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PubMed1978

The family life cycle: developmental crises and their structural impact on families in a community mental health center.

A typology for troubled families was developed based on the configuration of family members and the position of the identified patient within the family structure. This typology was investigated by surveying the demographic and clinical characteristics of 110 families of patients treated in a day hospital. Four types or "constellations" were found in the sample population. The families in the four Constellations differed significantly from one another in the gender, age, and diagnoses of the identified patient and the income level of the families. The Constellations thus appeared to constitute distinct clinical entities in the population studied. The reasons for the differences among Constellations are discussed in terms of the stress families experience during developmental crises involving structural change.

Affective Symptoms↗

PubMed1978

Familial clustering and immune response in family contacts of patients with HBsAg-positive liver cirrhosis.

Families of 11 patients with hepatitis B surface antigen (HBsAg)-positive cirrhosis were studied to evaluate the immunologic correlates and extent of intrafamilial HBsAg clustering. Of 76 family contacts, 12 were identified to be asymptomatic carriers of HBsAg and two were diagnosed to have HSsAg-positive cirrhosis. The over-all HBsAg prevalence for the 76 contacts was 18% and that for all 87 members studied 29.0%. Serologic evidence of hepatitis B virus (HBV) infection (either HBsAg, anti-HBs, or both) was detected in 59% of all family members. HBsAg was more prevalent in males (47%) compared with females (16%), and anti-HBs was more prevalent in females (42%) compared with males (18%). Evidence of an immunologic response in clinically unaffected HBsAg-negative family contacts consisted of elevated serum IgG levels (mean 1660 mg/100 ml) and increased prevalence of anti-smooth muscle and antimitochondrial antibodies (16% and 6%, respectively). The prevalence of one or more autoantibodies in all HBsAg-negative family contacts was 20%, and it was higher in females (25%) than in males (13%). The present study demonstrates that HBsAg clustering occurs in families of patients with cirrhosis in the Jerusalem area and indicates that HBsAg-negative family contacts may have increased B-cell activity.

Adult↗

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↗

PubMed1977

Family rituals a powerful tool in family therapy.

The use of systemic models in family therapy obliged our team to devise therapeutic tasks involving the entire family. Among these, one was found to be extremely effective: the prescribing of a family ritual. This article gives details of on such example aimed at the destruction of a myth that had been created by three generations of a family. In order that the reader may have a adequate understanding of this ritual, were shall fully describe the story of the family and of the transgenerational evolution of this myth. In the description of the treatment of the family, certain errors were made by the therapists that will come to light-errors that, as usual, were far more instructive than the actual successes. Eventually, it was the very understanding of these errors and their repercussions that led us to the successful prescription of the ritual. Finally, detailed analysis of the substance and aim of the ritual will illustrate and explain exactly what we mean by the term ritual.

Adolescent↗

PubMed1975

Toward clarification of objectives for family practice and family medicine.

This paper analyzes the social boundaries derived from an adequate definition of family practice and family medicine and explores the social dynamics between them and other social institutions and disciplines, More precise objectives for family practice and family medicine are delineated using a model which specifies social targets, methods, and purpose of intervention. Implication for further research in family medicine are discussed as well as their future effect on family practice.

Delivery of Health Care↗

PubMed1978

Management of familial breast cancer. I. Biostatistical-genetic aspects and their limitations as derived from a familial breast cancer resource.

Practical guidelines are given to promote decision-making logic by the physician in managing patients seeking consultation (consultands) because they may be at high familial risk for breast cancer and associated malignant neoplasms. The protocol is designed to aid in the assessment of patients who may become candidates for intensified cancer surveillance and/or prophylactic surgery. A resource comprised of 90 extended breast cancer-prone pedigrees provides the basis for these specific recommendations. The resource shows marked tumor heterogeneity among pedigrees, an approximate 50% incidence of breast cancer and associated malignancies among offspring of affected parents, and threefold higher risk for development of mammary carcinoma in the opposite breast of familial patients with unilateral disease than in sporadic patients. In utilizing this protocol, it is crucial that family history be highly accurate from the standpoint of genealogic relationships and pathologic tumor verification so that management recommendations may reflect sound risk factor assessment. Interpretation of familial risk factors should ideally be made by an informed medical-geneticist. All members of the medical team should then be appraised of familial risk and collectively engage in decision making with the consultand. We believe that this approach can foster more effective control of familial breast cancer.

Adolescent↗

PubMed1978

HLA-typing in juvenile diabetics with and without positive family history and in families with one and two diabetic siblings.

HLA-typing was performed in two groups of juvenile-onset diabetics, one with (n = 58) and one without (n = 109) a family history of the disease. The association of this type of diabetes with certain HLA antigens (excess of B8 and B15, shortage of B7) was confirmed. No heterogeneities could be established between the two groups. This suggests that the aetiologic basis in single and familial cases of juvenile diabetes is the same. The hypothesis, that the B8 associated gene is more penetrant than the B15 associated gene, cannot be confirmed. Haplotypes were determined in families with one and two diabetic siblings. The findings of high haplotype concordance among diabetic siblings was confirmed: concordance of 2, 1 and 0 haplotypes in 7, 5 and 3 pairs respectively. There was a low degree of haplotype concordance between diabetics and nonaffected siblings in the families with two diabetics: 2, 1, and 0 haplotypes in 2, 8 and 6 pairs respectively. This led to the hypothesis of negative selection against these HLA-linked "diabetogenic" genes. This tendency was not, however, observed in families with only one diabetic. The report of a high recombination rate in families with juvenile diabetics could not be confirmed.

