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A K Wuerker

Publications and source records attributed to A K Wuerker.

8 recordsLinked to original sources
PubMed2001

Interpersonal control and expressed emotion in families of persons with schizophrenia: change over time.

This study examined communication patterns in 62 families of persons with schizophrenia, comparing families with relatives who were low expressed emotion (EE) at the beginning and end of a 2-year study, those who were high EE at the beginning and end, and those whose EE status changed. Interaction was coded with the Relational Control Coding System and analyzed as a Markov process. Dialogues in the stable low-EE and stable high-EE families were rather similar initially, and both groups showed increasing flexibility at year 1. However, at year 2, low-EE dyads showed increasingly complex structure and flexibility in control, but high-EE dyads showed simpler structure and rigidly controlling patterns. When EE status changed, so did the structure of the dialogues and the patterning of control. Although earlier research found more "tightly joined" systems in families of high-EE relatives, it may be that over time, these family members distance from each other and so are less connected. It is also possible that relatives who remain high EE despite intervention are a subset of high-EE relatives who need more support or different therapeutic approaches to maintain change.

Adult↗
PubMed1999

Racial and gender differences in expressed emotion and interpersonal control in families of persons with schizophrenia.

Expressed Emotion (EE) has been shown to be predictive of course or severity in many illnesses, but the studies have been largely of white middle-class patients. This study examined gender and racial differences in parental EE level and communication patterns between the parent and patient with schizophrenia, using data from the NIMH Treatment Strategies in Schizophrenia study. Dialogues (n = 140) from 54 patient-parent dyads were coded into the Relational Control Coding System. Resultant data (n = 13,605 sequences) were analyzed with log-linear models. Results show that the relationship between control and EE level was stronger in African American families compared to Caucasians. Gender differences were as expected, with daughters less competitive and more deferential to their parents. Although the total number of high-EE parents with daughters was small, patterns in these families showed parents who responded submissively in contrast to the competitive symmetry in families with male patients.

Adolescent↗
PubMed1997

Patterns of psychiatric service use by homeless mentally ill clients.

The objective of this study was to describe the patterns of service use of homeless mentally ill clients prior to and for two years following an admission to Skid Row Mental Health (SRMH) services in Los Angeles during a recent year (N = 268). Twenty clients were still at SRMH two years later. These clients were older and more likely to be female; most of their prior service use was at SRMH. For the majority of the 124 clients in the second group, those who had been discharged and not readmitted, the index admission was their only admission. The 124 clients in the third group, these with admissions after the index admission, had long histories in the system. Cluster analysis showed distinct patterns in service use during the follow-up period. Knowledge of patterns of service use by homeless mentally ill persons will enhance understanding of interventions which have the greatest chance of success.

Adult↗
PubMed1996

The changing careers of patients with chronic mental illness: a study of sequential patterns in mental health service utilization.

The aim of this study was to describe patterns of service use over time by a group of persons with chronic mental illness who were homeless at the time of the index admission. Subjects were all persons admitted to Skid Row Mental Health Services in a recent year who had 25 or more previous admissions to any Los Angeles County Department of Mental Health service (N = 49). Sequences of type of service at each of the 25 admissions were compared with optimal matching and categorized with cluster analysis. Patients in earlier clusters had many inpatient admissions; those in later clusters had many admissions to outpatient, residential, and jail services. Service use by individuals in each cluster showed the same trends. However, there were also different patterns of service use for patients in cluster within the same tie frame. Analyzing multiple admissions sequentially helps to locate likely places to intervene in downward-spiraling careers.

Adolescent↗
PubMedDate not supplied

The family and schizophrenia.

There has been controversy about the role of family in the etiology and course of schizophrenia for almost 70 years. Psychoanalysts and family therapists have proposed theories about the development of schizophrenia that overtly blamed parents, and recently, expressed emotion (EE) research has been criticized as implicating families once again. However, the study of schizophrenia as a brain disorder has resulted in new understandings of the influence of the family. This article reviews recent research revealing a unique vulnerability to stress in persons with schizophrenia and suggesting that communication difficulties may be due to a shared genetic heritage. Advanced practice mental health nurses who have a solid foundation in neurobiology are ideally suited to help the person with schizophrenia and his or her family. Knowledge about the neurobiological basis of schizophrenia has become very sophisticated and complex, but that knowledge is nevertheless essential to understand the otherwise puzzling patterns of behavior shown by persons with schizophrenia.

Biological Psychiatry↗
PubMedDate not supplied

Mental health nursing in the 21st century.

Mental health nursing in the 21st century will expand to include a neuropsychiatric focus that encompasses the science, knowledge, and skills of both neurology and psychiatry. The shift to neuropsychiatric nursing is directed by the explosion of knowledge in the neurobiologic basis of mental illness, tremendous advances in diagnostic technology, and the discovery of new and more effective psychopharmacologic treatments. Neuropsychiatric disorders are common, disabling, costly, and stigmatizing. A neuropsychiatric paradigm allows treatment to reach more people who are affected and is less stigmatizing than a psychosocial view alone. Neuropsychiatric advanced practice nurses will need both primary care and specialty knowledge and skills. The challenge to nursing education is to determine how best to incorporate this knowledge and skills into curricula. Neuropsychiatric research must focus on both biologic and behavioral measures and interventions. The philosophical and ethical challenge to nursing is to integrate biologic and behavioral concepts into the nursing care of mentally ill people while remaining centered in the nursing domain and maintaining our focus on caring and our sensitivity to the human condition.

Biological Psychiatry↗
PubMedDate not supplied

Patterns of psychiatric diagnosis in a county mental health system.

This article examines concordance in psychiatric diagnoses received by 280 clients of a county mental health system throughout their history with the system. Automated Information System records from all episodes of care since the first admission to the county system were analyzed, and diagnoses for each client for the first 5, first 10, last 5, and last 10 episodes were compared with generalized kappa. Sequential patterns of diagnosis were also examined. Overall concordance for diagnoses for the last 5 episodes was fair (kappa = .46), and concordance for major depression, bipolar disorder, and paranoid schizophrenia was good. Sequential patterning showed some tendency for more of the clients with a given modal diagnosis to be assigned that diagnosis in the middle of the sequence, and then fewer toward the end of the sequence, possibly because of effects of homelessness. Overall, the degree of concordance was quite high for some of the major disorders and compared favorably with concordance in more rigorous research settings. However, clinicians need to be more aware of the potential for assigning diagnosis based on stereotypical views of clients, as well as the effects of substance abuse and homelessness, in arriving at their diagnoses.

Adult↗