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D J Miklowitz

Publications and source records attributed to D J Miklowitz.

At least 37 records · Page 2Linked to original sources
PubMed1994

Family risk indicators in schizophrenia.

The literature is reviewed on three family risk indicators that have prognostic significance in schizophrenia: expressed emotion, affective style, and communication deviance, each measured in key relatives of schizophrenia patients. Expressed emotion and affective style have been used primarily to characterize family environments that predispose patients to psychotic relapses. Communication deviance has been used primarily to distinguish the communication styles of families of schizophrenia patients from those of families without schizophrenia. Data on the roles of genetic, biological, and psychosocial factors in the origins of these family attributes are reviewed. Although studies of family risk indicators have yielded relatively consistent cross-sectional and longitudinal findings, much remains to be clarified about what these constructs actually measure and their mechanisms of prediction. The implications of family risk research for prevention efforts are discussed.

Adolescent↗
PubMed1992

Prodromal symptoms and signs of bipolar relapse: a report based on prospectively collected data.

Prospectively collected data on 19 recently hospitalized patients with bipolar disorder were examined for prodromal changes preceding relapse. The 4-month periods before six manic and six depressive relapses were compared with each other and with a comparable period for seven patients who did not relapse. The Brief Psychiatric Rating Scale was used to assess symptoms. Significant elevations in unusual thought content were found 1 month before manic relapse. Depressive relapsers evidenced higher levels of conceptual disorganization throughout the prerelapse period. Nonrelapsers showed very stable symptom profiles.

Adult↗
PubMed1992

Longitudinal outcome and medication noncompliance among manic patients with and without mood-incongruent psychotic features.

The prognostic utility of mood-incongruent psychotic features was examined in a sample of 23 hospitalized manic patients. Patients were initially subdivided according to whether they met Research Diagnostic Criteria (RDC) for schizoaffective, mainly affective (mood-incongruent) manic disorder (SAM; N = 11) or RDC primary manic (mood-congruent or nonpsychotic) manic disorder (PM; N = 12). Patients were then followed over a 9-month posthospitalization period and rated every 3 months for relapse status, symptom severity, social adjustment, and medication noncompliance. Patients with SAM and PM did not differ at follow-up on rates or timing of manic or depressive relapses or on cycling of symptoms of mood disorder. However, at follow-up, SAM patients had more severe positive and negative psychotic symptoms and poorer social adjustment, and were less medically compliant than PM patients. Results are consistent with the view that mania with mood-incongruent psychotic features is a poor-prognosis subtype of bipolar disorder.

Adolescent↗
PubMed1992

Communication deviance in families of schizophrenic and other psychiatric patients: current state of the construct.

High levels of parental communication deviance may represent risk markers for the onset of severe psychiatric disorders in vulnerable offspring, and are associated with markers of vulnerability among schizophrenic patients and among at-risk children. Future research that proceeds in the direction of further clarifying the longitudinal association between CD and the onset of severe psychiatric disorders, and the relation of CD to genetically-based vulnerabilities, may result in determining constellations of individual and family attributes that are powerful in identifying high-risk populations.

Communication Disorders↗
PubMed1991

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↗
PubMed1990

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↗
PubMed1990

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↗
PubMed1989

Parental communication deviance and schizophrenia: a cross-cultural comparison of Mexican- and Anglo-Americans.

Levels of parental communication deviance (CD), as measured on the Thematic Apperception Test (TAT), were compared among families of schizophrenic patients in two culturally distinct groups. Spanish-speaking Mexican-American parents of schizophrenics completed the TAT in their native language, and CD was coded from their stories by a Spanish-speaking rater. Mexican-American parents had levels of CD that were nearly identical to those of a carefully matched sample of English-speaking Anglo-American parents. Factor scores that measure distinct subtypes of CD also did not differ across groups. The data suggest that levels of CD, despite discriminating between parents of schizophrenics and nonschizophrenics, do not vary across different languages and cultures.

Adult↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1988

Family factors and the course of bipolar affective disorder.

Measures of family attitudes (expressed emotion [EE]) and interactional behaviors (affective style [AS]), both of which have been found to predict relapse in schizophrenia, were obtained from key relatives of 23 hospitalized recently manic bipolar patients. Patients were then followed up for a period of nine months after hospital discharge and rated on measures of clinical course, social adjustment, and medication compliance. Levels of intrafamilial EE and AS were found to predict likelihood of patient relapse at follow-up, especially when used as conjoint predictors of patient outcome status. Levels of AS also predicted degree of social adjustment at follow-up. The predictive relationships observed were independent of patient medication compliance, treatment regimen, baseline symptoms, demographics, and illness history. Results suggest that the emotional atmosphere of the family during the postdischarge period may be an important predictor of the clinical course of bipolar disorder.

Adolescent↗
PubMed1987

Expressed emotion: a call for partnership among relatives, patients, and professionals.

The emotional climate within the home is a powerful predictor of relapse and remission in schizophrenic disorders. Research has focused on "expressed emotion" (EE), a measure of relatives' expressed attitudes about the patient. Recently, EE has become a focus of controversy. Correcting a misperception that EE research blames families of schizophrenic patients, we clarify the concepts and data base that underlie EE research, provide an operational definition of EE, and briefly review the history of EE research in schizophrenia and other disorders. Then, methodological and conceptual issues in the interpretation of these data are discussed, and implications for clinical practice and mental health policy are considered.

Attitude↗
PubMed1986

A brief method for assessing expressed emotion in relatives of psychiatric patients.

A measure of the attitudes and feelings that a relative expresses about a mentally ill family member, termed expressed emotion (EE), is derived from an extensive, semistructured interview, the Camberwell Family Interview (CFI). The present article describes a method for the assessment of EE attitudes that uses a variation of the 5-minute speech sample, originally developed by Gottschalk and Gleser (1969). The measure is derived from responses made by a patient's key relative when prompted to give thoughts and feelings about the patient for a 5-minute period. A coding system was developed to score behaviors analogous to those rated on the CFI, such as criticism and emotional overinvolvement. The relationship between blind EE ratings derived from the 5-minute speech samples and those from the CFI was investigated with two separate samples of relatives of schizophrenics. The relationship between the sets of ratings was very close and supports the value of the 5-minute speech sample as a brief EE screening procedure.

Attitude↗