Adolescent↗

PubMed1979

Familial cutaneous collagenoma: genetic studies on a family.

Familial cutaneous collagenoma is an inherited condition characterized by the presence of multiple dermal nodules symmetrically distributed on the trunk and upper arms. In this study, six patients, the proband, his four siblings and a niece, representing a kindred of fifty-two subjects, were examined for aymptomatic cutaneous nodules mainly on the back and chest. The individual lesions varying from a few millimetres to several centimetres in size, were indurated, and showed minimal epidermal changes. Histologically, the nodules were characterized by an excessive accumulation of dense, coarse collagen fibres in the dermis. The elastic fibres appeared diminished in number, and in some areas they were abnormally thin and fragmented. The lesions, therefore, were connective tissue naevi of the collagen type. On the basis of the family history and histological observations the patients were diagnosed as having familial cutaneous collagenoma. Examination of the family pedigree indicated that the dermal nodules in familial cutaneous collagenoma were inherited in an autosomal dominant pattern. It was also observed that the lesions had an onset at the age of 15 to 19 years, and their number increased significantly during pregnancy. It is conceivable that familial cutaneous collagenoma is an inherited condition whose expression may be under a hormonal control.

Adolescent↗

PubMed1975

The excretion patterns of urinary glucosaminoglycans in a family with progressive familial myoclonus epilepsy.

The urinary excretion of uronic acid and the electrophoretic composition of urinary glucosaminoglycans were studied in 10 members of a family, of which 3 had progressive familial myoclonus epilepsy. This seems to be the first detailed investigation of the excretion of urinary glucosaminoglycans in patients suffering from this neurologic disease. The uronic acid excretion was found to be increased in the affected family members exclusively, whereas the excretion of the unaffected members were found within the normal limits characterized in this investigation. The urinary glucosaminoglycans could be separated into 5 fractions by electrophoresis. One or two of these fractions were increased in the urines of the three affected family members, the clinically most affected member showing the most abnormal electrophoretic results. An abnormal electrophoretic distribution of fractions was also found in the urines of 5 other members, clinically not affected. Only the maternal part of the family (mother and maternal grandmother) was shown to have a normal electrophoretic distribution of urinary glucosaminoglycans. The implication of these electrophoretic differences in the paternal and maternal family on the conditions for the development of the disease is discussed. The two fractions in question (designated fraction-0.65 and fraction-0.71) have until now been regarded as glycoproteins, but the present results show that they are true glucosaminoglycans (acid mucopolysaccharides), probably of low sulphate content.

Adolescent↗

PubMed1979

Nature and familial character of lepromin sensitivity in 27 families and their siblings.

A group of 27 families consisting of 176 individuals had been investigated for the lepromin sensitivity (with Dharmendra antigen). The families were arranged under group A (9 families) in whom either of the parents or both were suffering from Lepromatous type of leprosy, group B numbering 4 families, of whom either of the parents or both were suffering from non-lepromatous type of leprosy and group C comprising 14 families where none of the parents was suffering from leprosy but some of the each family had the disease in their siblings. The present study points towards the possible genetic influence on lepromin sensitivity but at times may be influenced by the environmental factors. However the study does not permit to reach any valid conclusions; further elaborate investigations alone could prove the useful role of genetic influence in the propagation of lepromin sensitivity to the subsequent sibs.

Adolescent↗

PubMed1978

[Familial sarcoidosis. 4 cases in 2 families].

Among the patients of the Bundeswehrzentralkrankenhaus Koblenz two new cases of familial sarcoidosis with two cases each became known from Nov. 1977 to Feb. 1978. These cases are reported with typical x-ray-findings. The above mentioned short period of time for finding two new cases of familial sarcoidosis seems extraordinary, as in the world literature on sarcoidosis until today only 114-150 cases are reported. "Sarcoidosis" is described referring to the newer literature. Possible causes for acquiring sarcoidosis are discussed. Specific research by the disciplines social medicine, genetics, and hygiene of the families suffering from familial sarcoidosis is proposed, in order to analyze genetic disposition and/or environmental factors. Long-term supervision of the families afflicted with familial sarcoidosis is proposed.

Adult↗

PubMed1979

Circumplex model of marital and family system: I. Cohesion and adaptability dimensions, family types, and clinical applications.

