problem.

Family Therapy↗
PubMed1986

Employing the God-family relationship in therapy with religious families.

In many religious families, God functions as a crucial family member, stabilizing interpersonal relationships and engaging in daily family transactions. In the psychological role of a transitional object, God can be usefully employed by the family therapist in therapeutic interventions, when the therapist keeps the focus upon the interpersonal relationship with God rather than the specific content of religious beliefs. This approach can access a vital resource in the family, particularly when conditions for therapy are otherwise difficult, such as an isolated, enmeshed dyad presenting alone for therapy. Four case examples illustrate how one may use this approach in family therapy.

Adolescent↗
PubMed1987

Families of adolescent drug abusers are "rigid": are these families either "disengaged" or "enmeshed," or both?

The FACES instrument, based on Olson's Circumplex Model of family functioning, was administered to 96 adolescent drug-abuse clients and their parents. The majority of these families categorized themselves as "disengaged" (rather than "enmeshed") on the cohesion dimension, and as "rigid" (rather than "chaotic") on the adaptability dimension. These findings were unexpected as they were substantially different from published findings on families with other types of problems. Family therapists, utilizing Olson's Clinical Rating Scale for the Circumplex Model, characterized significantly more of these same families as "enmeshed," rather than "disengaged." Possible explanations for the difference between the therapists' perceptions and the families' self-perceptions are discussed.

Adaptation, Psychological↗
PubMed1988

Family system functioning: behavior in the laboratory and the family treatment setting.

The Family System Functioning (FSF) scale is a new instrument for measuring dimensions of the intrafamilial environment thought to be important in recovery from major psychiatric illness. Modest statistical correlations were obtained when FSF ratings of laboratory-based family interactions were compared with researcher-guided therapist ratings of FSF based upon the family's behavior in family therapy sessions during the subsequent month. The data from these two settings provide support for the validity of some of the scales. Because of the modest size of the correlations, however, behavior in the laboratory setting may not always be an accurate indicator of how the family will behave in the early weeks of family therapy.

Adolescent↗