This article describes a new integrated child psychiatric family ward treatment model at the Tampere University Hospital. Theoretically, the treatment is based on an integration of systems and psychoanalytical theories as well as behavioral approach. A centerpiece of the model is a 3-week treatment period for the whole family at the family day ward. The work of the multidisciplinary team on the ward focuses on family relationships, on representational level, and on the interactional behavior of the family. Interaction and relationships are also used as tools, including a reflective working model and sharing concrete interaction with the family. So far, the family ward has offered 165 family treatment periods for 113 different families. Altogether in 63% of the total treatment periods one or both parents have had mental illness and in 15% of the total treatment periods there have been serious custody disputes with accusations of sexual abuse of the child. Helping these multi-problem families is a special challenge for our treatment model and at the moment we are developing new methods for assessment and support of parenthood. (+info)
Family therapy of schizophrenia.
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Family therapy of schizophrenia has long been conceived and practised under etiological premises. Familial disturbances as pathological regression/fixation (psychoanalytical) and individuation-impairing family dynamics (systemic) were addressed directly in the hope of "curing" the disorder. The efforts to prove the viability of the concepts and/or the efficacy of the therapeutic approach were largely unsuccessful. Newer strategies of family therapy of schizophrenia are both more precise in their theoretical assumptions and more performing in the pursuit of their therapeutic goals. We analyse the basis of modern family therapy in the "Expressed-Emotions (EE)"--research and propose a newer, more adequate understanding of the EE phenomenon. From our own studies and from a general review of relevant studies we derive an understanding of the rationale of family work and family therapy of schizophrenia. We discuss the results of a meta-analysis on the active ingredients and the conditions of efficacy of family interventions. (+info)
Evidence-based psychosocial treatment for schizophrenia.
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Current recommendations for evidence-based schizophrenia treatment support a comprehensive, individualized approach that integrates advances in psychopharmacology with psychosocial strategies for disease management. In this issue of the Schizophrenia Bulletin, we invited clinician investigators to summarize new empirical data concerning the efficacy of psychosocial interventions that target common and particularly problematic aspects of schizophrenia. A rich formulary of psychosocial interventions with demonstrated efficacy is now available. With new neuroleptic medications, these interventions should define the current standard of care for schizophrenia. (+info)
Update on family psychoeducation for schizophrenia.
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The Schizophrenia Patient Outcomes Research Team and others have previously included family psychoeducation and family support in best practices guidelines and treatment recommendations for persons with schizophrenia. In this article we review in detail 15 new studies on family interventions to consider issues around the implementation of family interventions in current practice. The data supporting the efficacy of family psychoeducation remain compelling. Such programs should remain as part of best practices guidelines and treatment recommendations. However, assessment of the appropriateness of family psychoeducation for a particular patient and family should consider (1) the interest of the family and patient; (2) the extent and quality of family and patient involvement; (3) the presence of patient outcomes that clinicians, family members, and patients can identify as goals; and (4) whether the patient and family would choose family psychoeducation instead of alternatives available in the agency to achieve outcomes identified. (+info)
Psychosocial approaches to dual diagnosis.
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Recent research elucidates many aspects of the problem of co-occurring substance use disorder (SUD) in patients with severe mental illness, which is often termed dual diagnosis. This paper provides a brief overview of current research on the epidemiology, adverse consequences, and phenomenology of dual diagnosis, followed by a more extensive review of current approaches to services, assessment, and treatment. Accumulating evidence shows that comorbid SUD is quite common among individuals with severe mental illness and that these individuals suffer serious adverse consequences of SUD. The research further suggests that traditional, separate services for individuals with dual disorders are ineffective, and that integrated treatment programs, which combine mental health and substance abuse interventions, offer more promise. In addition to a comprehensive integration of services, successful programs include assessment, assertive case management, motivational interventions for patients who do not recognize the need for substance abuse treatment, behavioral interventions for those who are trying to attain or maintain abstinence, family interventions, housing, rehabilitation, and psychopharmacology. Further research is needed on the organization and financing of dual-diagnosis services and on specific components of the integrated treatment model, such as group treatments, family interventions, and housing approaches. (+info)
Randomized, controlled trial of behavior therapy for families of adolescents with insulin-dependent diabetes mellitus.
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OBJECTIVE: To describe the short-term results of a controlled trial of Behavioral Family Systems Therapy (BFST) for families of adolescents with diabetes. METHODS: We randomized 119 families of adolescents with diabetes to 3 months' treatment with either BFST, an education and support Group (ES), or current therapy (CT). Family relationships, psychological adjustment to diabetes, treatment adherence and diabetic control were assessed at baseline, after 3 months of treatment (reported here), and 6 and 12 months later. RESULTS: Compared with CT and ES, BFST yielded more improvement in parent-adolescent relations and reduced diabetes-specific conflict. Effects on psychological adjustment to diabetes and diabetic control were less robust and depended on the adolescent's age and gender. There were no effects on treatment adherence. CONCLUSIONS: BFST yielded some improvement in parent-adolescent relationships; its effects on diabetes outcomes depended on the adolescent's age and gender. Factors mediating the effectiveness of BFST must be clarified. (+info)
Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease.
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BACKGROUND: The majority of patients with Alzheimer's disease live outside institutions and there is considerable serious psychological morbidity among their carers. AIMS: To evaluate whether family intervention reduces the subjective burden of care in carers of patients with Alzheimer's disease and produces clinical benefits in the patients. METHOD: A prospective single-blind randomised controlled trial with three-month follow-up in which the experimental group received family intervention and was compared with two control groups. RESULTS: There were significant reductions in distress and depression in the intervention group compared with control groups at post-treatment and follow-up. There were significant reductions in behavioural disturbance at post-treatment and an increase in activities at three months in patients in the intervention group. Based on an improvement on the General Health Questionnaire resulting in a carer converting from a case to a non-case, the number to treat was three immediately post-treatment and two at follow-up. CONCLUSIONS: Family intervention can have significant benefits in carers of patients with Alzheimer's disease and has a positive impact on patient behaviour. (+info)
Psychotherapies in psycho-oncology. An exciting new challenge.
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BACKGROUND: There is ample scope to devise forms of psychotherapy in consultation-liaison psychiatry, including the newly evolving area of psycho-oncology. AIMS: To highlight the development of psychotherapy in psycho-oncology, providing two illustrations. METHOD: We report on conceptual and clinical research in the context of oncology and palliative care, focusing on (a) an approach for families at risk of maladaptive bereavement; and (b) a group programme for women newly diagnosed with early-stage breast cancer. RESULTS: We were able to introduce new forms of psychological treatment for specific clinical groups, and anecdotal evidence points to useful benefits for participants. CONCLUSIONS: Psychotherapists should grasp the opportunity to bring their skills to the medical arena, but need to subject newly devised interventions to well-designed and methodologically rigorous research. (+info)