The conceptual clustering of numerous concepts from family therapy and other social science fields reveals two significant dimensions of family behavior, cohesion and adaptability. These two dimensions are placed into a circumplex model that is used to identify 16 types of marital and family systems. The model proposes that a balanced level of both cohesion and adaptability is the most functional to marital and family development. It postulates the need for a balance on the cohesion dimension between too much closeness (which leads to enmeshed systems) and too little closeness (which leads to disengaged systems). There also needs to be a balance on the adaptability dimension between too much change (which leads to chaotic systems) and too little change (which leads to rigid systems). The model was developed as a tool for clinical diagnosis and for specifying treatment goals with couples and families.

Adaptation, Psychological↗

PubMed1976

Lack of acknowledgment in the family Rorschachs of families with a child at risk for schizophrenia.

Lack of acknowledgment, a characteristic of the direct interactions of families of schizophrenics, was found also to characterize the Family Rorschach interactions of families whose disturbed, non-psychotic adolescents were assessed at high risk for schizophrenia on the basis of parental communication deviance. The same high-risk families had unbalanced interaction patterns as reflected in three measures of family structure.

Adolescent↗

PubMed1978

Family interaction and communication deviance in disturbed and normal families: a review of research.

Recent family interaction studies are reviewed with an emphasis on looking for dimensions along which disturbed and normal families differ. Several areas of consistency in the literature were found, including: family coalition patterns, patterns of conflict, flexibility versus rigidity, family effectiveness and efficiency, and deviant styles of communication. It was concluded that several measures reliably discriminate disturbed from normal families and that one type of measure in particular is a reliable predictor of thought disorder in offspring. Implications for clinical practice and future research are discussed.

Affective Symptoms↗

PubMed1979

Family dynamics and family psychotherapy of psychosomatic.

Family therapy of psychosomatic disorders is oftern difficult and comparable to the therapy of psychotic patients. Nonetheless, the results published today by authors such as Minuchin and Selvini and our own experiences are promising indeed. We have found that what seemed to be a deep-rooted psychic structure changed rapidly and enduringly if the relationship field changed. Amelioration of symptoms is in many cases easily attained if they are understood in their function within a relational system. Also, we regard the system or family approach as a chance for medical practice. The general practioner who usually deals with family systems has, in our view, an ideal position to bring about change if he uses his authority and trust properly. He has to obtain a positive, not pathology-oriented view and should use family and social resources in spite of engaging in an often fruitless and endless contact with the designated patient, which only serves to maintain and even to increase the homeostatic lock of the family system.

Adolescent↗

PubMed1978

Meeting families' treatment needs through a family psychotherapy center.

A small group of mental health professionals in St. Louis established a private-practice family therapy center staffed by therapists of various disciplines and theoretical orientations. Families receive a comprehensive, five-phase evaluation at the end of which the panel of evaluators recommends the type of family therapy and the therapist most suited to deal with the central problem. During the center's first two years of operation, 42 families received a complete evaluation and 36 began treatment, most of them in marital therapy. Of the 21 who completed treatment, 16 were rated as improved and five as unchanged. Thirty members within those 21 families manifested serious psychopathology, but none had to be hospitalized during treatment.

Adolescent↗

PubMed1976

Family sizes of children and family sizes of women.

This paper demonstrates the relation that obtains between the average family size of women and the average family size of offspring of those women. It estimates the value of these two measures for cohorts of American women aged 45-49 in various years from 1890 to 1970. It shows that children born during the post-war baby boom actually derived from smaller families than those born during the low-fertility 1930's; that under current patterns a woman would have to bear an average of almost two children fewer than were borne by her mother merely to keep population fertility rates constant from generation to generation; and that average family size for nonwhite children exceeds that for white by 50 percent, although the racial difference in family sizes of women is only 19 percent.

Ethnicity↗

PubMed2025

Pedigree analysis and genetic inheritance of fatal familial insomnia (FFI) in a Portuguese multigenerational family.

Fatal familial insomnia (FFI) is a rare, autosomal dominant prion disease caused by a mutation in the PRNP gene, leading to the misfolding of the cellular prion protein (PrPC) into its pathogenic form (PrPSc). This results in neurodegeneration, particularly in the thalamus, a key region regulating sleep-wake cycles, which underlies the hallmark symptoms of FFI, including insomnia, autonomic dysfunctions, motor disturbances and cognitive decline. This study focuses on a Portuguese family with FFI, providing a detailed pedigree analysis spanning five generations and comprising 134 individuals, to elucidate inheritance patterns, disease onset, and clinical progression. The findings confirm the autosomal-dominant inheritance pattern and a strong familial clustering of the disease with age of onset in the late 50s (mean 57 years). Although 67% of affected individuals succumbing to the disease within months to 1.5 years, a notably 33% exhibited prolonged survival beyond the typical disease duration, exceeding proportions reported in the literature. Family members retrospectively reported prodromal symptoms, including generalized pain, headaches, tinnitus, pruritus, and behavioral changes, occurring up to five years before diagnosis. In several cases, reportedly, disease onset was associated with major phycological stressors (e.g., emotional stress or mourning). While the significance of these observations remains uncertain, they may provide insights into potential early features in this kindred. Further research integrating genomic sequencing, biomarkers, and longitudinal clinical assessments are needed to better understand the mechanisms underlying the heterogeneity of FFI and to explore potential therapeutic interventions.

Humans↗