Demographics and treatment of the American family

Abstract

There have been numerous changes to the US family over the past several decades. Traditional family roles have changed, and the conception of what Americans consider a ‘family’ has likewise shifted with differing societal views regarding gender, gender roles, race, and ethnicity. This review examines demographics of the American family as well as a number of family therapies that have been historically and are presently used to treat family problems. We expect that with the changes present in US society, family therapies will need to continue to be sensitive and adaptive to these shifts in order to be effective.     

Rapidly cycling affective disorder. Demographics, diagnosis, family history, and course.

Of 919 patients with major affective disorders who completed at least 1 year of a 5-year, semiannual follow-up, 45 developed a rapidly cycling bipolar course during the first year, but only one developed a rapidly cycling unipolar course. In comparison with patients who showed a non-rapidly cycling bipolar course, those who became rapid cyclers were more likely to be female and to have exhibited depression, hypomania, or cycling between depression and hypomania within the index episode. Family study data revealed no evidence that high cycle frequencies breed true. Rapid cycling was associated with a significantly lower likelihood of recovery in the second year of follow-up but not in the third, fourth, or fifth. These data suggest that rapid cycling is, in the large majority of cases, a transient, nonfamilial manifestation of bipolar affective disorder.     

Demographics, treatment seeking, and diagnoses of anxiety support group participants.

Two peer-led anxiety disorder support groups were surveyed to ascertain characteristics of individuals seeking the services of these groups. Both groups had received information and consultation from the Anxiety Disorders Association of America. One hundred and eighty-four individuals were interviewed for diagnosis by structured clinical interview; demographics and treatment-seeking behaviors were ascertained by self-report questionnaires. Both groups surveyed were composed of more females than males and were predominantly Caucasian. Treatment was most frequently sought from psychiatrists, psychologists, and family doctors. One fourth of the sample had sought help for anxiety in a hospital emergency room. Eighty-eight subjects (94%) at the Dallas site and 57 subjects (61%) at the Durham site met criteria for at least one current anxiety or affective disorder. More than half of those who met criteria for current panic disorder with agoraphobia also met criteria for at least one other anxiety disorder, or for major depression. Approximately one third of each support group met criteria for current social phobia. Severity of social phobia symptoms was assessed by four scales. An increased risk of substance abuse was noted for individuals with a diagnosis of social phobia, as compared with diagnoses of other anxiety disorders.     

Integrated services for treatment of schizophrenic substance abusers: Demographics,symptoms, and substance abuse patterns

We have previously described a model of outpatient integrated treatment for patients with comorbid psychoactive substance use disorders and schizophrenia (PSUD/S)(1). Here we review relevant literature on comorbidity and outline the rationale for integrated services. Further, we describe results from 3 related studies: First, we document the approximate incidence of PSUD among a heterogeneous group of 602 schizophrenic inpatient admissions to our hospital. Second, we describe in greater detail the psychiatric symptoms and patterns of substance abuse among a subsample of 106 inpatients with PSUD/S, contrasting them with 112 patients with PSUD and mixed psychotic disorders, but who are not schizophrenic. Third, we present a prospective research project and describe a sample of 30 patients with PSUD/S, detailing demographic characteristics, psychiatric symptoms and substance abuse history. Attention is given to current issues in the differential diagnosis of patients with PSUD/S using standardized instruments.     

Ethnicity and family involvement in the treatment of schizophrenic patients

In a cross-ethnic study of neuroleptic response, the level of family involvement with the treatment of 26 Asian and 26 Caucasian patients was evaluated. Asian family members were intimately involved, Caucasians much less so. These results quantitatively demonstrated the relatively greater importance of working with family members when treating Asian patients. They also indicate that relatively more effort is needed to increase involvement of Caucasian families in the treatment process.     

Mental health and diurnal salivary cortisol patterns among African American and European American female dementia family caregivers.

Using a sociocultural stress and coping model, this pilot study examines the influence of depressive symptoms and stress on diurnal salivary cortisol patterns among African American (N=30) and European American (N=24) female dementia caregivers and noncaregivers (African American, N=48; European American, N=15). Caregiving participants completed the Center for Epidemiological Studies Depression Scale (CES-D), Perceived Stress Scale (PSS), and Stress-Related Growth Scale (SRGS) as respective measures of depressive symptoms, stress, and stress resilience. Participants also collected five saliva samples daily for two consecutive days. African American caregivers scored significantly higher than European American caregivers on the SRGS, but they did not differ on the PSS and CES-D scales. Regression analyses with age, ethnicity, caregiving status, and depressive symptoms as predictors, and cortisol slope as criterion, showed that only age and ethnicity predicted cortisol slope. African Americans had flatter slopes than the European Americans sampled, regardless of caregiving status. Findings highlight the role of cultural beliefs and of ethnicity in explaining cortisol function.     

Patient and family attitudes toward schizophrenia treatment

Patient and family member attitudes toward illness, psychopharmacologic and nonpharmacologic treatments in schizophrenia, as well as their attitudes toward psychiatric research are reviewed here. The authors’ recent work investigating patient and family member attitudes toward illness, medication, and a new method of receiving medication via surgical implants is also presented. The authors highlight the importance of understanding patient attitudes so that individual treatment plans and new treatments for schizophrenia can be facilitated. The important contribution of family members in caring for their loved ones is also emphasized. Patient participation in biomedical research is also discussed in the context of guiding the treatment of schizophrenia.     

Coherence in the urban family caregiver role with African American stroke survivors

Expressions of coherence by urban caregivers in African American family systems are the focus of this ethnographic study. The profound changes that can accompany stroke may create considerable stress for families caring for the affected person. Coherence, a sense of mutuality, and differences in functioning among family members were discovered in this study to be important for maintaining stability within the family. Through coherence, family caregivers felt connected and this helped them survive in stressful times related to caring situations. The findings aid in defining coherence as an interpersonal process and place it in a family system context.     

Combining individual and family treatment: guidelines for the therapist

Successfully combining individual and family treatment for psychosis-prone outpatients who live with their families is a process of keeping the needs of the patient and the family in balance. The therapist has to respond to each in an evenhanded way that preserves an alliance with both. Through guidelines and case reports, this chapter describes how to maintain that balance. The therapist-patient relationship is the core of treatment and keeps the clinician's focus squarely on the individual needs of the patient. In keeping with that focus, the therapist encourages self-determination on the patient's part and sets up opportunities for the family to communicate directly with the therapist in front of the patient, rather than surreptitiously behind the patient's back. In keeping with a collateral emphasis on the family, the therapist involves the family regularly and early in the course of treatment, respects the family's knowledge of the patient, puts that knowledge to use, and works with the family to deal promptly and effectively with incipient emergencies. The therapist knows that it is not only the therapist but also the family who stimulate a patient to change. The therapist, building on whatever strengths the patient and family possess, enlists the family as an ally in promoting and bringing about therapeutic progress.     

Developments in family treatment of schizophrenia

For the treatment of families of schizophrenics the following issues are discussed: (1) Is there any evidence that families cause schizophrenia? (2) Is it useful to consider the family as a system? (3) What is the aim of family therapy? (4) Does family therapy work for any kind of family? (5) Does family therapy work for families of schizophrenics? The conclusion is reached that systems theory can be applied successfully to some families when the patient suffers from certain conditions.